Climate Change and Health Seminar Series: "Climate Change and Urban Health: Opportunities for Research and Action”

February 21, 2024

Information

Ana V. Diez Roux, MD, PHD, MPH, is Director of the Urban Health Collaborative and Distinguished University Professor of Epidemiology at the Dornsife School of Public Health, Drexel University. From 2014 to 2023, she was the Dana and David Dornsife Dean of the Dornsife School of Public Health. Originally trained as a pediatrician in her native Buenos Aires, she completed public health training at the Johns Hopkins University School of Hygiene and PublicHealth. Dr. Diez Roux is internationally known for her research on the social determinants of population health and the study of how neighborhood physical and social environments affect health. Her research areas include social epidemiology and health disparities, psychosocial factors, social environment-gene interactions, environmental health effects, urban health, and the use of multilevel methods and complex systems approaches in population health. She is currently Principal Investigator of the Wellcome Trust-funded SALURBAL (Salud Urbana en América Latina/Urban Health in Latin America Study) study, and the NIH-funded Drexel Center on Climate Change and Urban Health. She is Co-Chair of the Population Health Roundtable of NAS. She has received the Wade Hampton Frost Award from the American Public Health Association, the Award for Outstanding Contributions to Epidemiology from the American College of Epidemiology, and the Rothman Career Award from the Society for Epidemiologic Research. She is an elected member of the American Epidemiological Society, the Academy of Behavioral Medicine Research and the National Academy of Medicine of the National Academy of Sciences.

Speaker: Dr. Ana V. Diez Roux, Director of the Urban Health Collaborative, Distinguished Professor of Epidemiology at the Dornsife School of Public Health

February 19, 2024

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To CiteDCA Citation Guide

00:00(indistinct)
00:03<v ->All right.</v>
00:04Hello, everyone.
00:05Hello, everyone.
00:08Great.
00:08Thank you, everyone for coming
00:09and thanks for folks joining online.
00:13Today, it's my great pleasure to introduce our speaker,
00:18Dr. Ana Diez Roux.
00:20Dr. Diez Roux is Director of the Urban Health Collaborative
00:26and a Distinguished Professor of Epidemiology
00:29at Donsife School of Public Health at Drexel University.
00:33And from 2014 to 2023,
00:37she was the Dean of the Donsife School of Public Health,
00:41originally trained as a pediatrician in Argentina.
00:46She completed her public health training
00:49at Johns Hopkins University School of Hygiene
00:52and Public Health.
00:53And Dr. Diez Roux is an internationally renowned scientist
00:58for her research on the social determinants of public health
01:01and the study of how neighborhood physical
01:03and social environments affects health.
01:08And her research area includes many,
01:11including the social epidemiology.
01:13So for the students,
01:14you might already read Dr. Diez Roux's paper
01:17on the overview of social epidemiology.
01:20And also including urban health,
01:22the topic of today, health disparities,
01:26environmental interactions,
01:28environmental health effects, et cetera,
01:29using multi-level methods and a complex system approaches.
01:35So she's currently the Principal Investigator
01:38of the Wellcome Trust Funded Grant called SILUBA
01:42and the NIH-funded Drexel Center
01:46on Climate Change and Urban Health.
01:49And she has many, many awards.
01:52I'll just name a few,
01:53including the Wade Hampton Frost Award
01:57from the American Public Health Association,
01:59the Award for the Outstanding Contributions to Epidemiology
02:03from the American College of Epidemiology
02:06and the Ruthman Career Award
02:09from Science Society for Epidemiological Research.
02:13She's also an elected member
02:15of the American Epidemiological Society,
02:18the Academy of Behavioral Medicine and Research
02:22and the National Academies of Medicine
02:24and National Academy of Sciences.
02:27So without further ado, let's welcome Dr. Ana Diez Roux.
02:37<v ->Thank you very much.</v>
02:39It's a real pleasure to be here
02:43visiting the Yale School of Public Health
02:45and learning about all the exciting work
02:47on climate change and health that's going on here.
02:51Look forward to learning and sharing with all of you.
02:54So today I thought I would do,
03:00oops, am I pressing the wrong button?
03:05<v ->You might.</v>
03:08<v ->Oh, okay.</v>
03:11Okay.
03:12Oh, there we go.
03:13Okay, so today I thought I would do three things.
