Interventions to promote healthy eating habits: evaluation and recommendations

Although in several EU Member States many public interventions have been running for the prevention and/or management of obesity and other nutrition-related health conditions, few have yet been formally evaluated. The multidisciplinary team of the EATWELL project will gather benchmark data on healthy eating interventions in EU Member States and review existing information on the effectiveness of interventions using a three-stage procedure (i) Assessment of the intervention's impact on consumer attitudes, consumer behaviour and diets; (ii) The impact of the change in diets on obesity and health and (iii) The value attached by society to these changes, measured in life years gained, cost savings and quality-adjusted life years. Where evaluations have been inadequate, EATWELL will gather secondary data and analyse them with a multidisciplinary approach incorporating models from the psychology and economics disciplines. Particular attention will be paid to lessons that can be learned from private sector that are transferable to the healthy eating campaigns in the public sector. Through consumer surveys and workshops with other stakeholders, EATWELL will assess the acceptability of the range of potential interventions. Armed with scientific quantitative evaluations of policy interventions and their acceptability to stakeholders, EATWELL expects to recommend more appropriate interventions for Member States and the EU, providing a one-stop guide to methods and measures in interventions evaluation, and outline data collection priorities for the future.

Sustainable urban metabolism as a link between bio-physical sciences and urban planning: the BRIDGE project

Urban metabolism considers a city as a system with flows of energy and material between it and the environment. Recent advances in bio-physical sciences provide methods and models to estimate local scale energy, water, carbon and pollutant fluxes. However, good communication is required to provide this new knowledge and its implications to endusers (such as urban planners, architects and engineers). The FP7 project BRIDGE (sustainaBle uRban plannIng Decision support accountinG for urban mEtabolism) aimed to address this gap by illustrating the advantages of considering these issues in urban planning. The BRIDGE Decision Support System (DSS) aids the evaluation of the sustainability of urban planning interventions. The Multi Criteria Analysis approach adopted provides a method to cope with the complexity of urban metabolism. In consultation with targeted end-users, objectives were defined in relation to the interactions between the environmental elements (fluxes of energy, water, carbon and pollutants) and socioeconomic components (investment costs, housing, employment, etc.) of urban sustainability. The tool was tested in five case study cities: Helsinki, Athens, London, Florence and Gliwice; and sub-models were evaluated using flux data selected. This overview of the BRIDGE project covers the methods and tools used to measure and model the physical flows, the selected set of sustainability indicators, the methodological framework for evaluating urban planning alternatives and the resulting DSS prototype.

Ensuring the right to the city: pro-poor housing, urban development and tenure legalization in São Paulo, Brazil

São Paulo is one of Latin America’s most modern and developed cities, yet around one-third of its 10 million inhabitants live in poor-quality housing in sub-standard settlements. This paper describes the response of the São Paulo municipal government that took office in 2001. Through its Secretariat of Housing and Urban Development, it designed a new policy framework with a strong emphasis on improving the quantity and quality of housing for low-income groups. Supported by new legislation, financial instruments and partnerships with the private sector, the mainstays of the new policy are integrated housing and urban development, modernization of the administrative system, and public participation in all decision-making and implementation processes. The programmes centre on upgrading and legalizing land tenure in informal settlements, and regeneration of the city centre. The new focus on valuing the investments that low-income groups have already made in their housing and settlements has proved to be more cost-effective than previous interventions, leading to improvements on an impressive scale.

Public awareness of, and attitude to, Reading's urban gardens: the findings of a questionnaire survey

This paper records and analyses the results of a questionnaire survey, undertaken in Reading in January and February 1994, into the awareness and use of Reading's town centre gardens. The results indicate that although the majority of those interviewed were aware of one or more of the gardens, relatively few visit any of the gardens and, of those who do, the majority visit infrequently. Although the gardens are generally very well liked by those who use them, no clear reasons emerge as to the motivation for visiting, beyond using them as a short cut or as a source of fresh air and tranquillity. Equally, beyond the provision of information and signposting, there appears to be little to turn current non-users into users of the gardens. The report concludes that beyond some managerial issues such as safety and cleanliness, the Borough Council needs to address the extent to which the gardens could play a more central role in the life of the town and, if this is the case, how this might be achieved.

