The impact of social housing on health in Glasgow and Baltimore, 1930-1980

This dissertation seeks to discern the impact of social housing on public health in the cities of Glasgow, Scotland and Baltimore, Maryland in the twentieth century. Additionally, this dissertation seeks to compare the impact of social housing policy implementation in both cities, to determine the efficacy of social housing as a tool of public health betterment. This is accomplished through the exposition and evaluation of the housing and health trends of both cities over the course of the latter half of the twentieth century. Both the cities of Glasgow and Baltimore had long struggled with both overcrowded slum districts and relatively unhealthy populations. Early commentators had noticed the connection between insanitary housing and poor health, and sought a solution to both of these problems. Beginning in the 1940s, housing reform advocates (self-dubbed ‘housers') pressed for the development of social housing, or municipally-controlled housing for low-income persons, to alleviate the problems of overcrowded slum dwellings in both cities. The impetus for social housing was twofold: to provide affordable housing to low-income persons and to provide housing that would facilitate healthy lives for tenants. Whether social housing achieved these goals is the crux of this dissertation. In the immediate years following the Second World War, social housing was built en masse in both cities. Social housing provided a reprieve from slum housing for both working-class Glaswegians and Baltimoreans. In Baltimore specifically, social housing provided accommodation for the city’s Black residents, who found it difficult to occupy housing in White neighbourhoods. As the years progressed, social housing developments in both cities faced unexpected problems. In Glasgow, stable tenant flight (including both middle class and skilled artisan workers)+ resulted in a concentration of poverty in the city’s housing schemes, and in Baltimore, a flight of White tenants of all income levels created a new kind of state subsidized segregated housing stock. The implementation of high-rise tower blocks in both cities, once heralded as a symbol of housing modernity, also faced increased scrutiny in the 1960s and 1970s. During the period of 1940-1980, before policy makers in the United States began to eschew social housing for subsidized private housing vouchers and community based housing associations had truly taken off in Britain, public health professionals conducted academic studies of the impact of social housing tenancy on health. Their findings provide the evidence used to assess the second objective of social housing provision, as outlined above. Put simply, while social housing units were undoubtedly better equipped than slum dwellings in both cities, the public health investigations into the impact of rehousing slum dwellers into social housing revealed that social housing was not a panacea for each city’s social and public health problems.

Quantification of air quality in space and time and its effects on health

The long-term adverse effects on health associated with air pollution exposure can be estimated using either cohort or spatio-temporal ecological designs. In a cohort study, the health status of a cohort of people are assessed periodically over a number of years, and then related to estimated ambient pollution concentrations in the cities in which they live. However, such cohort studies are expensive and time consuming to implement, due to the long-term follow up required for the cohort. Therefore, spatio-temporal ecological studies are also being used to estimate the long-term health effects of air pollution as they are easy to implement due to the routine availability of the required data. Spatio-temporal ecological studies estimate the health impact of air pollution by utilising geographical and temporal contrasts in air pollution and disease risk across $n$ contiguous small-areas, such as census tracts or electoral wards, for multiple time periods. The disease data are counts of the numbers of disease cases occurring in each areal unit and time period, and thus Poisson log-linear models are typically used for the analysis. The linear predictor includes pollutant concentrations and known confounders such as socio-economic deprivation. However, as the disease data typically contain residual spatial or spatio-temporal autocorrelation after the covariate effects have been accounted for, these known covariates are augmented by a set of random effects. One key problem in these studies is estimating spatially representative pollution concentrations in each areal which are typically estimated by applying Kriging to data from a sparse monitoring network, or by computing averages over modelled concentrations (grid level) from an atmospheric dispersion model. The aim of this thesis is to investigate the health effects of long-term exposure to Nitrogen Dioxide (NO2) and Particular matter (PM10) in mainland Scotland, UK. In order to have an initial impression about the air pollution health effects in mainland Scotland, chapter 3 presents a standard epidemiological study using a benchmark method. The remaining main chapters (4, 5, 6) cover the main methodological focus in this thesis which has been threefold: (i) how to better estimate pollution by developing a multivariate spatio-temporal fusion model that relates monitored and modelled pollution data over space, time and pollutant; (ii) how to simultaneously estimate the joint effects of multiple pollutants; and (iii) how to allow for the uncertainty in the estimated pollution concentrations when estimating their health effects. Specifically, chapters 4 and 5 are developed to achieve (i), while chapter 6 focuses on (ii) and (iii). In chapter 4, I propose an integrated model for estimating the long-term health effects of NO2, that fuses modelled and measured pollution data to provide improved predictions of areal level pollution concentrations and hence health effects. The air pollution fusion model proposed is a Bayesian space-time linear regression model for relating the measured concentrations to the modelled concentrations for a single pollutant, whilst allowing for additional covariate information such as site type (e.g. roadside, rural, etc) and temperature. However, it is known that some pollutants might be correlated because they may be generated by common processes or be driven by similar factors such as meteorology. The correlation between pollutants can help to predict one pollutant by borrowing strength from the others. Therefore, in chapter 5, I propose a multi-pollutant model which is a multivariate spatio-temporal fusion model that extends the single pollutant model in chapter 4, which relates monitored and modelled pollution data over space, time and pollutant to predict pollution across mainland Scotland. Considering that we are exposed to multiple pollutants simultaneously because the air we breathe contains a complex mixture of particle and gas phase pollutants, the health effects of exposure to multiple pollutants have been investigated in chapter 6. Therefore, this is a natural extension to the single pollutant health effects in chapter 4. Given NO2 and PM10 are highly correlated (multicollinearity issue) in my data, I first propose a temporally-varying linear model to regress one pollutant (e.g. NO2) against another (e.g. PM10) and then use the residuals in the disease model as well as PM10, thus investigating the health effects of exposure to both pollutants simultaneously. Another issue considered in chapter 6 is to allow for the uncertainty in the estimated pollution concentrations when estimating their health effects. There are in total four approaches being developed to adjust the exposure uncertainty. Finally, chapter 7 summarises the work contained within this thesis and discusses the implications for future research.

