Module 3 Flashcards
1
Q
social gradient
A
phenomenon whereby low socioeconomic groups have worse health outcomes (+ shorter lives) than those more advantaged in terms of SEP
- most key social determinants follow gradient
2
Q
socio-economic position
A
Social (people, place, ethnicity) and economic factors that influence what positions individuals or groups hold within the structure of a society
- ranking structure
3
Q
determinants must be
A
- objective
- measurable
- meaningful
4
Q
SEP aka
A
Socioeconomic status, social class (UK), social stratification (US)
5
Q
why measure SEP
A
- Quantify level of inequality within or between societies
- Highlight changes (stratification/differences between/within groups) to population structure over time, between Census periods, between generations
- Understand relationship between health and other social variables (age, sex, ethnicity)
6
Q
SEP history
A
Have been associated with health and life chances for as long as social groups have existed
7
Q
individual lifestyle factor indicators
A
- education
- occupation
- income
- housing
- assets/wealth
- use of services
8
Q
social and community influences
A
PARENT’s indicators (some evidence for association between parent-child)
- commonly used to measure SEP in studies of children/adolescents
9
Q
living and working conditions
A
area-based measures
- deprivation (NZ index of deprivation - NZDep, Index of Multiple Deprivation - IMD)
- access to resources/services (accessibility indices)
10
Q
deprivation
A
State of observable and demonstrable disadvantage relative to the local community or wider society or nation to which an individual, family or group belongs
- 1 is best => 5 is worst
11
Q
deprivation features
A
- another way of measuring people’s relative position in society but reports based on where they live, not who they are
- respondents more willing to respond and easier to ask as surveyor
- focus on material deprivation
- easier to measure “don’t have”s than “have”s
- should be applied to conditions and quality of life that are of lower standard than is ordinary in a particular society
- what is defined as ordinary is predominantly Eurocentric
- don’t factor in intragenerational accommodation => focus on majority
12
Q
poverty
A
lack of income/resources to obtain normative standard of living
13
Q
potential access
A
service available
14
Q
realised access
A
service actually utilised
15
Q
general socioeconomic, cultural and environmental conditions
A
group populations with similar SEP levels together
- cross-sectional or longitudinal analyses
16
Q
areas where policy environ. shapes actions on social determinants of health
A
- child poverty
- education
- employment and working conditions
- minimum income for healthy living
- healthy communities to live and work in
- social determinants and prevention (causes of causes)
17
Q
global determinants
A
- Income inequality
- National income
- Gross Domestic Product (GDP) per capita
(used by economists)
- Gross Domestic Product (GDP) per capita
- Literacy rates
- Free trade agreements
18
Q
understanding causes of causes
A
work backwords, asking why?
- access to health care -> income -> employment status -> educational attainment -> access to education -> discrimination -> belonging to a marginalised group
19
Q
unwelcome types of growth
A
- jobless growth
- ruthless growth
- voiceless growth
- rootless growth
- futureless growth
20
Q
access
A
relates consumers’ ability or willingness to enter into the healthcare system
21
Q
reasons for seeking health service - patient side
A
- predisposing factors
- enabling factor
- need
22
Q
health service - hospital side
A
enough resources?
23
Q
when patient side and hospital side meet
A
most likely to utilise/access health services
24
Q
dimensions of access
A
- Viewed as a set of more specific areas (dimensions) representing degree of fit between the patient and healthcare system
- Generally independent of one another but not standalone and can be linked
25
influences of access
- patient satisfaction
- service utilisation
- provider practice patterns
26
availability
relationship of volume (quantity) and type of existing services (and resources) to the clients' volume and type of needs
27
availability examples
- supply of providers (physicians, dentists etc.)
- facilities (clinics, hospitals etc.)
- specialised programs/services (mental health, emergency care etc.)
28
accommodation
relationship between manner in which supply resources are organised to accept clients and the clients' ability to accommodate these factors/their expectations
29
accommodation examples
- appointment system
- hours of operation
- walk-in facilities
- telephone services
30
acceptability
relationship between clients' and providers' attitudes to what constitutes appropriate care
31
acceptability examples
- consumer reaction to provider attributes
| - providers' attitudes about preferred patient attributes/financing mechanism
32
accessibility
relationship between location of supply and clients, taking into account client transportation resources and travel time, distance and cost
33
affordability
cost of provider services in relation to clients' ability and willingness to pay for these services
34
affordability examples
- providers' insurance and deposit requirements
- clients' income, ability to pay, existing health insurance
- clients' knowledge of prices, total cost, GP surcharge, possible credit arrangements
- client perception of worth relative to total cost (value of cost)
35
direct cost
paid to provider
36
indirect cost
time off work, fuel, car etc.
