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Impact of the China Healthy Cities Initiative on Urban Environment.

ABSTRACT: The China Healthy Cities initiative, a nationwide public health campaign, has been implemented for 25 years. As "Healthy China 2030" becomes the key national strategy for improving population health, this initiative is an important component. However, the effects of the initiative have not been well studied. This paper aims to explore its impact on urban environment using a multiple time series design. We adopted a stratified and systematic sampling method to choose 15 China healthy cities across the country. For the selected healthy cities, 1:1 matched non-healthy cities were selected as the comparison group. We collected longitudinal data from 5 years before cities achieved the healthy city title up to 2012. We used hierarchical models to calculate difference-in-differences estimates for examining the impact of the initiative. We found that the China Healthy Cities initiative was associated with increases in the proportion of urban domestic sewage treated (32 percentage points), the proportion of urban domestic garbage treated (30 percentage points), and the proportion of qualified farmers' markets (40 percentage points), all of which are statistically significant (P?

SUBMITTER: Yue D

PROVIDER: S-EPMC5391322 | biostudies-literature | 2017 Apr

REPOSITORIES: biostudies-literature

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Impact of the China Healthy Cities Initiative on Urban Environment.

Yue Dahai D Ruan Shiman S Xu Jin J Zhu Weiming W Zhang Luyu L Cheng Gang G Meng Qingyue Q

Journal of urban health : bulletin of the New York Academy of Medicine 20170401 2

The China Healthy Cities initiative, a nationwide public health campaign, has been implemented for 25 years. As "Healthy China 2030" becomes the key national strategy for improving population health, this initiative is an important component. However, the effects of the initiative have not been well studied. This paper aims to explore its impact on urban environment using a multiple time series design. We adopted a stratified and systematic sampling method to choose 15 China healthy cities acros ...[more]

PMID: 28032240

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Project description:ObjectiveUsing data compiled by the SALURBAL project (Urban Health in Latin America; 'Salud Urbana en América Latina') we quantified variability in low birth weight (LBW) across cities in Latin America, and evaluated the associations of socio-economic characteristics at various levels (maternal, sub-city and city) with the prevalence of LBW.MethodsThe sample included 8 countries, 360 cities, 1321 administrative areas within cities (sub-city units) and birth registers of more than 4.5 million births for the year 2014. We linked maternal education from birth registers to data on socioeconomic characteristics of sub-cities and cities using the closest available national population census in each country. We applied linear and Poisson random-intercept multilevel models for aggregated data.ResultsThe median prevalence of city LBW by country ranged from a high of 13% in Guatemala to a low of 5% in Peru (median across all cities was 7.8%). Most of the LBW variability across sub-cities was between countries, but there were also significant proportions between cities within a country, and within cities. Low maternal education was associated with higher prevalence of LBW (Prevalence rate ratios (PRR) for less than primary vs. completed secondary or more 1.12 95% CI 1.10, 1.13) in the fully adjusted model. In contrast, higher sub-city education and a better city social environment index were independently associated with higher LBW prevalence after adjustment for maternal education and age, city population size and city gross domestic product (PRR 1.04 95% CI 1.03, 1.04 per SD higher sub-city education and PRR 1.02 95% CI 1.00, 1.04 per SD higher SEI). Larger city size was associated with a higher prevalence of LBW (PRR 1.06; 95% CI 1.01, 1.12).ConclusionOur findings highlight the presence of heterogeneity in the distribution of LBW and the importance of maternal education, local and broader social environments in shaping LBW in urban settings of Latin America. Implementing context-sensitive interventions guided to improve women's education is recommended to tackle LBW in the region.