The Impact of Regulation on a Firm's Incentives to Invest in Emergent Smart Grid Technologies

This paper analyzes the implementation of new technologies in network industries through the development of a suitable regulatory scheme. The analysis focuses on Smart Grid (SG) technologies which, among others benefits, could save operational costs and reduce the need for further conventional investments in the grid. In spite of the benefits that may result from their implementation, the adoption of SGs by network operators can be hampered by the uncertainties surrounding actual performances. A decision model has been developed to assess the firms' incentives to invest in "smart" technologies under different regulatory schemes. The model also enables testing the impact of uncertainties on the reduction of operational costs, and of conventional investments. Under certain circumstances, it may be justified to support the development and early deployment of emerging innovations that have a high potential to ameliorate the efficiency of the electricity system, but whose adoption faces many uncertainties.

Study on health status and remediation potential of Phragmites australis employed in an Emilia Romagna (IT) Constructed Wetland to assess zonal variability of the facility.

Phragmites australis (Cav.) Trin. ex Steud. is a hydrophyte particularly resistant to harsh conditions, e.g. drought, high salinity, contaminants, such as heavy metals and toxic molecules, and high nutrients concentrations. These resistances render the plant suitable for water depuration, where its particular metabolism is exploited to remove pollutants and excessive nutrients from the environment. In constructed wetlands, this principle is applied to phyto-purify wastewater with various origins, such as industrial, agricultural and household, with the aim to improve its quality to an extent which would render its reuse possible. In the framework of a pre-existing project of Department of Agricultural and Food Sciences (DiSTAl), this work integrates the knowledge and data relative to an Emilia Romagna (IT) constructed wetland plant, in order to expand the knowledge about this particular facility and of the system in general. By assaying antioxidants, both non- enzymatic and enzymatic, chlorophylls content and net photosynthetic rates, and by measuring the elemental composition of the specimens, the health status and the elemental uptake of the wetland plants sampled in different areas were investigated. The results were compared amongst the examined specimens with the aim to detect areas where there may be a higher stress due to a different wastewater composition, potentially varying along the constructed route. In addition, different parameters regarding the extraction and assay protocols were investigated, in order to optimise the procedure and to select the best conditions to perform the analyses, as well as to integrate information missing in literature or found as contradictory.