37
patient satisfaction
- art of care
- technical quality of care
- accessibility/convenience (accessibility and accommodation)
- finances (affordability)
- physical environment (acceptability)
- availability
- continuity
- efficacy/outcomes
38
population structure
- age
| - sex
39
population composition
other attributes
- ethnicity
- education
- religion
40
population (pyramids) are
a window into the past and future
41
demographic transition
global shift from high to low birth/death rates and the one-off spurt in population growth that accompanies the trend
- began in 1700s
42
population data sources for epidemiology
- census
- integrated data infrastructure (IDI)
- estimated resident populations (ERP)
- vital events
- health service utilisation and outcomes (HSU)
- nationally representative surveys
- ad hoc surveys
43
data considerations
- ethics, data privacy/confidentiality
- purpose of data collection vs use in analysis
- population vs population SAMPLES
- participants representative of NZ pop.?
- objective vs subjective measures of health
44
events determining population structure
- age-sex structure is a function of previous patterns/trends in fertility, migration and mortality events
- vital events affect structure in different ways/extents (fertility/infant mortality: dramatic but time lag, adult mortality: less dramatic/variable, migration: dramatic)
45
population structure determining events
- fertility, mortality, migration not evenly distributed across population by age and sex
- age-sex structure has crucial influence on rates at which events occur in population
46
dependency ratios
pop. defined by law as dependent pop./working age x 100
47
dependent pop. and working age
```
dependent pop:
- children: 0-14
- eldery: ≥65
working age:
- 15-64
```
48
types of ageing
- numerical ageing
| - structural ageing
49
numerical ageing
absolute increase in pop. that is elderly
- due to improvements in life expectancy
- reflects previous demographic patterns (reduction in infant/child mortality + increased probability of survival at old age)
50
structural ageing
increase in proportion of pop. that is elderly
- driven by decline in fertility/birth rates
- began occurring in 1800s
51
relationship between numerical and structural ageing
occur independently of each other with different causes and different implications
- high death rates => pop won't age numerically
- high birth rates => pop won't age structurally
52
population impacts of ageing
- natural decline of pop.
| - absolute decline of pop.
53
natural decline
occurs when deaths > births in a pop.
- combo of absolute and structural ageing
- more elderly (than children) = more deaths (than births) eventually, despite increasing life expectancy
54
absolute decline
occurs when there is insufficient migration to replace lost births and increased deaths
- competition for migration
- not expected to happen in NZ for 70+ years but happening in some european/asian countries
55
transitional growth
compounding of pop. growth driven NOT by rising birth rates but declining infant/child mortality rates
56
premature ageing
- low fertility
- increased life expectancy
- migration driven gains at older age (accelerated structural ageing)
- migration driven losses at younger age
57
inequities and politics
pophlth is laden with politics => addressing inequities is political
- all govt want to improve health/wellbeing of society but HOW improvements are approached differs widely
58
inequalities
- measurable differences/variations in health (EGO, CGO, prevalence, incidence)
- social gradient
59
health inequalities
differences in HEALTH experience/outcomes between different population groups
- according to SEP, area, age, disability, gender, ethnic group
60
inequities
- inequalities that are deemed to be unfair/stemming from some form of injustice
- relations of equal and unequal power (who has power to make changes, political/social/economic power, justice/injustice)
61
health inequities
differences in distribution of resources/services across population which do not reflect health needs
62
equity
- response to need => cater/tailor intervention
| - for whom? NZ? all of NZ? Te Tiriti O Waitangi?
63
equity - ministry of health definition
- In Aotearoa New Zealand, people have differences in health that are not only avoidable but unfair and unjust
- Equity recognises different people with different levels of advantage require different approaches and resources to get equitable health outcomes
64
manawhenua
right of Maori tribe to manage particular area of land
65
mataawaka
Maori living in Auckland
66
PROGRESS stands for
- Place of residence
- Race/ethnicity/culture/language
- Occupation
- Gender/sex
- Religion
- Education
- Socioeconomic status
- Social capital
+ Disability
67
PROGRESS is...
- socially stratifying factors that drive variations in health outcomes
- helps use spectrum of social stratifiers as opposed to just one
- helps avoid unintended intervention effects that may increase the gap between the most and least disadvantaged
- advantage/disadvantage? why?
