Examining the effectiveness of place-based interventions to improve public health and reduce health inequalities: an umbrella review

Background Locally delivered, place-based public health interventions are receiving increasing attention as a way of improving health and reducing inequalities. However, there is limited evidence on their effectiveness. This umbrella review synthesises systematic review evidence of the health and health inequalities impacts of locally delivered place-based interventions across three elements of place and health: the physical, social, and economic environments. Methods Systematic review methodology was used to identify recent published systematic reviews of the effectiveness of place-based interventions on health and health inequalities (PROGRESS+) in high-income countries. Nine databases were searched from 1st January 2008 to 1st March 2020. The quality of the included articles was determined using the Revised Assessment of Multiple Systematic Reviews tool (R-AMSTAR). Results Thirteen systematic reviews were identified - reporting 51 unique primary studies. Fifty of these studies reported on interventions that changed the physical environment and one reported on changes to the economic environment. Only one primary study reported cost-effectiveness data. No reviews were identified that assessed the impact of social interventions. Given heterogeneity and quality issues, we found tentative evidence that the provision of housing/home modifications, improving the public realm, parks and playgrounds, supermarkets, transport, cycle lanes, walking routes, and outdoor gyms – can all have positive impacts on health outcomes – particularly physical activity. However, as no studies reported an assessment of variation in PROGRESS+ factors, the effect of these interventions on health inequalities remains unclear. Conclusions Place-based interventions can be effective at improving physical health, health behaviours and social determinants of health outcomes. High agentic interventions indicate greater improvements for those living in greater proximity to the intervention, which may suggest that in order for interventions to reduce inequalities, they should be implemented at a scale commensurate with the level of disadvantage. Future research needs to ensure equity data is collected, as this is severely lacking and impeding progress on identifying interventions that are effective in reducing health inequalities. Trial registration PROSPERO CRD42019158309

22.E. Workshop: The planet, economic growth and ourselves: evidence from population health trends in rich countries

Sustainable Development Goal 8 (SDG8) calls for sustainable economic growth, and this is essential for improving population health in developing countries. However, SDG8 also raises a vital and poorly addressed question for rich countries. Is it possible for population health to continue to improve rather than stagnate or even worsen over long periods of zero or low economic growth? The Preston curve, relating average income per person to life expectancy at one point in time, shows the association across countries is highly nonlinear, but does not assess the longitudinal relationship within countries. In the past decade of low growth and austerity, long-term increasing life expectancy trends in UK and USA have stalled. The reasons for the interruption in health improvement are disputed, and include increased socioeconomic and geographic inequalities, such as early disadvantage, and deaths of despair. If the pattern of low growth and stagnant health trends was repeated across rich countries, there would be reason for concern that continuing population health improvement was incompatible with an environmentally sustainable economy. The workshop will examine evidence from G7 countries on trends in health and health inequalities over the past 40 years. The headline health indicators are life expectancy, lifespan variation, all-cause and cause-specific mortality and self-rated health. The workshop will bring together recent findings from two distinct research networks, based in UK, Japan and Sweden. The research has been conducted independently, yet is highly complementary in respect of population health trends in the context of the SDG8 policy question: is it possible that rich countries could thrive, absent of economic growth? Key messages The relation between economic growth and population health is a vitally important consideration, as policy makers strive to meet climate change targets. Among G7 countries, recent trends in health and health inequalities are both adverse (USA, UK) and favourable (Japan) indicating that low growth can be compatible with improving population health.

The Impact of Regeneration and Climate Adaptations of Urban Green–Blue Assets on All-Cause Mortality: A 17-Year Longitudinal Study

Urban waterways are underutilised assets, which can provide benefits ranging from climate-change mitigation and adaptation (e.g., reducing flood risks) to promoting health and well-being in urban settings. Indeed, urban waterways provide green and blue spaces, which have increasingly been associated with health benefits. The present observational study used a unique 17-year longitudinal natural experiment of canal regeneration from complete closure and dereliction in North Glasgow in Scotland, U.K. to explore the impact of green and blue canal assets on all-cause mortality as a widely used indicator of general health and health inequalities. Official data on deaths and socioeconomic deprivation for small areas (data zones) for the period 2001–2017 were analysed. Distances between data zone population-weighted centroids to the canal were calculated to create three 500 m distance buffers. Spatiotemporal associations between proximity to the canal and mortality were estimated using linear mixed models, unadjusted and adjusted for small-area measures of deprivation. The results showed an overall decrease in mortality over time (β = −0.032, 95% confidence interval (CI) [−0.046, −0.017]) with a closing of the gap in mortality between less and more affluent areas. The annual rate of decrease in mortality rates was largest in the 0–500 m buffer zone closest to the canal (−3.12%, 95% CI [−4.50, −1.73]), with smaller decreases found in buffer zones further removed from the canal (500–1000 m: −3.01%, 95% CI [−6.52, 0.62]), and 1000–1500 m: −1.23%, 95% CI [−5.01, 2.71]). A similar pattern of results was found following adjustment for deprivation. The findings support the notion that regeneration of disused blue and green assets and climate adaptions can have a positive impact on health and health inequalities. Future studies are now needed using larger samples of individual-level data, including environmental, socioeconomic, and health variables to ascertain which specific elements of regeneration are the most effective in promoting health and health equity.

A sick city in a sick country

The comparatively poor contemporary health profiles of Scotland and, in particular, Glasgow have become widely known. Drawing on a body of research compiled by the Glasgow Centre for Population Health, this chapter provides a detailed examination of the health profiles of these populations as they have been shaped over time. The chapter begins by tracing their historical development in their UK and European context, before turning to examine the political, social and economic causal factors and processes which have, over time, contributed to the particularly poor health outcomes experienced in Glasgow. Building on this knowledge, the chapter draws to a close by exploring the potential future health trajectory of the city’s population. Glasgow provides a potent case for other cities and countries as they consider the ways in which politics and policy come to shape health, and health inequalities, across their populations.