Rural-urban disparities in child nutrition in Bangladesh and Nepal

Background The persistence of rural-urban disparities in child nutrition outcomes in developing countries alongside rapid urbanisation and increasing incidence of child malnutrition in urban areas raises an important health policy question - whether fundamentally different nutrition policies and interventions are required in rural and urban areas. Addressing this question requires an enhanced understanding of the main drivers of rural-urban disparities in child nutrition outcomes especially for the vulnerable segments of the population. This study applies recently developed statistical methods to quantify the contribution of different socio-economic determinants to rural-urban differences in child nutrition outcomes in two South Asian countries – Bangladesh and Nepal. Methods Using DHS data sets for Bangladesh and Nepal, we apply quantile regression-based counterfactual decomposition methods to quantify the contribution of (1) the differences in levels of socio-economic determinants (covariate effects) and (2) the differences in the strength of association between socio-economic determinants and child nutrition outcomes (co-efficient effects) to the observed rural-urban disparities in child HAZ scores. The methodology employed in the study allows the covariate and coefficient effects to vary across entire distribution of child nutrition outcomes. This is particularly useful in providing specific insights into factors influencing rural-urban disparities at the lower tails of child HAZ score distributions. It also helps assess the importance of individual determinants and how they vary across the distribution of HAZ scores. Results There are no fundamental differences in the characteristics that determine child nutrition outcomes in urban and rural areas. Differences in the levels of a limited number of socio-economic characteristics – maternal education, spouse’s education and the wealth index (incorporating household asset ownership and access to drinking water and sanitation) contribute a major share of rural-urban disparities in the lowest quantiles of child nutrition outcomes. Differences in the strength of association between socio-economic characteristics and child nutrition outcomes account for less than a quarter of rural-urban disparities at the lower end of the HAZ score distribution. Conclusions Public health interventions aimed at overcoming rural-urban disparities in child nutrition outcomes need to focus principally on bridging gaps in socio-economic endowments of rural and urban households and improving the quality of rural infrastructure. Improving child nutrition outcomes in developing countries does not call for fundamentally different approaches to public health interventions in rural and urban areas.

Evaluating canalside hedgerows to determine future interventions

This paper describes a project undertaken during 2001/2002 which developed a method for valuing hedgerows adjacent to the inland waterway network of Great Britain. The method enables the landowner, British Waterways, to manage their valuable environmental asset to achieve a good level of biodiversity and robust habitat balanced against the heavy amenity use the 3000 km canal network endures. Valuation techniques were developed using a combination of new and existing ecological indices for components of biodiversity, hedgerow structure and amenity, and synthesised into an index in an innovative combined approach. The resultant index was then applied to a sample 20 km section of hedge alongside the Grand Union Canal in Southeast England. The results obtained reflect the hedgerows' present value, and highlight factors that might improve or limit their future increase in value. The results from the case study application also demonstrate that there is a positive relationship between hedgerow structure and biodiversity, and that hedgerows in urban areas are less biodiverse and structurally sound than those in rural areas. Furthermore, there is a zone within rural areas influenced by the adjacent urban areas and/or higher amenity use. The paper concludes with an assessment of the approaches' strengths and weaknesses with a view to its compatibility with other hedgerow evaluations, such as HEGS, its use by other agencies or landowners, and to aid hedgerow management and future development. (C) 2004 Elsevier Ltd. All rights reserved.

A systematic review of controlled trials of interventions to prevent childhood obesity and overweight: realistic synthesis of the evidence

Background: Preventing childhood overweight and obesity has become a major public health issue in developed and developing countries. Systematic reviews of this topic have not provided practice-relevant guidance because of the generally low quality of research and the heterogeneity of reported effectiveness. Aim: To present practice-relevant guidance on interventions to reduce at least one measure of adiposity in child populations that do or do not contain overweight or obese children. Design: Systematic review of eligible randomized, controlled trials or controlled trials using a novel approach to synthesizing the trial results through application of descriptive epidemiological and realistic evaluation concepts. Eligible trials involved at least 30 participants, lasted at least 12 weeks and involved non-clinical child populations. Results: Twenty-eight eligible trials were identified to 30 April 2006. Eleven trials were effective and 17 were ineffective in reducing adiposity. Blind to outcome, the main factor distinguishing effective from ineffective trials was the provision of moderate to vigorous aerobic physical activity in the former on a relatively 'compulsory' rather than 'voluntary' basis. Conclusions: By using a novel approach to synthesizing trials, a decisive role for the 'compulsory' provision of aerobic physical activity has been demonstrated. Further research is required to identify how such activity can be sustained and transformed into a personally chosen behaviour by children and over the life course. (C) 2007 The Royal Institute of Public Health. Published by Elsevier Ltd. All rights reserved.