68
PROGRESS-Plus includes
- personal characteristics that attract discrimination (e.g age, disability)
- features of relationships (e.g smoking parents, excluded from school)
- time-dependent relationships (e.g leaving hospital, respite care, temporarily at disadvantage)
69
PROGRESS-Plus considers...
additional context-specific factors
70
Reasons for reducing inequities
1) UNFAIR (societal value)
- poor health is the consequence of an unjust distribution of underlying social determinants of health
2) AVOIDABLE
3) affect EVERYBODY
- everyone may be affected by the conditions of the weakest/most vulnerable members of their community
4) reducing them can be COST-EFFECTIVE (more instrumental consideration)
71
inequities in health outcomes result from
inequities in opportunities
72
Drawing a Lorenz curve
1) order the population from lowest to highest and ask
- what % of wealth is owned by the poorest 10% pop?
- what % of wealth is owned by the poorest 20% pop? etc.
2) draw a line of absolute equality (45º)
3) draw line based on available data (concave)
4) the more concave, the greater the income inequality in a pop.
73
gini-coefficient
ratio of area between the line of perfect equality and the observed Lorenz curve to the area between the line of perfect equality and the line of perfect inequality
74
interpreting the gini-coefficient
0: very equal society
1: very unequal society
75
improvements in average health status and narrowing differentials by socioeconomic status
are not always correlated
- e.g policies aiming to narrow the gap may conflict with interventions that would achieve the greatest health gain for the pop. overall
76
exclusion is:
(other than moral considerations)
- costly
- inefficient (represents loss of potential resources)
- unsafe
77
implications of (income) inequities
- unequal society
- less social cohesion
- notion of support: support system? Who do you contact?
- less trust between groups
- neighbourhood? Relationship with neighbours?
- increased stress
- reduced economic productivity
- poorer health outcomes
78
reducing inequities can be achieved through...
the redistribution of resources according to need
- extent of redistribution is a matter of social preference
Using examples of best practice it is possible to improve performance of others, and therefore reduce inequities
- everybody else is brought up
79
inequity myths busted
1) widening inequalities: NOT a necessary outcome of “high waged, highly educated, economically expanding society” (wealthier society)
2) everybody is NOT better off in a society that is “economically expanding and predominantly middle class [and increasingly unequal]”
3) NOT inevitable that public health interventions result in widening of health inequalities (while SOME may)
80
A society that tolerates a steep socioeconomic gradient in health outcomes
will experience a drag on improvements in life expectancy, and pay the cost via excess health care utilisation
81
systematic disparities
exemplify maori health and is highly visible in:
- health outcomes
- exposure to determinants of health
- health system responsiveness
- representation in health workforce
82
systematic disparities are the result of
underperformance of the govt., society and systems
83
disparities
differences
84
inequalities simplified
unequal but no judgement
85
inequities simplified
brings in factor of social justice/fairness
| - does everyone have equal chances?
86
structural issues
- physical barriers?
| - location advantage/disadvantage?
87
social issues
influences of social values
88
leveling or privileging
equitable distribution is not always equal distribution
| - NZ particularly hung up on providing equal access
89
types of interventions
- structural interventions
| - social interventions (rights based approach and commitment to review and level playing field)
90
population-based approach
- NOT aimed at individual behaviour
- are people able to access services and know how to access them?