Evaluation of the real nutritional value of processed food to improve their effect on health and increase their sustainability

Cured meats and dairy products are criticized for their salt content and synthetic additives. This has led to the development of strategies to reduce and replace these ingredients. Since the food matrix and technological processes can affect the bioaccessibility of nutrients, it is necessary to study their release during digestion to determine the real nutritional value of foods. In the first part of this PhD project, the impact on the nutritional quality of the reduction of sodium content and of the replacement of synthetic nitrates/nitrites with a combination of innovative formulations was evaluated in Parmigiano Reggiano Cheese and salami. For this purpose, an in vitro digestion model combined with different analytical techniques was used. The results showed that fatty acids and proteins release increased over time during digestion. At the end of digestion, the innovative formulation/processing did not negatively affect fatty acids release and protein hydrolysis, and led to the formation of bioactive peptides. The excessive intake of sugars is correlated with metabolic diseases. After the intestinal uptake, their release in the blood stream depends on their metabolic fate within the enterocyte. In the second part of this PhD project, the absorption and metabolism of glucose, fructose and sucrose was evaluated using intestinal cell line. A faster absorption of fructose than glucose was observed, and a different modulation of the synthesis/transport of other metabolites by monosaccharides was shown. Intestinal cells were also used to verify the stability and intestinal uptake of vitamins (A and D3) delivered to cells through two vehicles. It was shown that the presence of lipids protected the vitamin from external factors such as light, heat and oxygen, and improved their bioavailability Overall, the results obtained in this PhD project confirmed that considering only the chemical composition of foods is not sufficient to determine their nutritional value.

Influence of the natural environment on health: evaluation of different environmental contexts (urban, green spaces) and intervention proposals

Urbanization has grown during the last decades, with an increase in population concentrated in cities. Cities are usually relatively nature-poor, and the loss of green urban space likely leads to less contact with the natural world for urban dwellers. It is known that the natural environment could provide important advantages, and the loss of contact with this type of environment has potential negative impacts on the quality of life. The use of green urban space demonstrated stronger benefits for mental health and stress reduction. In general, exposure to green urban space is linked to a reduction in mortality rates, due to the promotion of a healthy lifestyle. Green urban space could be an optimal environment in which to perform physical activity. Undertaking regular physical activity is one of the major determinants of health. The benefits of exercise have been widely demonstrated through a wide range of studies. Benefits are linked to the treatment and prevention of most chronic and non-communicable diseases, that are not contagious, but they are usually long-lasting. Regular physical activity could reduce mental health problems, such as anxiety. The World Health Organization proposed to improve physical activity programs through the implementation of interventions in green urban spaces. Green urban space provides a safe, accessible, and attractive place to perform physical activity. All the interventions aimed to promote the practice of physical activity and to reduce sedentary behavior are important. It is well known that physical activity has several positive effects, a great amount of the population remains inactive. A good strategy could be to show people how integrated physical activity into their all-day life, for example through the use of green urban space or active commuting. The results in the present thesis showed the effectiveness of performing physical activity in a natural environment and of active commuting.

Precarious employment and social reproduction: the impact on health and well-being

This dissertation aims to make a theoretical and empirical contribution to the debate on precarious employment, social reproduction and the impact on health and well-being. In recent years, numerous studies have examined the effect of precarious employment as a social determinant on health and well-being, focusing on gender differences in this phenomenon. Within this framework, the research design is to investigate this topic quantitatively in the United Kingdom using longitudinal data to assess the long-term effects of precarious employment and informal care work on health. More specifically, the aim of this thesis is to investigate the impact of precarious employment on health and to analyze gender differences within this phenomenon, particularly in relation to the role of informal care work. The analysis shows that precarious employment is indeed associated to a detrimental effect on health and that this effect is stronger for women’s mental health. Additionally, the analysis shows that time spent on informal care work explains part of the gender gap in mental health, and that informal care and the number of hours spent on it are associated with worse mental health for women. Finally, during the first few months of Covid-19, for both men and women, performing more hours of care work on average is associated with worse mental health, showing that it is not so much the change from fewer to more hours that affects health, but rather those who do more hours on average, hence the long-term effect of being an intensive informal carer.

