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      Advancing Global Health through Environmental and Public Health Tracking

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          Abstract

          Global environmental change has degraded ecosystems. Challenges such as climate change, resource depletion (with its huge implications for human health and wellbeing), and persistent social inequalities in health have been identified as global public health issues with implications for both communicable and noncommunicable diseases. This contributes to pressure on healthcare systems, as well as societal systems that affect health. A novel strategy to tackle these multiple, interacting and interdependent drivers of change is required to protect the population’s health. Public health professionals have found that building strong, enduring interdisciplinary partnerships across disciplines can address environment and health complexities, and that developing Environmental and Public Health Tracking (EPHT) systems has been an effective tool. EPHT aims to merge, integrate, analyse and interpret environmental hazards, exposure and health data. In this article, we explain that public health decision-makers can use EPHT insights to drive public health actions, reduce exposure and prevent the occurrence of disease more precisely in efficient and cost-effective ways. An international network exists for practitioners and researchers to monitor and use environmental health intelligence, and to support countries and local areas toward sustainable and healthy development. A global network of EPHT programs and professionals has the potential to advance global health by implementing and sharing experience, to magnify the impact of local efforts and to pursue data knowledge improvement strategies, aiming to recognise and support best practices. EPHT can help increase the understanding of environmental public health and global health, improve comparability of risks between different areas of the world including Low and Middle-Income Countries (LMICs), enable transparency and trust among citizens, institutions and the private sector, and inform preventive decision making consistent with sustainable and healthy development. This shows how EPHT advances global health efforts by sharing recent global EPHT activities and resources with those working in this field. Experiences from the US, Europe, Asia and Australasia are outlined for operating successful tracking systems to advance global health.

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          Most cited references87

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          Bronchiolitis-associated hospitalizations among US children, 1980-1996.

          Respiratory syncytial virus (RSV) causes more lower respiratory tract infections, often manifested as bronchiolitis, among young children than any other pathogen. Few national estimates exist of the hospitalizations attributable to RSV, and recent advances in prophylaxis warrant an update of these estimates. To describe rates of bronchiolitis-associated hospitalizations and to estimate current hospitalizations associated with RSV infection. Descriptive analysis of US National Hospital Discharge Survey data from 1980 through 1996. Children younger than 5 years who were hospitalized in short-stay, non-federal hospitals for bronchiolitis. Bronchiolitis-associated hospitalization rates by age and year. During the 17-year study period, an estimated 1.65 million hospitalizations for bronchiolitis occurred among children younger than 5 years, accounting for 7.0 million inpatient days. Fifty-seven percent of these hospitalizations occurred among children younger than 6 months and 81 % among those younger than 1 year. Among children younger than 1 year, annual bronchiolitis hospitalization rates increased 2.4-fold, from 12.9 per 1000 in 1980 to 31.2 per 1000 in 1996. During 1988-1996, infant hospitalization rates for bronchiolitis increased significantly (P for trend <.001), while hospitalization rates for lower respiratory tract diseases excluding bronchiolitis did not vary significantly (P for trend = .20). The proportion of hospitalizations for lower respiratory tract illnesses among children younger than 1 year associated with bronchiolitis increased from 22.2% in 1980 to 47.4% in 1996; among total hospitalizations, this proportion increased from 5.4% to 16.4%. Averaging bronchiolitis hospitalizations during 1994-1996 and assuming that RSV was the etiologic agent in 50% to 80% of November through April hospitalizations, an estimated 51, 240 to 81, 985 annual bronchiolitis hospitalizations among children younger than 1 year were related to RSV infection. During 1980-1996, rates of hospitalization of infants with bronchiolitis increased substantially, as did the proportion of total and lower respiratory tract hospitalizations associated with bronchiolitis. Annual bronchiolitis hospitalizations associated with RSV infection among infants may be greater than previous estimates for RSV bronchiolitis and pneumonia hospitalizations combined.
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            Spending at least 120 minutes a week in nature is associated with good health and wellbeing

            Spending time in natural environments can benefit health and well-being, but exposure-response relationships are under-researched. We examined associations between recreational nature contact in the last seven days and self-reported health and well-being. Participants (n = 19,806) were drawn from the Monitor of Engagement with the Natural Environment Survey (2014/15–2015/16); weighted to be nationally representative. Weekly contact was categorised using 60 min blocks. Analyses controlled for residential greenspace and other neighbourhood and individual factors. Compared to no nature contact last week, the likelihood of reporting good health or high well-being became significantly greater with contact ≥120 mins (e.g. 120–179 mins: ORs [95%CIs]: Health = 1.59 [1.31–1.92]; Well-being = 1.23 [1.08–1.40]). Positive associations peaked between 200–300 mins per week with no further gain. The pattern was consistent across key groups including older adults and those with long-term health issues. It did not matter how 120 mins of contact a week was achieved (e.g. one long vs. several shorter visits/week). Prospective longitudinal and intervention studies are a critical next step in developing possible weekly nature exposure guidelines comparable to those for physical activity.
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              Why behavioural health promotion endures despite its failure to reduce health inequities