03:18Frame a little bit why an interest on cities
03:22is fundamental to public health
03:25and also to understanding the impacts of climate change
03:28and acting on climate change
03:31to prevent the health impacts of climate change on health.
03:35I'll share with you work that we've been doing
03:38as part of a large international collaboration
03:41called Salud Urbana America Latina,
03:43Urban Health in Latin America
03:45as sort of a foundation for new climate change related work
03:51that we are just launching
03:53and tell you a little bit about our plans
03:57for Salud Val Climate,
03:58which just launched a few months ago,
04:00as well as for our very new center
04:04on climate change and urban health
04:05that was funded also a few months ago by NIH.
04:10And hopefully generate some discussion
04:12about what we need to do to address effectively
04:17the impact of climate change in urban areas.
04:20So probably it's not necessary to remind people
04:24in this audience why cities are important to public health
04:28or to understanding the impacts of climate change on health.
04:31But I just wanted to say a few words about this.
04:35First of all, as you all know,
04:36urban environments continue to grow
04:39and have a major impact on climate change.
04:43It's estimated that by 2030,
04:45over two thirds of the world's population
04:47will live in urban areas,
04:48but most importantly,
04:49the majority of the growth that we're seeing
04:51will happen in lower and middle income countries
04:54is happening in lower and middle income countries.
04:57As you may know,
04:59cities contribute a large proportion
05:01of global energy related carbon,
05:03but can also be places where we can find policy solutions
05:09that make things more efficient
05:12and that actually reduce the climate impact.
05:15And so urban policies present major opportunities
05:18for climate mitigation as well.
05:20Urban areas are also especially vulnerable
05:24to the adverse effects of climate change.
05:26And this is because many urban areas are coastal,
05:30they're often particularly,
05:32especially in lower and middle income countries,
05:34they're often characterized by rapid growth,
05:37poor planning, high density,
05:39inadequate and precarious housing, poor infrastructure.
05:42They have very high levels of social
05:44and health inequality.
05:46Urban areas are very diverse in race
05:49and ethnic background and social class.
05:51And that creates a lot of sources of inequality.
05:55And for all these reasons,
05:57adaptation policies are obviously very important
06:00in cities as well to mitigate the adverse effects
06:03of climate change that has already happened.
06:06And last but not least,
06:07urban policies can support both mitigation and adaptation.
06:12Some of them are actually can address both things
06:15sort of at the same time
06:16and have health and environmental co-benefits.
06:20And so for this reason,
06:22robust and actionable evidence showing the impact
06:25of things that cities, many cities are already doing,
06:28showing the impact of these things on health
06:31and the environment is important to continue to advocate
06:35and also to support action.
06:41All these reasons,
06:44it's important to think about,
06:46to focus on urban health
06:47and the impact of climate change in cities.
06:51And I wanna spend a little bit of time telling you a bit
06:57about an urban health, a global urban health study
07:00that has been in place for several years now.
07:05We were funded back in 2017,
07:06originally by the Wellcome Trust
07:08as part of a big initiative they had called
07:10Our Planet, Our Health,
07:12which was not explicitly climate focused,
07:14but it was focused on environmental sustainability.
07:17And so a number of the foundational work
07:19that we've developed as part of this initial funding phase
07:24is what we'll be leveraging to do the climate related work.
07:27So I wanna spend a few minutes telling you
07:29about what we've done so far in SALURBAL
07:32as an example of a really, from my perspective,
07:37very special multi-country collaboration,
07:41which I think we really need to do more of.
07:46Hopefully that will become clear
07:48as I tell you a little bit more about the study.
07:50So the study has the ambition, SALURBAL,
07:54of creating the evidence base needed
07:56to make Latin American cities,
07:57but also other cities,
07:58because we think that there's a lot that can be learned
08:01from Latin American cities
08:02that is relevant to cities worldwide
08:04to make these cities healthier, more equitable,
08:06and environmentally sustainable
08:08with the idea that these three things
08:10are interconnected and entwined.
08:14Also, and this was new,
08:16certainly for me as a researcher,
08:19I have led a number of projects,
08:22but it was very rare that the funder
08:24and required an explicit objective
08:27to engage policymakers and the public.
08:30And so this was actually part of the grant
08:32from the very beginning.
08:33I think we're seeing more of that now.
08:37Certainly NIH is doing more of that now,
08:39which is something that was not very common before.