The comfort, energy and health implications of London’s urban heat island

The urban heat island (UHI) is a well-known effect of urbanisation and is particularly important in world megacities. Overheating in such cities is expected to be exacerbated in the future as a result of further urban growth and climate change. Demonstrating and quantifying the impact of individual design interventions on the UHI is currently difficult using available software tools. The tools developed in the LUCID (‘The Development of a Local Urban Climate Model and its Application to the Intelligent Design of Cities’) research project will enable the related impacts to be better understood, quantified and addressed. This article summarises the relevant literature and reports on the ongoing work of the project.

Remarkable dynamics of nanoparticles in the urban atmosphere

Nanoparticles emitted from road traffic are the largest source of respiratory exposure for the general public living in urban areas. It has been suggested that the adverse health effects of airborne particles may scale with the airborne particle number, which if correct, focuses attention on the nanoparticle (less than 100 nm) size range which dominates the number count in urban areas. Urban measurements of particle size distributions have tended to show a broadly similar pattern dominated by a mode centred on 20–30 nm diameter particles emitted by diesel engine exhaust. In this paper we report the results of measurements of particle number concentration and size distribution made in a major London park as well as on the BT Tower, 160 m high. These measurements taken during the REPARTEE project (Regents Park and BT Tower experiment) show a remarkable shift in particle size distributions with major losses of the smallest particle class as particles are advected away from the traffic source. In the Park, the traffic related mode at 20–30 nm diameter is much reduced with a new mode at <10 nm. Size distribution measurements also revealed higher number concentrations of sub-50 nm particles at the BT Tower during days affected by higher turbulence as determined by Doppler Lidar measurements and indicate a loss of nanoparticles from air aged during less turbulent conditions. These results suggest that nanoparticles are lost by evaporation, rather than coagulation processes. The results have major implications for understanding the impacts of traffic-generated particulate matter on human health.

Policy interventions to promote healthy eating: a review of what works, what does not and what is promising

Unhealthy diets can lead to various diseases, which in turn can translate into a bigger burden for the state in the form of health services and lost production. Obesity alone has enormous costs and claims thousands of lives every year. Although diet quality in the European Union has improved across countries, it still falls well short of conformity with the World Health Organization dietary guidelines. In this review, we classify types of policy interventions addressing healthy eating and identify through a literature review what specific policy interventions are better suited to improve diets. Policy interventions are classified into two broad categories: information measures and measures targeting the market environment. Using this classification, we summarize a number of previous systematic reviews, academic papers, and institutional reports and draw some conclusions about their effectiveness. Of the information measures, policy interventions aimed at reducing or banning unhealthy food advertisements generally have had a weak positive effect on improving diets, while public information campaigns have been successful in raising awareness of unhealthy eating but have failed to translate the message into action. Nutritional labeling allows for informed choice. However, informed choice is not necessarily healthier; knowing or being able to read and interpret nutritional labeling on food purchased does not necessarily result in consumption of healthier foods. Interventions targeting the market environment, such as fiscal measures and nutrient, food, and diet standards, are rarer and generally more effective, though more intrusive. Overall, we conclude that measures to support informed choice have a mixed and limited record of success. On the other hand, measures to target the market environment are more intrusive but may be more effective.

Expectation versus provision in the management and use of urban open space

This paper discusses the implications of the shifting cultural significance of public open space in urban areas. In particular, it focuses on the increasing dysfunction between people's expectations of that space and its actual provision and management. In doing so, the paper applies Lefebvre's ideas of spatiality to the evident paradigm shift from 'public' to 'private' culture, with its associated commodification of previously public space. While developing the construct of paradigm shift, the paper recognises that the former political notions inherent in the provision of public space remain in evidence. So whereas public parks were formerly seen as spaces of confrontation between the 'rationality' of public order as the 'irrationality' of individual leisure pursuits, they are now increasingly seen, particularly 'out of hours', as the domain of the dispossessed, to be defined and policed as 'dangerous'. Where once people were welcomed into public open spaces as a means of 'educating' them in good, acceptable, leisure practices, therefore, they are now increasingly excluded, but for the same ostensible reasons. Building on survey work undertaken in Reading, Berkshire, the paper illustrates how communities can become separated from 'their' space, leaving them with the overriding impression that they have been 'short-changed' in terms of both the provision and the management of urban open space. Rather than the intimacy of local space for local people, therefore, the paper argues that parks have become externalised places, increasingly responding to commercial definitions of culture and what is 'public'. Central urban open spaces are therefore increasingly becoming sites of stratification, signification of a consumer-constructed citizenship and valorisation of public life as a legitimate element of the market surface of town and city centres.