- do not focus on the negative group (not what's wrong with them) but the environ./system
91
determinants of ethnic inequities in health
1) Differential access to health determinants or exposures leading to differences in disease influence
2) Differential access to health care
3) Differences in quality of care received
92
Internationally, minorities report:
* Less likely to feel they have been listened to
* Less time spent with health care provider
* Less likely to have received adequate explanations
* More likely to have unanswered questions
* More dissatisfaction with health service and system
93
Maori history
1) early contact
| 2) official engagement
94
early contact
- initially flourished - economically, socially
| - beginning of complex changes
95
official engagement
- colonisation
- declaration of independence
- treaty of waitangi
96
colonisation
heralding an era of depopulation, disease and dispossession
- not value-free
- assumptions held by colonisers
- notions of superior and inferior peoples,
- notions of civilisation especially religious but also including economic and scientific knowledge e.g. land use, conservation
- notions of deserving & undeserving
- ? still obvious today - societal barriers
97
treaty of waitangi implications
- creation of govt
- maori land
- different or denied citizenship
98
Creation of Government – Art I & II
– Art I - Construction of state sector – justice system, education, health, welfare etc - remnants of treaty (treaty-based)
– Constitution Act 1852 – created settler government
– Who got to vote - maori had to get individual title
– Laws and policies – Art II
(Disregard for Māori voice/authority despite Art II)
99
govt - relation to health
policy alienation
100
Māori land
= historical basis of settler wealth
– Pre-emption clause of ToW
– The Māori Land Court – 1860s • Individual title
101
land - relation to health
```
Land alienation
– social disruption of community
– breakdown of political power & alliances
– economic resource depletion & poverty
– resentment by indigenous peoples
```
102
Different or denied citizenship – Art III
– Pensions – Old Age Pensions – 1898
| – Social Security Act 1938
103
Pensions – Old Age Pensions – 1898
* Equal provisions for Māori and pākehā
* [Asians particularly excluded]
* Māori access difficult – thru Māori Land Court
* Māori regularly removed from rolls
* Reduced amount paid to Māori
104
– Social Security Act 1938
• Underpayment continued until after WWII
105
unequal citizenship - relation to health
– entrenchment of poverty & dependency
– increased barriers to development
– acceptance of inequity by non-indigenous groups
– resentment, frustration and anger
– social breakdown, crime, high risk behaviours
106
powerful, historical predisposing factors lie outside of control
while resulting inequality in health status from action that one was responsible for could not be described as unfair, health is more than a matter of personal choice
107
For Māori health development, we need to...
address the structural barriers to equitable access to the determinants of health and to address attitudes in society that stigmatises one group or assigns them differing value
108
levels of racism
- institutionalised racism
- personally mediated racism
- internalised racism
109
institutionalised racism
differential access to goods, services, and opportunities of society by race
- normative (societal norms)
- sometimes legalised
- inherited disadvantage (initial historical insult, biological determinism)
- unearned privilege
- inaction in face of need
- structural barriers
110
institutionalised racism examples
- material conditions
| - access to power
111
material conditions
differential access to:
- quality education
- sound housing
- gainful employment
- appropriate medical facilities
- clean environment
112
access to power
differential access to:
- information
e. g one’s own history
- resources
e. g wealth and organisational infrastructure
- voice
e. g voting rights, representation in government, control of media
113
personally mediated racism
prejudice and discrimination
- could be intentional or unintentional
- act of commission as well as omission
114
prejudice
Differential assumptions about the abilities, motives, and intentions of others according go their race
115
discrimination
Differential action toward others according to their race
116
personally mediated racism examples
- lack of respect
- suspicion
- devaluation
- scapegoating
- dehumanisation
117
internalised racism
acceptance by members of the stigmatised races of negative messages about their own abilities and intrinsic worth
118
levels of racism comparison
institutionalised racism is the most fundamental and once this is addressed, other levels of racism may cure themselves over time
119
levels of racism - role of govt
```
has the:
- power to decide
- power to act
- control of resources
dangerous when:
- allied with one group
- not concerned with equity
```
120
racism against pacific people in 1970s
- viewed as units of productivity (humanity not part of anyone's vision)
- got beaten up by police for nothing (injustice)
- forced to cut hair (even though it had cultural significance)
121
dawn raids
1974-1976
- Kicking out people with expired visas
- Didn’t feel like New Zealander
- Revenge
122
springbok tour
- Non-violence didn’t cut it
123
evidence for institutional racism against pasifika
statistics don’t change even though it looks like it on the surface
124
Crucible years
1971-1974
125
what the panthers did
- legal aid
- tenants aid brigade (TAB)
- police investigation group (PIG patrol)
- homework centres
- paremoremo prison visits
- community programmes
- protests
126
legal aid booklet and human rights
- Educating teenagers, having the knowledge and understanding to protect themselves (being able to ask “am I under arrest”)
- Didn’t know their human rights and more importantly their legal rights
127
TAB
```
rent strikes (now Tenants Tribunal)
- not paying rent until the house is brought up to liveable standards
```
128
PIG patrol
Now Police Conduct authority
| - accusing police of little things such as uniform codes so that they don't get arrested for nothing
129
Paremoremo prison visits
creating bus to visit their families (in prison due to their institutions)
- otherwise would not be able to see them due to being too far
130
community programmes
Food co-ops, street/kids Xmas parties, Seniors’ concerts & outings, Westend News deliveries, lawn-mowing services for Seniors
131
protests
- Not accepting things like above
| - Supporting by partaking in all these activities
132
pacific panther collaborations
- Black Panther Party USA
- Mayor of Auckland City - Sir Dove-Meyer Robinson
- Politicians: Minister of Justice
- Nga Tamatoa
- During school visits?