08:41And so engaging policymakers and the public
08:44in a new dialogue about urban health
08:46and urban sustainability
08:47and its implications for societal action
08:50was a very, very important part of the project
08:52from the very beginning.
08:55Also creating a platform or network
08:57that will ensure continued learning and translation.
09:00So we have worked very hard to engage the region
09:04and to engage investigators
09:05from the Latin American region in the study
09:08in a very meaningful way
09:09so that it's not just about send us your data,
09:12we'll analyze it and then publish papers with it.
09:16And last but not least,
09:18really a desire to really respond
09:21to the needs of the region,
09:23which is characterized by high urbanization
09:25and a high inequity among the highest in the world,
09:28but also to draw general lessons
09:30that could be applicable to other regions.
09:33So this is the SALURBAL team.
09:35It's coordinated by the Urban Health Collaborative
09:38at Drexel University,
09:39Dornsife School of Public Health in Philadelphia,
09:42but it includes a number of partners across the region,
09:46most of them in Latin America.
09:48We also partner with the Pan American Health Organization.
09:52And the initial formulation of the project of SALURBAL
09:56had four aims.
09:59One was to really use observational data
10:02to identify city and neighborhood drivers of health
10:06and health inequities.
10:08A second aim was to do policy evaluation.
10:11So to identify opportunities to do natural experiments
10:16or quasi experiments to try to characterize
10:19the impacts of actions that cities
10:22were already taking in the region.
10:25So this was done, we funded six of these
10:28after a competitive RFA process
10:30in several different cities of the region.
10:32So it was very focused on partnership
10:34between the research institutions in the countries
10:37and mayor's offices or other local partners
10:42that were actually doing the intervention,
10:44but trying to do it in a rigorous way.
10:48We also had an aim that was focused on bringing
10:53sort of a systems thinking lens
10:55to understanding the drivers of urban health
10:57and also the impacts that policies might have.
11:00And so I won't tell you a lot about this,
11:05but we did employ both more qualitative approaches
11:08such as participatory group model building,
11:10which is sort of a systems inspired way of thinking
11:13about increasing understanding of the drivers
11:19of urban health and what policies might work
11:21in the context of complexity.
11:23And then actual some simulation models,
11:25I'll tell you a little bit about that
11:26'cause they can connect to some of the climate work as well,
11:30including agent based models.
11:32And last but not least our policy aim,
11:34which was really about policymaker engagement.
11:39And so really we were really about science,
11:43but also impact and also inclusion,
11:45inclusion of the region in a meaningful way
11:48in all aspects of the study.
11:52So SALURBAL includes our sort of our city universe
11:56is all cities of 100,000 or more people
11:59in the 11 countries that are represented in the study.
12:03So it's not all countries in Latin America,
12:05but it's a large proportion.
12:08And this figure shows the population of the cities
12:11by country, Argentina, Brazil, Chile, et cetera.
12:14And what I wanna highlight here is that,
12:17of course we include smaller emerging cities,
12:20but also the big metropolis.
12:22So that there's a high, a lot of diversity
12:25in the characteristics of the cities that are in the study,
12:28which is a very, very important fact it turns out
12:34because it helps us learn more
12:37because it allows us to contrast very different cities.
12:41But it also recognizes that we need to,
12:45when looking at urban issues,
12:46we need to think about not just the huge cities,
12:49which is what people immediately think about,
12:51Sao Paulo, Buenos Aires, Mexico City,
12:53but also thinking about the many smaller cities
12:56that are growing rapidly across the region.
13:00The SALURBAL data resource we compiled,
13:04working with the countries,
13:06we compiled a range of data, including health data,
13:13physical and built environment data
13:15and social and economic environment data
13:17across all of our cities, 371 cities,
13:21but not just for the city as a whole,
13:23but also for smaller units within the city,
13:26which we call sub city units,
13:28for example, if a city is composed
13:30of several municipalities,
13:31we have disaggregated data for municipalities,
13:34but also even smaller neighborhoods within the cities
13:37to allow within city comparisons.
13:40And we have, this is of course,
13:41longitudinal linkable to other data resources.
13:44And there's also a public data dashboard
13:48that we recently launched called the SALURBAL data portal,
13:52where we make available the data
13:53that we can make publicly available.
13:56And that also includes a number of interactives
13:59to help with some of the dissemination efforts.
14:02So this is a really, has been a huge effort,
14:08lots of information.