Project description:BackgroundFeatures of the urban physical environment may be linked to the development of high blood pressure, a leading risk factor for global burden of disease.ObjectivesWe examined associations of urban physical environment features with hypertension and blood pressure measures in adults across 230 Latin American cities.MethodsIn this cross-sectional study we used health, social, and built environment data from the SALud URBana en América Latina (SALURBAL) project. The individual-level outcomes were hypertension and levels of systolic and diastolic blood pressure. The exposures were city and subcity built environment features, mass transit infrastructure, and green space. Odds ratios (ORs) and mean differences and 95% confidence intervals (CIs) were estimated using multilevel logistic and linear regression models, with single- and multiple-exposure models adjusted for individual-level age, sex, education, and subcity educational attainment.ResultsA total of 109,176 participants from 230 cities and eight countries were included in the hypertension analyses and 50,228 participants from 194 cities and seven countries were included in the blood pressure measures analyses. Participants were 18-97 years of age. In multiple-exposure models, higher city fragmentation was associated with higher odds of having hypertension (OR per standard deviation (SD) increase=1.11; 95% CI: 1.01, 1.21); presence (vs. no presence) of mass transit in the city was associated with higher odds of having hypertension (OR=1.30; 95% CI: 1.09, 1.54); higher subcity population density was associated with lower odds of having hypertension (OR per SD increase=0.90; 95% CI: 0.85, 0.94); and higher subcity intersection density was associated with higher odds of having hypertension [OR per SD increase=1.09; 95% CI: 1.04, 1.15). The presence of mass transit was also associated with slightly higher systolic and diastolic blood pressure in multiple-exposure models adjusted for treatment. Except for the association between intersection density and hypertension, associations were attenuated after adjustment for country. An inverse association of greenness with continuous blood pressure emerged after country adjustment.DiscussionOur results suggest that urban physical environment features-such as fragmentation, mass transit, population density, and intersection density-may be related to hypertension in Latin American cities. Reducing chronic disease risks in the growing urban areas of Latin America may require attention to integrated management of urban design and transport planning. https://doi.org/10.1289/EHP7870.

Project description:BACKGROUND: China has one of the world's largest health insurance systems, composed of government-run basic health insurance and commercial health insurance. The basic health insurance has undergone system-wide reform in recent years. Meanwhile, there is also significant development in the commercial health insurance sector. A phone call survey was conducted in three major cities in China in July and August, 2011. The goal was to provide an updated description of the effect of health insurance on the population covered. Of special interest were insurance coverage, gross and out-of-pocket medical cost and coping strategies. RESULTS: Records on 5,097 households were collected. Analysis showed that smaller households, higher income, lower expense, presence of at least one inpatient treatment and living in rural areas were significantly associated with a lower overall coverage rate. In the separate analysis of basic and commercial health insurance, similar factors were found to have significant associations. Higher income, presence of chronic disease, presence of inpatient treatment, higher coverage rates and living in urban areas were significantly associated with higher gross medical cost. A similar set of factors were significantly associated with higher out-of-pocket cost. Households with lower income, inpatient treatment, higher commercial insurance coverage, and living in rural areas were significantly more likely to pursue coping strategies other than salary. CONCLUSIONS: The surveyed cities and surrounding rural areas had socioeconomic status far above China's average. However, there was still a need to further improve coverage. Even for households with coverage, there was considerable out-of-pocket medical cost, particularly for households with inpatient treatments and/or chronic diseases. A small percentage of households were unable to self-finance out-of-pocket medical cost. Such observations suggest possible targets for further improving the health insurance system.

Project description:Accessible urban nature is a key component of creating sustainable urban communities and promoting human health and well-being. To balance the economic, social, and environmental dimensions of sustainable development, the United Nations adopted several sustainable developmental goals (SDGs), such as SDG 11 for sustainable cities and communities, which aims to improve urban planning and management, including equitable access to urban nature. However, more information is still needed regarding how planners and managers can promote urban nature visitation and equitable access during health and environmental crises, such as the COVID-19 pandemic. The purpose of this study was to examine trends in urban nature visitation during the pandemic and then to determine if the effect of the pandemic on the frequency of urban nature site visitation varied by distance to home, using an innovative approach of analyzing both publicly available large-scale mobility data and a web-based survey of urban residents of Tel Aviv-Yafo, Israel. The mobility data results showed that there was a negative mean % difference in park visits compared to baseline during the first and third lockdowns, but an increase compared to baseline between lockdowns and even during the second lockdown. This suggests that urban residents had greater need to reconnect with urban nature during and after periods of intense stress. In addition, the survey results showed an increasing negative effect of distance on urban nature site visitation during the pandemic, specifically for urban nature sites located more than 1 km from home. Altogether, the mobility data and survey results suggest that people who lived within 1 km of their preferred urban nature site had disproportionate access to the benefits of urban nature during and after lockdowns than others. To effectively make social and ecological transitions toward urban sustainability, it is vital that cities promote urban nature accessibility during current and future environmental and health crises. Cities should collaborate with diverse stakeholders to create/maintain accessible urban nature sites nearby all sociodemographic groups, provide sustainability education and training to convey the benefits of urban nature, and pursue participatory solutions for understanding urban nature needs and preferences. In this manner, it will be possible to address the growing influence of proximity/travel distance and additional factors that affect urban nature visitation and ultimately, human health and urban sustainability.

Dataset Information

Impact of the China Healthy Cities Initiative on Urban Environment.

Publications

Impact of the China Healthy Cities Initiative on Urban Environment.

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