Metabolomics to investigate the effects of treatments on food and of food consumption on health

Metabolomics has established itself as a discipline that can offer a unique point of view on how a technological treatment could impact on the charactersitics of a food. Even more, the same analytical platforms necessary for the purpose can also effectively unravel intricate interactions between such food and human health upon consumption. This PhD thesis investigates the application of metabolomics in understanding the impact of technological treatments on food and their subsequent effects on human health, utilizing 1H-NMR as the analytical platform. The study involves the development of standard operating procedures (SOPs) to ensure a fast and stable preparation of seafood samples, incorporating novel algorithms to enhance the accuracy of metabolome profiles. To gain insight on how metabolomics can allow exploring the effects of a technological treatment on a food, we performed three sets of experiments to investigate the application of metabolomics in studying the impact of high hydrostatic pressure (HHP) treatment on seafood metabolome during storage. The first experiment employs untargeted metabolomic analysis on chill-stored rose shrimp, revealing significant post-HHP treatment metabolic alterations and mechanisms. The investigation is extended to grey mullet in the second experiment, utilizing both untargeted and targeted metabolomic analyses to account for matrix-related effects. The third experiment assesses the targeted metabolome of striped prawns, showing that HHP significantly influences metabolic pathways, positively impacting freshness and taste through alterations in related metabolites. Shifting focus to the effects of food on humans, the study explores the impact of multistrain probiotics on cirrhosis patients using 1H-NMR. The platform reveals notable alterations in glutamine/glutamate metabolism, enhancing the patients' ammonia detoxification capacity. This research underscores the potential of metabolomics in uncovering intricate interactions between technological treatments, food, and human health, providing valuable insights for both the food industry and healthcare interventions.

Foodstuffs and medicines as legal categories in the EU and China. Functional foods as a borderline case

The thesis discusses the regulation of foodstuffs and medicines, and particularly the regulation of functional foods. Legal systems investigated are the EU and China. Both are members of the WTO and Codex Alimentarius, which binds European and Chinese rules together. The study uses three Chinese berries as case examples of how product development faces regulation in practice. The berries have traditional uses as herbal medicines. Europe and China have similar nutrition problems to be resolved, such as obesity, cardiovascular disease, and diabetes. The three berries might be suitable raw materials for functional foods. Consumer products with health-enhancing functions, such as lowering blood pressure, might legally be classifi ed either as foodstuffs or medicines. The classifi cation will depend on functions and presentation of the product. In our opinion, food and medicine regulation should come closer together so the classifi cation issue would no longer be an issue. Safety of both foodstuffs and medicines is strictly regulated. With medicines, safety is a more relative concept, where benefi ts of the product are compared to side-effects in thorough scientifi c tests and trials. Foods, on the other hand, are not allowed to have side-effects. Hygiene rules and rules on the use of chemicals apply. In China, food safety is currently at focus as China has had several severe food scandals. Newly developed foods are called novel foods, and are specifi cally regulated. The current European novel food regulation from 1997 treats traditional third country products as novel. The Chinese regulation of 2007 also defi nes novel foods as something unfamiliar to a Chinese consumer. The concepts of novel food thus serve a protectionist purpose. As regards marketing, foods are allowed to bear health claims, whereas medicines bear medicinal claims. The separation is legally strict: foods are not to be presented as having medicinal functions. European nutrition and health claim regulation exists since 2006. China also has its regulation on health foods, listing the permitted claims and how to substantiate them. Health claims are allowed only on health foods. The European rules on medicines include separate categories for herbal medicines, traditional herbal medicines, and homeopathic medicines, where there are differing requirements for scientifi c substantiation. The scientifi c and political grounds for the separate categories provoke criticism. At surface, the Chinese legal system seems similar to the European one. To facilitate trade, China has enacted modern laws. Laws are needed as the country moves from planned economy to market economy: ‘rule of law’ needs to replace ‘rule of man’. Instead of being citizens, Chinese people long were subordinates to the Emperor. Confucius himself advised to avoid confl ict. Still, Chinese people do not and cannot always trust the legal system, as laws are enforced in an inconsistent manner, and courts are weak. In China, there have been problems with confl icting national and local laws. In Europe, the competence of the EU vs. the competence of the Member States is still not resolved, even though the European Commission often states that free trade requires harmonisation. Food and medicine regulation is created by international organisations, food and medicine control agencies, standards agencies, companies and their organisations. Regulation can be divided in ‘hard law’ and ‘soft law’. One might claim that hard law is in crisis, as soft law is gaining importance. If law is out of fashion, regulation certainly isn’t. In the future, ‘law’ might mean a process where rules and incentives are created by states, NGOs, companies, consumers, and other stakeholders. ‘Law’ might thus refer to a constant negotiation between public and private actors. Legal principles such as transparency, equal treatment, and the right to be heard would still be important.