14:10And I just wanna highlight,
14:12we have 11 countries, 371 cities,
14:14almost 1500 sub cities and almost 250,000 neighborhoods.
14:20So I wanna share with you a few select findings
14:25from the study in four key areas
14:31that are relevant to climate impacts.
14:33And these are areas that we will be building on
14:36as part of the new phase of SALURBAL climate
14:41to understand better and to also take us
14:44in slightly different directions,
14:46which I'll share with you.
14:48When we talk in a few minutes.
14:50So health inequities across and within cities,
14:53air quality and policy drivers,
14:55sustainable transportation and mobility
14:57and temperature impacts on health
14:59as well as flood exposures.
15:02So a big goal of SALURBAL was to make
15:06urban health inequities visible,
15:10to spur action.
15:13This is not news that there are health inequities,
15:15but the magnitude and presence of these inequities
15:18has not been as visible in the region
15:21as perhaps it has in other contexts,
15:23particularly in higher income countries.
15:26So one of the first things we did
15:29was characterize health across our cities.
15:32And so here you see a map showing life expectancy
15:36at birth for men in 363 cities.
15:41And one thing that was very striking to us
15:44was that there's a huge difference in life expectancy
15:47across different cities.
15:48And you can see in some cities,
15:50the life expectancy for men is close
15:53to what it was in Afghanistan at the time.
15:55And in other cities, it's close to what it was in Germany.
15:59So huge heterogeneity in life expectancy.
16:02And it turns out that the social environment,
16:06which is a social environment index
16:09that the study created,
16:10which includes measures of education,
16:13crowding, water and sanitation,
16:15no surprise is the strongest predictor
16:17of differences in life expectancy across cities.
16:20Now, it wasn't only life expectancy,
16:23but also the causes of death differ across cities.
16:26And this figure shows proportionate mortality
16:29for several major causes of death.
16:35Each line, each vertical line is a city
16:38and they're sorted by country, as you can see here.
16:43And they're also sorted by one of the causes of death,
16:47which is violent injuries, which
16:48is this green at the bottom.
16:50So you can see here, for example,
16:52how for violent injuries, even within countries,
16:54there's also enormous heterogeneity
16:56in the proportion of deaths that
16:58are due to violent injuries.
16:59Now, if we sorted by other causes of death,
17:01you would also see a lot of heterogeneity.
17:06But this is one example.
17:09And we found, of course, that several social indicators,
17:13social and economic indicators
17:14were also strongly related to violent injuries
17:19across our cities.
17:22We also did additional analyses
17:24looking at heterogeneity within cities and life expectancy.
17:27This kind of thing has been done a lot
17:29for high-income countries.
17:30I'm sure you've seen maps of this,
17:33but it has not been done
17:34for lower and middle-income countries
17:36very much at all.
17:37And so, first we looked at subsidies for the larger cities,
17:43and then we've been looking in more depth
17:47at smaller areas or neighborhoods.
17:51And just describing these inequities
17:54and looking at select indicators
17:56that might be associated with them.
17:58And I'll show you later,
17:59but this kind of work has got huge media impact
18:04in the region, which we were quite surprised by,
18:07but I think motivated a lot of discussion.
18:11And of course, climate change is operating
18:14on top of this inequity already,
18:17and which is something
18:18that I'll talk a little bit more about
18:20when we talk about sort of what our next steps are
18:22in terms of looking at the equity impacts of climate change.
18:27The other area that I just wanted
18:29to share a few findings with you
18:31has to do with evidence on air quality and its drivers.
18:36So one of the things that we looked at was PM2.5 levels.
18:38Of course, we found a lot of heterogeneity.
18:42These are, each dot is a city,
18:45and they're categorized by country.
18:47So a lot of heterogeneity in annual mean PM2.5.
18:53Very high levels of exposure.
18:55I mean, even using the old WHO standards,
18:58which is when we first published this paper,
19:00the new standards hadn't come out yet.
19:02Almost 60% of the population lives in areas
19:05with levels above the standards.
19:07And if you use the newer standard, that's even over 90%.
19:11And we also looked at what city factors are related
19:14to having higher or lower levels of PM2.5.
19:18And we found that there are several policy relevant factors
19:23like motorization, traffic congestion,
19:26policy amenable factors that are strongly related
19:29to higher levels of PM2.5.
19:31And in contrast, for example,
19:33greater access to public transit
19:35was related to lower levels of PM2.5,
19:37as was more green space.
