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ENVIRONMENTAL HEALTH

ELLAWAY, A and MORRIS, G and others. Associations between health and different types of environmental incivility : a Scotland-wide study. Public Health Vol 123, No 11 - November 2009: 708-713
Abstract: Objectives: Concern about the impact of the environment on health and well-being has tended to focus on the physical effects of exposure to toxic and infectious substances, and on the impact of large-scale infrastructures. Less attention has been paid to the possible psychosocial consequences of people's subjective perceptions of their everyday, street-level environment, such as the incidence of litter and graffiti. As little is known about the potential relative importance for health of perceptions of different types of environmental incivility, a module was developed for inclusion in the 2004 Scottish Social Attitudes survey in order to investigate this relationship. Study design: A random sample of 1637 adults living across a range of neighbourhoods throughout Scotland was interviewed. Methods: Respondents were asked to rate their local area on a range of possible environmental incivilities. These incivilities were subsequently grouped into three domains: (i) street-level incivilities (e.g. litter, graffiti); (ii) large-scale infrastructural incivilities (e.g. telephone masts); and (iii) the absence of environmental goods (e.g. safe play areas for children). For each of the three domains, the authors examined the degree to which they were thought to pose a problem locally, and how far these perceptions varied between those living in deprived areas and those living in less-deprived areas. Subsequently, the relationships between these perceptions and self-assessed health and health behaviours were explored, after controlling for gender, age and social class. Results: Respondents with the highest levels of perceived street-level incivilities were almost twice as likely as those who perceived the lowest levels of street-level incivilities to report frequent feelings of anxiety and depression. Perceived absence of environmental goods was associated with increased anxiety (2.5 times more likely) and depression (90% more likely), and a 50% increased likelihood of being a smoker. Few associations with health were observed for perceptions of large-scale infrastructural incivilities. Conclusions: Environmental policy needs to give more priority to reducing the incidence of street-level incivilities and the absence of environmental goods, both of which appear to be more important for health than perceptions of large-scale infrastructural incivilities.

FRIEL, Sharon and DANGOUR, Alan D and others. Health and Climate Change 4 : public health benefits of strategies to reduce greenhouse-gas emissions : food and agriculture. Lancet 12 December 2009: 2016-2025
Abstract: Agricultural food production and agriculturally-related change in land use substantially contribute to greenhouse-gas emissions worldwide. Four-fifths of agricultural emissions arise from the livestock sector. Although livestock products are a source of some essential nutrients, they provide large amounts of saturated fat, which is a known risk factor for cardiovascular disease. We considered potential strategies for the agricultural sector to meet the target recommended by the UK Committee on Climate Change to reduce UK emissions from the concentrations recorded in 1990 by 80% by 2050, which would require a 50% reduction by 2030. With use of the UK as a case study, we identified that a combination of agricultural technological improvements and a 30% reduction in livestock production would be needed to meet this target; in the absence of good emissions data from Brazil, we assumed for illustrative purposes that the required reductions would be the same for our second case study in São Paulo city. We then used these data to model the potential benefits of reduced consumption of livestock products on the burden of ischaemic heart disease: disease burden would decrease by about 15% in the UK (equivalent to 2850 disability-adjusted life-years [DALYs] per million population in 1 year) and 16% in São Paulo city (equivalent to 2180 DALYs per million population in 1 year). Although likely to yield benefits to health, such a strategy will probably encounter cultural, political, and commercial resistance, and face technical challenges. Coordinated intersectoral action is needed across agricultural, nutritional, public health, and climate change communities worldwide to provide affordable, healthy, low-emission diets for all societies.

MARKANDYA, Anil and ARMSTRONG, Ben G and others. Health and Climate Change 3 : public health benefits of strategies to reduce greenhouse-gas emissions : low-carbon electricity generation. Lancet 12 December 2009: 2006-2015
Abstract: In this report, the third in this Series on health and climate change, we assess the changes in particle air pollution emissions and consequent effects on health that are likely to result from greenhouse-gas mitigation measures in the electricity generation sector in the European Union (EU), China, and India. We model the effect in 2030 of policies that aim to reduce total carbon dioxide (CO2) emissions by 50% by 2050 globally compared with the effect of emissions in 1990. We use three models: the POLES model, which identifies the distribution of production modes that give the desired CO2 reductions and associated costs; the GAINS model, which estimates fine particulate matter with aerodynamic diameter 2.5 µm or less (PM^sub 2.5^) concentrations; and a model to estimate the effect of PM^sub 2.5^ on mortality on the basis of the WHO's Comparative Risk Assessment methods. Changes in modes of production of electricity to reduce CO2 emissions would, in all regions, reduce PM^sub 2.5^ and deaths caused by it, with the greatest effect in India and the smallest in the EU. Health benefits greatly offset costs of greenhouse-gas mitigation, especially in India where pollution is high and costs of mitigation are low. Our estimates are approximations but suggest clear health gains (co-benefits) through decarbonising electricity production, and provide additional information about the extent of such gains.

MCCARTNEY, G and HANLON, P. What can health professionals contribute to the challenge of sustainability? Public Health Vol 123, No 12 - December 2009: 761-764
Abstract: Just as doctors have led aspects of social change in the past, health professionals today must contribute to and lead actions on sustainability. Exponential growth and unsustainability can be observed in the global population, energy use, money supply and greenhouse gas emissions. As with all unsustainable systems, they will become sustainable, but the timing and manner are undecided and carry profound health threats. We are trapped using outmoded forms of thinking and by our cognitive dissonance as we consider these threats in the light of our own lifestyles. The aim should be a transition that will lessen inequalities, combat problems such as obesity, depression and addictive behaviours, and improve well-being. The challenge is similar to other major public health issues in that the problem needs to be identified, evidence gathered, theories developed, alliances built, policies formulated and actions taken. This paper outlines how this can be done but suggests that the response needed will be unprecedented, and calls for action on what is known and debate about what is uncertain.

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