Expectativas del nuevo proyecto para la reforma al sistema de salud 2013

Esta investigación se desarrolla, bajo una hipótesis, la cual se busca comprobar, analizando la evidencia encontrada en documentos Teóricos investigativos de autores expertos y especialistas en el tema y en publicaciones de la prensa nacional además de las leyes que corresponden a las dos reformas de la salud la 1122 de 2007 y la 1438 de 2011. La hipótesis planteada para esta investigación es que “mientras los nuevos planteamientos para la reforma de la salud no incluyan dentro de su propuesta una solución evidente a los principales problemas encontrados en el sistema de salud actual y no establezca un control fiscal y una regulación verdadera sobre el manejo de los fondos del sistema de salud; Los principios de universalidad, eficiencia, integralidad, libre escogencia, competencia sana y calidad no serán cumplidos y por lo tanto el pueblo Colombiano no podrá ejercer su derecho a la salud como lo plantea la Constitución Política de Colombia de 1991 y la ley 100 de 1993. Para comprobar la hipótesis se han seleccionado como documentos a analizar, tres publicaciones de la prensa nacional, cuatro de autores expertos y especializados en el tema y tres documentos adicionales que corresponden a las dos reformas realizadas al sistema de salud en los años 2007 y 2011 y a la nueva propuesta radicada por el gobierno nacional a inicios de este año. Es de suma importancia conocer las apreciaciones de los autores sobre el grupo de variables que se utilizarán para desarrollar este estudio. Estas variables pertenecen a aquellas que influencian el equilibrio financiero y que adicionalmente afectan directamente a la población impactando su bienestar y su calidad de vida. Entre esas variables se destacan (i) aspectos demográficos y de la fuerza laboral, (ii) aspectos económicos como los niveles de ingreso, salarios y empleo, (iii) cobertura del sistema de salud, (iv) calidad y acceso a los servicios del sistema, (v) duplicidad del gasto (vi) flujo de los recursos del sistema de salud (problemas institucionales), (vii) Gasto en salud y estabilidad financiera y (viii) regulación financiera. El Formato utilizado para la comparación análisis y síntesis de los documentos teóricos investigativos y de las publicaciones de la prensa nacional, consta de tres cuerpos. El primero, contiene las características relacionadas con tiempo y espacio de la publicación. El segundo, hace énfasis en el contenido y en los temas y variables de interés para el desarrollo de la investigación. Y el tercero hace énfasis en el contenido y en los temas y variables de interés para el desarrollo de la investigación. Al hacer el análisis, síntesis y comparación de estos artículos se resolverán algunos interrogantes que pueden llevarnos a comprobar la hipótesis como los son:¿Cuáles han sido los principales logros en salud con el sistema actual?, ¿Cuáles han sido las principales fallas o problemas en el sistema actual de salud?, ¿Hay un buen manejo de los fondos destinados al sistema de Salud actual?, ¿La gestión financiera del Sistema de Salud Colombiano, permite que este sea un sistema de salud sostenible y perdurable para todos los colombianos?. Adicionalmente, existen otros interrogantes a destacar como lo son ¿En qué consiste la nueva reforma de Salud propuesta para el 2013?, ¿Los cambios planteados en la última propuesta para hacer una reforma al sistema de salud, realmente conducen a un avance o dejan de lado los principales problemas de la seguridad social en Colombia?, ¿La nueva propuesta para la reforma de la salud busca lograr una mejora radical en la gestión financiera del Sistema de Salud Colombiano?, ¿Cuál es la percepción de los principales autores, especialistas en el tema en cuanto a la erradicación total de los problemas más álgidos en el actual Sistema de Salud Colombiano, con la nueva propuesta para la reforma de la salud para el 2013? Este trabajo de investigación surgió debido a la radicación de una nueva propuesta para la reforma a la salud y la polémica que se ha generado alrededor de esta. Veinte años después de la aprobación de la ley 100, se han identificado logros importantes principalmente en cuanto a cobertura; lastimosamente, actualmente se han manifestado problemas financieros y de liquidez, a pesar de lo cual, vale la pena destacar que el sistema fue rentable e incluso generó excedentes financieros en su operación, durante sus primeros 10 años de funcionamiento. Ahora, según la evidencia teórica investigativa y de la prensa nacional, se determinará si la nueva propuesta para la reforma de la salud es una buena opción para el país.

