Periodic Reporting for period 1 - SURREAL (Systems approach of URban enviRonmEnts and heALth)
Reporting period: 2021-01-01 to 2022-12-31
Across the world, demographic growth, primary energy uses, vehicle mobility and urbanization come with enormous public health challenges, such as cardiometabolic and mental health problems. Increasingly, it is recognized that an integrated, comprehensive approach toward the physical, social, and institutional factors that shape urban health is lacking and that research and policies on urban health is in need for a systems approach. However, currently health research and training at universities, at other research institutes and governance of urban health problems is often too narrow in scope and short-termed in approach. SURREAL (Systems approach of urban environments and health) is a Marie Skłodowska-Curie Innovative Training Network (ITN) action funded by the European Commission, which addresses these needs.
The major aim of SURREAL is to develop a solid understanding of the complex and dynamic relationships between exposures to urban environments, behaviors of people and relationships with health and health equity in the urban health system. Effective interventions at the individual and the urban level to improve health and health equity will be identified and tested. The 15 Early Stage Researchers (ESRs) will be trained to work in an interdisciplinary and intersectoral systems approach. To that purpose, SURREAL draws upon interactions between academic disciplines such as epidemiology, public health, human movement science, psychology, sociology, geography, and urban planning and a wide range of entities such as medical centres, public authorities, firms, and NGOs as well as citizens. Equipped with this expertise and supported by innovative training formats, such as Collaborative Learning in Practice (CLiP), SURREAL trains the next generation of professionals in urban health.
The major aim of SURREAL is to develop a solid understanding of the complex and dynamic relationships between exposures to urban environments, behaviors of people and relationships with health and health equity in the urban health system. Effective interventions at the individual and the urban level to improve health and health equity will be identified and tested. The 15 Early Stage Researchers (ESRs) will be trained to work in an interdisciplinary and intersectoral systems approach. To that purpose, SURREAL draws upon interactions between academic disciplines such as epidemiology, public health, human movement science, psychology, sociology, geography, and urban planning and a wide range of entities such as medical centres, public authorities, firms, and NGOs as well as citizens. Equipped with this expertise and supported by innovative training formats, such as Collaborative Learning in Practice (CLiP), SURREAL trains the next generation of professionals in urban health.
Most ESRs started their position in September 2021. ESRs originate from South-East Asia, Europe, Northern and Central America. In November 2021, due to COVID-19 restrictions, a virtual kick-off meeting was organized including a key note given by Harry Rutter, Professor of Global Public Health at the University of Bath, UK on ‘Obesity as a complex systems approach’. In June 2022, the first Network School was organized in Utrecht, NL. The program included key notes on the exposome and area-based inequalities as well as presentations and workshops on co-creation, citizen science, visualizations and serious games given by stakeholders included in the SURREAL-consortium. All participants in the network school visited the neighborhood in the municipality of Utrecht, which has been adopted for three years to study developments in health and lifestyle interventions. The SURREAL website (https://surreal-itn.eu/(opens in new window)) gives at a regular basis updates of events. The same counts for the SURREAL Twitter account: https://twitter.com/Surreal_ITN(opens in new window).
The major aim of SURREAL is to develop a solid understanding of the complex and dynamic relationships between exposures to urban environments, behaviors of people and relationships with health and health equity in the urban health system. To that purpose, 15 Early Stage Researchers (ESRs) are trained to work in an interdisciplinary and intersectoral systems approach. Some preliminary findings of their work can be highlighted.
A literature review on mental health and greenness shows that research examining the positive effects of exposure to greenspace is largely based on greenspace interactions that produce health effects stemming from some form of recreational activity. However, increasing evidence suggests that urban greenspace can be used as solution to solve deeper community issues. For instance, urban greenspace schemes have been used to help people with mental health disorders join the work force by offering them a space in which to produce local agricultural products. Similar initiatives have been used in disadvantaged neighborhoods with high unemployment. Such grassroot schemes demonstrate that urban greenspaces have the ability to go beyond being a space for relaxation and recreational activities, which perhaps cater more to the lifestyle of affluent populations. For low SES communities, they can become spaces that can provide solutions to chronic issues, such as unemployment, distrust, and social discrimination.