19:39Now you may say, well, this is obvious.
19:41We already know this.
19:42And I think to some extent that's true,
19:43but being able to demonstrate this
19:45across the Latin American cities
19:47also got a lot of attention in the region
19:49because it shows that there are things
19:52that cities can actually do
19:54to impact these very high exposure levels.
19:59Another pollutant that we looked at, of course,
20:02which has a lot of connections to climate change is NO2.
20:06And of course, NO2, we looked at variability
20:10across much smaller areas
20:11because of the spatial heterogeneity,
20:14even across small areas in NO2.
20:17And so this is examples of neighborhood levels of NO2
20:21in two of our cities,
20:22Buenos Aires and Quetzaltelango in Guatemala.
20:25And again, we observed a lot of heterogeneity
20:29across neighborhoods, but very high levels of exposure.
20:32So of the almost 236 million people
20:36who lived in the cities that we studied in these analyses,
20:3885% lived in neighborhoods
20:42with NO2 levels above the standard.
20:44So very high levels of exposure here as well,
20:48and higher NO2 levels also linked to traffic congestion
20:54and less neighborhood green space, for example.
20:59So in thinking about the impact of climate change
21:02on these cities, the impact of climate change
21:05on these pollutants, but also interactions
21:07between things like temperature and these pollutants,
21:09of course, become very salient
21:11in terms of understanding the impacts
21:12and also understanding the health inequities.
21:18SALURBAL also had a major focus
21:21on healthy and sustainable urban mobility,
21:23because this is a big issue in the region
21:26because of the very high levels of urbanization,
21:30but also because the region has been,
21:32Latin American region has been a source
21:35of a lot of innovative thinking around urban mobility.
21:38One prime example is Colombia, for example,
21:42Bogotá and several cities in Colombia
21:44have been at the forefront of thinking about strategies
21:47to deal with urban mobility.
21:51So we were very interested that our partners
21:54were very interested in this.
21:57And so we had a big focus on this.
21:59Of course, the region is experiencing
22:02very high levels of motorization.
22:03I mean, the levels of motorization are rapidly increasing.
22:08This is just one example, a 30% increase over five years.
22:15And this has had a major impact
22:18in how urban commuting happens in the region.
22:22Anecdotally, when I go back to Buenos Aires,
22:25and I take a bus that I used to take from my home
22:28when I was a resident at a big children's hospital,
22:30the ride used to take like 25 minutes.
22:33Now it takes like an hour and a half
22:35because there's so much traffic, so many cars.
22:39And motorcycles have also increased dramatically,
22:42especially since the pandemic.
22:44And so this is a huge health issue for the region.
22:49Traffic-related mortality is a major source of mortality
22:53in the region, among the highest rates in the world.
22:57And so we looked at the relationship between city features
23:01and traffic-related mortality,
23:03and of course found that cities with more public transport
23:06have lower traffic-related mortality
23:08and higher traffic mortality
23:12is linked to more isolated urban development.
23:15Again, factors that are policy amenable,
23:17and you can start to see sort of the health
23:19and environmental co-benefits
23:20because the same factors are emerging
23:23across analyses looking at environmental outcomes
23:26and health outcomes.
23:30It turns out that in the region,
23:32urban mobility is also linked to health behaviors.
23:35We had some intriguing results looking,
23:39using some survey data showing that more time commuting
23:42and delays in traffic were linked to worse diets
23:46and more depressive symptoms.
23:49This also got tons of press in the region.
23:51It's a very interesting, I think, way,
23:55brings in things that people don't usually think about
23:57how commute can be affecting behaviors
24:00that then relate to non-communicable diseases
24:02in ways that you might not have anticipated.
24:07As part of one of our policy evaluation studies
24:12and that AIM2 that I mentioned
24:14where we're doing natural experiments,
24:17the team in Colombia led by Olga Lucia Sarmiento
24:20who is co-PI of the SALURBAL Climate Study now with me,
24:26they partnered with the city of Bogota
24:28to evaluate a new public transportation initiative
24:32called Transmicable which is an extension
24:35of the BRT which is this bus fleet
24:41which travels through dedicated lanes
24:43and extension into the outskirts of the city
24:45which tend to be much poor areas
24:49through a cable car system.
24:52And so they did a really nice quasi-experimental design
24:59where they compared the neighborhood
25:01that received the intervention
25:03with a matched neighborhood
25:05that was not receiving it at the time
25:07but was scheduled to receive it later in time.