Local space for local people? Trends in the provision and management of urban outdoor recreation in the UK

This paper examines the growing trend in the UK towards the effective privatisation of formerly public open space and the relationship of this trend to the recent shifts in public sector management. A case study of Reading, England, illustrates the growing cultural and spatial dysfunction, particularly in terms of the declining knowledge and use of the town's urban gardens by the local population. Where once the gardens were a focus of social activity, therefore, they are now a largely irrelevant site of urban decline. In contrast to central urban space, it is clear that other types of open space in other areas can still assume a significance in peoples' lives. In many cases the use of these areas illustrates a counter cultural position in which the consumerism of the city management is actively being resisted. The paper concludes that while there appear to be ways in which local space could be reclaimed for local people, the power to achieve this lies predominantly in the same hands as those responsible for appropriating central space to the imperative of the market in the first instance

Urban land and property ownership patterns in the UK: trends and forces for change

The first part of this review examines what is meant by ‘urban land and property’ (ULP) and looks at the background of ULP in the light of trends in UK urban areas over the past 50 years. Key conceptual approaches to the ULP ‘ownership issue’ are identified, together with the constraints to empirical analysis, which include a lack of data and patchy and inconsistent datasets. Three main components of ULP ownership in the UK are then examined using published data on commercial property, residential property and urban land, including ‘previously developed land’ (PDL) and ‘development land, covering both the private and public sectors. The review examines past trends in ULP ownership patterns in these sectors within the UK, and the key drivers which have created the present day patterns of ULP ownership. It concludes by identifying possible future trends in ULP ownership over the next 50 years to 2060 in the three main ULP sectors.

Spatio-temporal variation in predation by urban domestic cats (Felis catus) and the acceptability of possible management actions in the UK

Urban domestic cat (Felis catus) populations can attain exceedingly high densities and are not limited by natural prey availability. This has generated concerns that they may negatively affect prey populations, leading to calls for management. We enlisted cat-owners to record prey returned home to estimate patterns of predation by free-roaming pets in different localities within the town of Reading, UK and questionnaire surveys were used to quantify attitudes to different possible management strategies. Prey return rates were highly variable: only 20% of cats returned ≥4 dead prey annually. Consequently, approximately 65% of owners received no prey in a given season, but this declined to 22% after eight seasons. The estimated mean predation rate was 18.3 prey cat−1 year−1 but this varied markedly both spatially and temporally: per capita predation rates declined with increasing cat density. Comparisons with estimates of the density of six common bird prey species indicated that cats killed numbers equivalent to adult density on c. 39% of occasions. Population modeling studies suggest that such predation rates could significantly reduce the size of local bird populations for common urban species. Conversely, most urban residents did not consider cat predation to be a significant problem. Collar-mounted anti-predation devices were the only management action acceptable to the majority of urban residents (65%), but were less acceptable to cat-owners because of perceived risks to their pets; only 24% of cats were fitted with such devices. Overall, cat predation did appear to be of sufficient magnitude to affect some prey populations, although further investigation of some key aspects of cat predation is warranted. Management of the predation behavior of urban cat populations in the UK is likely to be challenging and achieving this would require considerable engagement with cat owners.

Economic rationale for interventions to control livestock disease

Disease in farm animals has significant economic impacts on livestock production and incurs substantial costs for societies. Impacts affect not only livestock farms and the livestock industries but also sectors outside of farming. Important negative externalities of livestock disease include impacts on the health of other producers’ livestock, on human health, and on animal welfare. Good disease risk management/biosecurity and good animal welfare are public goods. Not taking account of these externality and public good aspects can lead to a misallocation of resources for livestock disease control. In such instances, there may be a strong case for government or other authority to intervene to ensure a better use of resources. There are a number of policy instruments that can be implemented for this purpose. One potential instrument is a Farm Animal Health and Welfare Stewardship Scheme funded under Pillar II of the CAP. A number of countries have public–private partnership cost-sharing schemes that aim to share appropriately both responsibilities and costs of epidemic livestock disease. There is a strong future agenda for appropriate intervention by governments in the management of livestock disease risks, including responsibility and cost sharing for livestock disease control, within the European Union and elsewhere.