Promoting Resilient and Healthy Cities for Everyone in an Urban Planning Context by Assessing Green Area Accessibility

Rapid economic development and population growth has led to urban densification and massive land use changes, putting pressure on both ecosystems, and people. In this context, public health issues have become crucial for cities to address to ensure they remain livable and healthy for everyone. Since the health challenges of cities tend to manifest themselves differently among different population groups—e.g., groups of higher socioeconomic status tend to be correlated with better health than groups of low socioeconomic status—closing the health gap has become a priority for creating healthy cities for everyone. More greenness close to where people live and better accessibility to green areas has been shown to be useful for improving human health and for tackling health inequalities. This paper aims at developing a method for supporting urban planners and policymakers on where to geographically prioritize investments in green infrastructure to contribute to closing the health gap and promote community resilience through improving public health. Using the City of Stockholm as a pilot, we apply a GIS analysis to identify vulnerable population groups in relation to geotagged empirical human health- and socio-economic data. By then assessing vulnerable populations in relation to population numbers and accessibility to urban green areas, an Urban Green Opportunity Map (UGOM) was created, identifying focus areas where investment in green infrastructure will contribute most to closing the health gap and building community resilience.

Health Patterns among Migrant and Non-Migrant Middle- and Older-Aged Individuals in Europe—Analyses Based on Share 2004–2017

Introduction: European populations are becoming older and more diverse. Little is known about the health differences between the migrant and non-migrant elderly in Europe. The aim of this paper was to analyse changes in the health patterns of middle- and older-aged migrant and non-migrant populations in Europe from 2004 to 2017, with a specific focus on differences in age and gender. We analysed changes in the health patterns of older migrants and non-migrants in European countries from 2004 to 2017. Method: Based on data from the Survey of Health, Ageing and Retirement in Europe (6 waves; 2004–2017; n = 233,117) we analysed three health indicators (physical functioning, depressive symptoms, and self-rated health). Logistic regression models for complex samples were calculated. Interaction terms (wave * migrant * gender * age) were used to analyse gender and age differences and the change over time. Results: Middle- and older-aged migrants in Europe showed significantly higher rates of depressive symptoms, lower self-rated health, and a higher proportion of limitations on general activities compared to non-migrants. However, different time trends were observed. An increasing health gap was identified in the physical functioning of older males. Narrowing health gaps over time were observed in women. Discussion: An increasing health gap in physical functioning in men is evidence of cumulative disadvantage. In women, evidence points towards the hypothesis of aging-as-leveler. These different results highlight the need for specific interventions focused on healthy ageing in elderly migrant men.

Conducting decolonizing research and practice with Australian First Nations to close the health gap

The purpose of this paper is to highlight a perspective for decolonizing research with Australian First Nations and provide a framework for successful and sustained knowledge translation by drawing on the recent work conducted by a research group, in five remote communities in North-Western Australia. The perspective is discussed in light of national and international calls for meaningful and dedicated engagement with First Nations people in research, policy and practice, to help close the health gap between First Nations and other Australians.

Mental Health Gap Action Programme training in Nigeria: reflections for progressive learning among primary care workers

In the majority of low- and middle-income countries, mental healthcare is delivered by primary care workers. Often, they are the only contact for patients and their families. Although their knowledge base can be limited, they are expected to manage complex cases with few resources. The authors describe their experience of partnership with mental health centres set up by the Nigeria Health Care Project, and training their primary care workers based on the World Health Organization's Mental Health Gap Action Programme. Although the programme was very effective in helping to upskill their knowledge and experience, a need for continued professional development was highlighted. Based on their feedback, multiple evidence-based options are explored, including the use of remote learning and social media (increased significantly around the world because of the COVID-19 pandemic), to help primary care workers improve their knowledge base and maintain their competencies with the limited resources available.

