Periodic Reporting for period 2 - SURREAL (Systems approach of URban enviRonmEnts and heALth)
Periodo di rendicontazione: 2023-01-01 al 2025-07-31
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. SURREAL addresses these needs by developing 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 individual and urban level to improve health and health equity are identified and tested. The 15 ESRs are 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.
Each ESR pursued a doctoral research project:
•WP1: Research investigated social and environmental determinants of health, such as neighborhood inequalities, environmental exposures in children, migrant health disparities, effects of green spaces on mental health. ESRs produced systems maps.
•WP2: Research examined how changes in neighborhood environments, Socio-economic status {SES}, and physical surroundings influence cardiometabolic health, addressing urban greenness, active living environments, relocation effects, industrial contamination, inequalities in exposure to air pollution.
•WP3: Sensor-based and virtual reality (VR) methodologies were established to capture real-time exposures and health outcomes. ESRs implemented field studies in cities (Jerusalem, Luxembourg), advanced VR experiments to study active mobility and wellbeing, and contributed to methodological innovation in geospatial analysis, ecological momentary assessment {EMA}, and data integration.
•WP4: Research focused on the impact of urban policies and interventions on social health inequalities. ESRs conducted health impact assessments of transport and housing policies in cities (Barcelona, Utrecht, Paris), and co-created community-based interventions with local stakeholders.
Outputs and achievements:
•Website, Twitter, Linked-In;
•Multiple peer-reviewed journal publications, plus approx. 32 articles forthcoming;
•Mobile app and data analysis procedures/algorithms for portable sensors;
•Databases usable in future projects;
•Serious game;
•Systems maps, health indices, policy-relevant tools;
•Academic conferences, network schools, stakeholder workshops;
•Academic and non-academic secondments across Europe, fostering interdisciplinary skills and policy engagement;
•Doctoral theses.
Overall, the project advanced knowledge on how environmental and social inequalities shape health outcomes in urban contexts. It also provided novel methodological contributions (sensors, VR, systems thinking) and policy-relevant evidence to guide healthier, more equitable urban development.
•WP1: Research investigated social and environmental determinants of health, such as neighborhood inequalities, environmental exposures in children, migrant health disparities, effects of green spaces on mental health. ESRs produced systems maps.
•WP2: Research examined how changes in neighborhood environments, Socio-economic status {SES}, and physical surroundings influence cardiometabolic health, addressing urban greenness, active living environments, relocation effects, industrial contamination, inequalities in exposure to air pollution.
•WP3: Sensor-based and virtual reality (VR) methodologies were established to capture real-time exposures and health outcomes. ESRs implemented field studies in cities (Jerusalem, Luxembourg), advanced VR experiments to study active mobility and wellbeing, and contributed to methodological innovation in geospatial analysis, ecological momentary assessment {EMA}, and data integration.
•WP4: Research focused on the impact of urban policies and interventions on social health inequalities. ESRs conducted health impact assessments of transport and housing policies in cities (Barcelona, Utrecht, Paris), and co-created community-based interventions with local stakeholders.
Outputs and achievements:
•Website, Twitter, Linked-In;
•Multiple peer-reviewed journal publications, plus approx. 32 articles forthcoming;
•Mobile app and data analysis procedures/algorithms for portable sensors;
•Databases usable in future projects;
•Serious game;
•Systems maps, health indices, policy-relevant tools;
•Academic conferences, network schools, stakeholder workshops;
•Academic and non-academic secondments across Europe, fostering interdisciplinary skills and policy engagement;
•Doctoral theses.
Overall, the project advanced knowledge on how environmental and social inequalities shape health outcomes in urban contexts. It also provided novel methodological contributions (sensors, VR, systems thinking) and policy-relevant evidence to guide healthier, more equitable urban development.
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.
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.