Another systematic literature review identified novel findings on the impact of industrial air pollutants on the public health of early life stages. The review article shows that the health risks, such as low birth weight, premature birth, timely birth but with low weight, of industrial pollutants to a vulnerable population, especially new-borns, are greater. New-borns’ poorer health status is affected by where their pregnant mothers lived before they were born. Thus, the state of the environment having polluted air is found as a key driver of health inequalities in public health measures in the contaminated areas.
In most epidemiologic studies, to calculate the exposure to air pollution is based on the use of spatial-temporal models. This approach results in incomplete information about residential mobility and leading to unbiased but more variable health effects estimates. As alternative, for individuals an internal exposure marker to trace black carbon particles in urine samples was recently developed. This cutting-edge approach allows the readily visualization and quantitative determination of black carbon particles. It is demonstrated in SURREAL that urinary black carbon loading is related to the level of external environmental air pollution over the life course. The technique can be used in different study populations over the entire life course, helping to unravel the complexity of particulate-related health effects.
SURREAL has adopted for three years a neighborhood in the municipality of Utrecht, The Netherlands. The aim is to implement and analyze lifestyle interventions to improve the health of adolescents. To prepare these interventions, qualitative interviews and observations of adolescent’s behaviors were done. The first results show that the adolescents have a broad understanding of health. Social aspects of health, related to belonging, relaxing and feeling safe, are especially important to adolescents. Differentiation in belonging between youth groups, are based on behavioral habits (e.g. being quiet or more chaotic), the area in the neighborhood where they live or usually hang out, and family migration background. Public spaces can affect the health of youth by creating opportunities for meeting with friends and peers, for getting to know each other, which can improve their well-being. A good example are multifunctional football courts, surrounded by grass, benches and other sports facilities. These would make it easier for different groups of youth to be present simultaneously and to interact. As such, they may promote social connections between groups of youth.
A literature review on mental health and greenness shows that research examining the positive effects of exposure to greenspace is largely based on greenspace interactions that produce health effects stemming from some form of recreational activity. However, increasing evidence suggests that urban greenspace can be used as solution to solve deeper community issues. For instance, urban greenspace schemes have been used to help people with mental health disorders join the work force by offering them a space in which to produce local agricultural products. Similar initiatives have been used in disadvantaged neighborhoods with high unemployment. Such grassroot schemes demonstrate that urban greenspaces have the ability to go beyond being a space for relaxation and recreational activities, which perhaps cater more to the lifestyle of affluent populations. For low SES communities, they can become spaces that can provide solutions to chronic issues, such as unemployment, distrust, and social discrimination.
Another systematic literature review identified novel findings on the impact of industrial air pollutants on the public health of early life stages. The review article shows that the health risks, such as low birth weight, premature birth, timely birth but with low weight, of industrial pollutants to a vulnerable population, especially new-borns, are greater. New-borns’ poorer health status is affected by where their pregnant mothers lived before they were born. Thus, the state of the environment having polluted air is found as a key driver of health inequalities in public health measures in the contaminated areas.
In most epidemiologic studies, to calculate the exposure to air pollution is based on the use of spatial-temporal models. This approach results in incomplete information about residential mobility and leading to unbiased but more variable health effects estimates. As alternative, for individuals an internal exposure marker to trace black carbon particles in urine samples was recently developed. This cutting-edge approach allows the readily visualization and quantitative determination of black carbon particles. It is demonstrated in SURREAL that urinary black carbon loading is related to the level of external environmental air pollution over the life course. The technique can be used in different study populations over the entire life course, helping to unravel the complexity of particulate-related health effects.
SURREAL has adopted for three years a neighborhood in the municipality of Utrecht, The Netherlands. The aim is to implement and analyze lifestyle interventions to improve the health of adolescents. To prepare these interventions, qualitative interviews and observations of adolescent’s behaviors were done. The first results show that the adolescents have a broad understanding of health. Social aspects of health, related to belonging, relaxing and feeling safe, are especially important to adolescents. Differentiation in belonging between youth groups, are based on behavioral habits (e.g. being quiet or more chaotic), the area in the neighborhood where they live or usually hang out, and family migration background. Public spaces can affect the health of youth by creating opportunities for meeting with friends and peers, for getting to know each other, which can improve their well-being. A good example are multifunctional football courts, surrounded by grass, benches and other sports facilities. These would make it easier for different groups of youth to be present simultaneously and to interact. As such, they may promote social connections between groups of youth.