Impact of racism and discrimination on physical and mental health among Aboriginal and Torres Strait islander peoples living in Australia: a systematic scoping review

Background Racism is increasingly recognised as a significant health determinant that contributes to health inequalities. In Australia efforts have been made to bridge the recognised health gap between Aboriginal and Torres Strait Islander people and other Australians. This systematic scoping review aimed to assess, synthesise, and analyse the evidence in Australia about the impacts of racism on the mental and physical health of Aboriginal and Torrens Strait Islander peoples. Methods A systematic search was conducted to locate Australian studies in English published between 2000 and 2020. Five electronic databases were used: PubMed, CINAHL, Embase, Web of Science and the Australia’s National Institute for Aboriginal and Torres Strait Islander Health Research. The search strategy included a combination of key words related with racism, mental health, physical health and Indigenous people. Data were extracted based on review questions and findings were synthesized in a narrative summary. Results Of total 338 searched studies from five databases, 12 studies met the inclusion criteria for narrative synthesis where eight were cross-sectional studies and four prospective cohorts. General mental health and general health perception were the most frequently studied outcomes followed by child behaviour, smoking and substance consumption and specific health conditions. The prevalence of racism varied between 6.9 and 97%. The most common health outcomes associated with racism were general poor mental health and poor general health perception. More specific health outcomes such as anxiety, depression, child behaviour, asthma, increased BMI and smoking were also associated with racism but were analysed by a limited number of studies. Three studies analysed psychological distress, negative mental health, sleeping difficulties and negative perceived mental health according to severity of exposition to racism. Conclusion Racism is associated with negative overall mental and negative general health outcomes among Aboriginal and Torres Strait Islander peoples. Strategies to prevent all forms and sources of racism are necessary to move forward to bridging the health gap between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians. Further research is needed to understand in more detail the impact of racism from an Aboriginal and Torres Strait Islander definition of health and wellbeing.

Implementation of the Mental Health Gap Action Programme (mhGAP) in Kosrae State in the Federated States of Micronesia

Improving access to mental health care is a global health priority, and a significant treatment gap exists in Pacific Island Countries. One strategy to bridge the gap is the World Health Organization’s Mental Health Gap Action Programme (mhGAP), which provides evidence-based guidance for managing mental, neurological, and substance abuse conditions. mhGAP has been implemented in more than 90 countries, but there has been limited training within many Pacific Island countries. We describe implementation of mhGAP training in Kosrae, a state within the Federated States of Micronesia. mhGAP training was conducted with 18 members of the Kosrae Community Health Center (KCHC). Our training model included 2 helpful modifications: (1) participants attended a combination of online sessions and a 1-week in-person training, which allowed for more time and flexibility in delivering training; and (2) longitudinal support posttraining, which has been identified as an important factor in successful implementation of mhGAP.

WHO mental health gap action programme (mhGAP) intervention guide: updated systematic review on evidence and impact

QuestionThere is a large worldwide gap between the service need and provision for mental, neurological and substance use disorders. WHO’s Mental Health Gap Action Programme (mhGAP) intervention guide (IG), provides evidence-based guidance and tools for assessment and integrated management of priority disorders. Our 2017 systematic review identified 33 peer-reviewed studies describing mhGAP-IG implementation in low-income and middle-income countries.Study selection and analysisWe searched MEDLINE, Embase, PsycINFO, Web of Knowledge, Scopus, CINAHL, LILACS, ScieELO, Cochrane, PubMed databases, 3ie, Google Scholar and citations of our review, on 24 November 2020. We sought evidence, experience and evaluations of the mhGAP-IG, app or mhGAP Humanitarian IG, from any country, in any language. We extracted data from included papers, but heterogeneity prevented meta-analysis.FindingsOf 2621 results, 162 new papers reported applications of the mhGAP-IG. They described mhGAP training courses (59 references), clinical applications (n=49), research uses (n=27), contextual adaptations (n=13), economic studies (n=7) and other educational applications (n=7). Most were conducted in the African region (40%) and South-East Asia (25%). Studies demonstrated improved knowledge, attitudes and confidence post-training and improved symptoms and engagement with care, post-implementation. Research studies compared mhGAP-IG-enhanced usual care with task-shared psychological interventions and adaptation studies optimised mhGAP-IG implementation for different contexts. Economic studies calculated human resource requirements of scaling up mhGAP-IG implementation and other educational studies explored its potential for repurposing.ConclusionsThe diverse, expanding global mhGAP-IG literature demonstrates substantial impact on training, patient care, research and practice. Priorities for future research should be less-studied regions, severe mental illness and contextual adaptation of brief psychological interventions.