133
3-point panther platform:
1) Peace resistance against racism
- What is racism?
- Institutional
- Personal
- Internalised
- Everyday
2) Celebrate mana Pacifica
- your own identity
3) Educate to liberate
134
pacific panthers next steps
- Becoming political - raising awareness of racism and doing something about it
- Putting Pacific people in NZ and Ponsonby on the map - we are here to stay!
- Changing attitudes towards Pacific Islanders
- The first example of Pacific activism in NZ by a group of 18-19 year old first NZ-born
Polynesian generation
135
key principles for population health - COVID19
1) sizing up pandemics
2) choosing a response strategy
3) choosing interventions as part of elimination strategy
4) vaccinating against COVID-19
5) measuring impact of pandemic response and equity
6) reducing risk of cases and outbreaks
7) using testing to control COVID-19
8) using information and combating misinformation
9) planning for future scenarios
10) lessons for improving public health
136
factors influencing response to pandemic
- how transmissible
- how severe and unequal
- how controllable
- how certain the info is and how stable the threat is
137
how transmissible
reproduction number, RoReff
138
how severe and unequal
- case fatality risk (CFR) and infection fatality risk (IFR)
| - inequalities of pandemic and responses
139
how controllable
- available interventions and effectiveness
- feasibility of response, sector capacity, public acceptability and adherence
- economic assessment, cost of action and inaction, counterfactuals
140
how certain the info is and how stable the threat is
- availability and quality of info, experience, dogma
- science capacity, ability to track threat and generate/test scenarios
- stability of threat, evolution
141
pandemic response choices
- control
| - elimination
142
pandemic response choices - control
reduce to an acceptable endemic level using feasible means
- mitigation
- suppression
143
pandemic response choices - control - mitigation
reduce to avoid overwhelming the healthcare system
144
pandemic response choices - control - suppression
reduce to minimise negative health impacts
145
pandemic response choices - elimination
reduce to zero in a country or region for prolonged periods
| - eradication
146
pandemic response choices - elimination - eradication
reduce to zero at a global level permanently
147
reproduction number
- basic reproduction number
| - effective reproduction number
148
basic reproduction number, Ro
mean number of infections directly generated by 1 case in a population where all individuals are susceptible to infection
149
effective reproduction number, Reff or Rt
mean number of additional infections caused by an initial infection at a specific time
- Reff > 1 => exponential increase
150
elimination interventions
- exclusion of cases
- case and outbreak management
- preventing community transmission
- social safety net
151
vaccinations
as the basic reproduction number increases, the herd immunity threshold increases
152
herd immunity threshold
proportion of pop. that needs to be vaccinated
| = 1 - 1/Ro
153
measures of vaccinations
- herd immunity threshold
- vaccine effectiveness
- vaccine coverage = total pop.
- population immunity = vaccine effectiveness x vaccine coverage
154
measures of success of pandemic response
- cases
- deaths
- life expectancy impact
- economy using average GDP
- freedoms using stringency index
- equity in hospitalised cases, vaccinated proportion
155
epidemiological triad
environment, organism, host
156
strategies in order of effectiveness
1) elimination
2) engineering controls
3) administrative controls
4) PPE
157
misinformation
false information that is spread, regardless of intent to mislead
158
disinformation
deliberately misleading or biased information; manipulated narrative or facts; propaganda
159
variables in NZDep2013
- communication
- income
- employment
- qualifications
- owned home
- support
- living space
- transport
160
NZDep - communication
people aged <65 with no access to the Internet at home
161
NZDep - income
- people aged 18-64 receiving a means of tested benefit
| - people living in equivalised households with income below an income threshold
162
NZDep - employment
people aged 18-64 unemployed
163
NZDep - qualifications
people aged 18-64 without any qualifications
164
NZDep - owned home
people not living in own home
165
NZDep - support
people aged <65 living in a single parent family
166
NZDep - living space
people living in equivalised households below a bedroom occupancy threshold
167
NZDep - transport
people with no access to a car
168
NZDep appropriate uses
- planning and resource allocation
(Distribution uses areas NOT individuals so that individuals are not stigmatised - “People living in the most deprived neighbourhoods” NOT “the most deprived people”)
- research
- advocacy
169
IMD vs NZDep13
- IMD has more indicators, indicate relative importance and show causes
170
ecological fallacy
error that arises when information about groups of people is used to make inferences about individuals
171
Three Levels of Influence
1) The person
- Age, sex, biology, behaviour risk factors and lifestyle