              Increasing rates of chronic conditions have resulted in governments targeting health behaviour such as smoking, eating high-fat diets, or physical inactivity known to increase risk for these conditions. In the process, many have become preoccupied with disease prevention policies focused excessively and narrowly on behavioural health-promotion strategies. These aim to improve health status by persuading individuals to change their health behaviour. At the same time, health promotion policy often fails to incorporate an understanding of the social determinants of health, which recognises that health behaviour itself is greatly influenced by peoples' environmental, socioeconomic and cultural settings, and that chronic diseases and health behaviour such as smoking are more prevalent among the socially or economically disadvantaged. We identify several reasons why behavioural forms of health promotion are inadequate for addressing social inequities in health and point to a dilemma that, despite these inadequacies and increasing evidence of the social determinants of health, behavioural approaches and policies have strong appeal to governments. In conclusion, the article promotes strategies addressing social determinants that are likely to reduce health inequities. The article also concludes that evidence alone will not result in health policies aimed at equity and that political values and will, and the pressure of civil society are also crucial.
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                Author and article information

                Journal
                Int J Environ Res Public Health
                Int J Environ Res Public Health
                ijerph
                International Journal of Environmental Research and Public Health
                MDPI
                1661-7827
                1660-4601
                17 March 2020
                March 2020
                : 17
                : 6
                : 1976
                Affiliations
                [1 ]National Research Council, Institute of Clinical Physiology, Unit of Environmental Epidemiology and Disease Registries, 56124 Pisa, Italy
                [2 ]Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Didcot, Oxon OX11 0RQ, UK; helen.crabbe@ 123456phe.gov.uk (H.C.); Tony.fletcher@ 123456phe.gov.uk (T.F.); Giovanni.leonardi@ 123456phe.gov.uk (G.S.L.)
                [3 ]Centre for Medical Education, Cardiff University, United Kingdom, Cardiff CF14 4XW, UK
                [4 ]Centers for Disease Control and Prevention, Atlanta, GA 30341, USA; fay1@ 123456cdc.gov
                [5 ]Direction of Environmental and Occupational Health, Santé Publique France, 94415 Saint Maurice, France; Sylvia.MEDINA@ 123456santepubliquefrance.fr
                [6 ]Scientific Assessment Section, European Centre for Disease Prevention and Control, 169 73 Solna, Sweden, Sweden; JanC.Semenza@ 123456ecdc.europa.eu
                [7 ]National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra 2601, Australia; sotiris.vardoulakis@ 123456anu.edu.au
                [8 ]Vital Strategies, New York, NY 10005, USA; dkass@ 123456vitalstrategies.org
                [9 ]Environmental Health and Epidemiology, Brunel University, London UB8 3PH, UK; Ariana.Zeka@ 123456brunel.ac.uk
                [10 ]Medical University Centre “Nene Teresa”, Rruga e Dibres, #370 Tirana, Albania
                [11 ]National Center for Disease Control and Public Health, 0198 Tbilis, Georgia; i.khonelidze@ 123456ncdc.ge
                [12 ]Institute of Environmental Science and Research Limited, Kenepuru, Porirua 5240c, New Zealand; Matthew.Ashworth@ 123456esr.cri.nz
                [13 ]Swiss Tropical and Public health Institute, Basel, Switzerland, 4051 Basel, Switzerland; c.dehoogh@ 123456swisstph.ch
                [14 ]University of Basel, Basel, 4001 Basel, Switzerland
                [15 ]National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China; shixm@ 123456chinacdc.cn
                [16 ]National Institute for Public Health and the Environment, 3720BA Bilthoven, The Netherlands; Brigit.staatsen@ 123456rivm.nl (B.S.); Danny.Houthuijs@ 123456rivm.nl (D.H.)
                [17 ]Department of Public Health, Denmark University of Copenhagen, 1353 Copenhagen, Denmark; liek@ 123456sund.ku.dk
                [18 ]London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
                Author notes
                [* ]Correspondence: paolo.lauriola@ 123456gmail.com ; Tel.: +39-335-5756961
                Author information
                https://orcid.org/0000-0002-8548-5785
                https://orcid.org/0000-0002-5997-8367
                https://orcid.org/0000-0003-3944-7128
                https://orcid.org/0000-0001-9797-8053
                https://orcid.org/0000-0001-7477-1762
                Article
                ijerph-17-01976
                10.3390/ijerph17061976
                7142667
                32192215
                e6c57b39-4a04-4c5e-a0ac-c78976bdb8bc
                © 2020 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 05 February 2020
                : 10 March 2020
                Categories
                Review

                Public health
                environmental health,public health,global health,environmental public health tracking,surveillance,hazard,exposure and health outcomes,environmental epidemiology,health policy,prevention strategy

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