O Sistema de Gestão do Ressarcimento ao SUS: análise de seu desempenho no período 2011-2014

O ressarcimento ao Sistema Único de Saúde (SUS), criado pela Lei n. 9.656, de 1998, apresentou resultados expressivos no período 2011-2014, em contraposição ao período 2007-2010. O presente estudo, de caráter exploratório, buscou analisar o ressarcimento ao SUS, sua origem, base legal, fundamentação jurídica, organização, funcionamento, desempenho operacional e efetividade, com foco nos resultados alcançados no período 2011-2014. Para isso, o autor apoiou-se em estudos anteriores, em documentos e relatórios oficiais, na legislação em vigor, nos acórdãos do Tribunal de Contas da União e nas ações ajuizadas perante o Supremo Tribunal Federal. As análises efetuadas indicam que os resultados alcançados nos últimos quatro anos são promissores, refletindo um cenário favorável à consolidação do ressarcimento ao SUS como um importante instrumento de regulação para o setor de saúde suplementar.

Women's health Australia: On the progress of the main cohort studies

More than 41,000 women aged 18-23, 45-50, and 70-75 years in 1996 are participating in the Australian Longitudinal Study on Women's Health (Women's Health Australia). Baseline surveys were conducted for all three cohorts in 1996, and the first follow-up survey of the mid-age group in 1998 has achieved a response rate exceeding 90%. The main findings so far reflect the large differences in the life experiences of the three cohorts. The young women report high levels of stress. The physical and mental health of those with young children is worse than for those without children, but confounding by sociodemographic characteristics may account for the differences. Two thirds of young women in the healthy weight or underweight range would like to weigh less, and early onset of dieting is associated with poorer physical and mental health. Most of the women in the mid-age group have multiple roles-in paid work, home duties, and caring for children and other dependents. The potential of the study to investigate the long-term impact of such busy lives on health outcomes is considerable. At this stage, the main health issues for these women relate to tiredness, weight gain, and menopause. The older cohort presents a picture of positive aging. These women are heavier users of health services than the mid-age and younger women, and they are also more satisfied with these services. Although their physical health is poorer, their mental health is better, and they report less stress than women in the other two cohorts. The follow-up survey of this group, planned for 1999, will focus on the coping strategies used by these women. An overall goal of the project is to understand the interactions among social roles, life events, and women's health in order to provide a basis for improved health policies and services. Analysis of these interactions, which relies on both quantitative and qualitative data, poses many challenges that will be addressed as the longitudinal data become available.

Impact of socioeconomic status on Brazilian elderly health

OBJECTIVE: To investigate the impact of socioeconomic status on elderly health. METHODS: The study was based on cross-sectional data from Survey on Health, Well-Being, and Aging in Latin America and the Caribbean. The sample comprised 2,143 non-institutionalized elderly aged 60 years and older living in the urban area of São Paulo, southeastern Brazil. Linear regression models estimated the effect of socioeconomic status indicators (years of schooling completed, occupation and purchasing power) on each one of the following health indicators: depression, self-rated health, morbidity and memory capacity. A 5% significance level was set. RESULTS: There was a significant effect of years of education and purchasing power on self-rated health and memory capacity when controlled for the variables number of diseases during childhood, bed rest for at least a month due to health problems during childhood, self-rated health during childhood, living arrangements, sex, age, marital status, category of health insurance, intake of medicines. Only purchasing power had an effect on depression. Despite the bivariate association between socioeconomic status indicators and number of diseases (morbidity), this effect was no longer seen after including the controls in the model. CONCLUSIONS: The study results confirm the association between socioeconomic status indicators and health among Brazilian elderly, but only for some dimensions of socioeconomic status and certain health outcomes.