- Attitudes to physical activity, health and well-being
2) The community
- Availability of parks and recreation opportunities
- Family, friends and neighbours’ habits in relation to healthy activities
3) The environment
- Physical, built, school, work, home
172
healthy environments
- The physical, social or political setting(s) that prevent disease while enhancing human
health and well-being
- Chronic diseases such as CVD and obesity are associated with environments that favour
more sedentary lifestyles and/or poor nutrition
173
elements of healthy environments
- Clean air and water
- Appropriate housing
- Access to wholesome food
- Safe community spaces
- Access to transport
- Opportunities to incorporate exercise as part of daily life
174
ways of measuring built environments
often context-specific thus depends on research question on health outcome of interest
- Urban density: Population and/or employment density
- Land-use mix: Residential, commercial, industrial, wasteland
- Street connectivity: “Lollipop” neighbourhoods vs. well connected streets
- Community resources: Access to recreational facilities or healthy foods
175
community resource accessibility index
36 facilities representing 6 domains:
- Recreational: Parks, beaches
- Public Transport: Bus, ferry stops
- Educational: Childcare, primary, intermediate
- Shopping facilities: Dairy, supermarket, banks
- Health: Plunket, GP, pharmacy, A&E
- Social: Marae, Churches, community halls etc
176
five key determinants of health
1) class and socio-economic gradient
2) early child development
3) poverty, deprivation and social exclusion
4) health literacy
5) gender
177
characteristics of big data
1) volume
2) velocity
3) variety
4) veracity
178
big data - volume
computing capacity required to store and analyse data
179
big data - velocity
speed at which that data are created and analysed
180
big data - variety
types of data sources available
| - text, images, social media, administrative
181
big data - veracity
accuracy and credibility of data (truth)
| - how likely can it be replicated
182
big data - addition Vs of relevance through development of data science and other related research
5) variability
6) value
7) visualisation
183
big data - variability
internal consistency of your data
| - e.g reproducible research
184
big data - value
costs required to undertake big data analysis should pay dividends for your organisation and their patients
185
big data - visualisation
use of novel techniques to communicate the patterns that would otherwise be lost in massive tables of data
186
using privilege
with privilege comes responsibilities:
- To advocate strongly for our members of society who do not have a voice
- Challenge social norms and be the agents of change
187
Challenges of big data
1) data governance
2) data generation
3) data output
188
Data governance
Storage, transferring, sharing and privacy
189
Data generation
Capturing, curating, updating and accuracy
190
Data output
Analysis, querying large datasets and generating meaningful and reliable outputs
191
Imd domains
- employment
- income
- crime
- housing
- health
- education
- access
192
IMD - employment
Measure the degree to which working age people are excluded from employment
193
Income
Captures the extent of income deprivation in a data zone by measuring state-funded financial assistance to those with insufficient income
194
Crime
Measures risk of personal and material victimisations (mostly theft, burglaries and assaults): damage to person or property
195
Housing
Proportion of people living in overcrowded housing and the proportion living in rented accommodation
196
Health
Identifies areas with high level of ill health (hospitalisations, cancer) or mortality
197
Éducation
Captures youth disengagement and the proportion of the working age population without a formal qualification
198
Access
Measures cost and inconvenience of travelling to access basic services (supermarkets, GPs, service stations, ECE, primary and intermediate schools)
199
Urban design concepts
- street connectivity
- traffic calming and other street design features
- mix of residential, commercial and business uses
- public open spaces and physical activity spaces
200
Street connectivity key features
Grid like pattern
201
Street connectivity health related benefit
Reduces distance between destination, encouraging use of active transport
202
Traffic calming key features
Street width, cycle lanes, traffic management, pedestrian crossings
203
Traffic calming health related benefit
Facilities that encourage walking and cycling and discourage driving
204
Land use mix key features
Different uses of land within given zone
205
Land use mix health related benefit
Increases opportunities for active transport
206
Public open Space key features
Open spaces in close proximity of residents: pools, parks, playgrounds
207
Public open spaces health related benefit
Increase opportunities for physical activity
208
Climate change direct effects
Floods, infection hurricanes drought heat fire
209
Climate change indirect effects
Spread of disease vectors, agriculture and food supply, migration
210
Actions against climate change
- planetary diet
- bikes for transport
- better heating