25:10And they found that the cable car had a number of benefits
25:16of course, reductions in trip time
25:18but also increased leisure time,
25:21something we don't think much about
25:22but that is probably quite important to health,
25:26reductions in inhaled pollutants,
25:29more physical activity among users,
25:31improvements in health related quality of life
25:33and also reduced perceptions of insecurity
25:36and reduced community stigma.
25:38And so thinking about the climate implications
25:42of these kinds of things is also something
25:45that is very important to build on.
25:51So this idea of leveraging urban mobility initiatives
25:55to address, to both mitigate and adapt to climate change.
26:03We have also used simulation models to build on this
26:08to really try to understand the impact
26:12of different policies under various scenarios.
26:15Agent-based models are very good
26:17for looking at conditional effects.
26:19So what happens if one policy
26:21is combined with another policy?
26:24They have a lot of challenges
26:26which we can talk about if you're interested in that
26:29but this is one example of an agent-based model
26:32that was developed also for the city of Bogota.
26:34So it's a pretty abstract model
26:36but informed by certain characteristics
26:38of the city of Bogota to make it sort of illustrate
26:42sort of an exemplar of a Latin American city to some extent.
26:46And we use the model to look at congestion taxes
26:50and fare policies, which were two things
26:53that the city was actively considering
26:56as part of transportation initiatives.
26:59And I don't have time to get into the details
27:03but the model allowed us to examine
27:06the independent and combined effects of both policies
27:11and major conclusions were that to reduce time poverty
27:15among lower SES people, fare policies were needed.
27:18Fare policies are expensive
27:20but the cost can be offset through combined implementation
27:22of a congestion tax.
27:24So this was sort of the bottom line of the results
27:28which some aspects were surprising, but that's because,
27:32I mean, that's what you expect with an agent-based model
27:34to show you things that you wouldn't necessarily predict.
27:37And part of it is driven by the fact
27:39that in many of the cities,
27:40a large proportion of the population actually walks a lot.
27:44So it's very different than US cities
27:46where very few people walk.
27:48Well, in these places, a significant proportion
27:50of low SES people walk because they have no choice
27:53but to walk and they walk very long distances.
27:56And so paradoxically, when you do fare policies,
28:03you may see reductions in walking time
28:05but that can be a good thing,
28:07not necessarily a bad thing, right?
28:09It's all a question of balance.
28:11So these are some of the nuances that can emerge
28:13when you do these kinds of analysis.
28:15So thinking about how this can be expanded
28:18to incorporate climate change
28:19and answer questions relevant to climate change policies
28:23is something that we're also thinking about.
28:27We've also been looking at health impacts
28:31of some climate change related exposures.
28:34Of course, temperature is a critical one
28:37that we have focused on as part of the initial phase
28:41of SALURBAL through an ancillary study
28:43led by Daniel Rodriguez at Berkeley.
28:47And we, for our 371 cities,
28:51we looked at the relationship
28:53between temperature and mortality,
28:55similar to what has been done
28:56in many high-income countries.
28:58Some of you may recognize these kinds of figures
29:00that show the distribution,
29:03the histogram of the distribution of temperature
29:06across days in a year,
29:07and then the relationship,
29:09the relative risk for temperatures,
29:12various temperatures compared
29:14to the minimum mortality temperature
29:16for the particular city.
29:17And so we've created these,
29:19we've done these analyses
29:21and created these figures for all of our cities.
29:24And found similar to others
29:27that about 6% of deaths can be linked
29:29to non-optimal temperatures,
29:32temperatures below or above
29:33the minimum mortality temperature.
29:37The proportion is higher for cold than for heat,
29:40primarily because the days at cold temperatures
29:44are much more, so it's an attributable risk.
29:47So the prevalence of the exposure impacts
29:51the attributable fraction a lot.
29:55But when we looked at the steepness of the curve
30:00associated with cold and hot,
30:02we found that the steepness was much,
30:05for the most part,
30:06much more significant for hot days overall.
30:09So a one degree centigrade increase
30:11was linked to almost a 6% increase in mortality.
30:17Signaling that as temperatures continue
30:19to shift towards the right,
30:23we're likely to see significant increases in mortality.
30:26Of course, adaptation may kick in to a certain extent,
30:28but that's something to evaluate.
30:32But at the same time,
30:33there's a lot of heterogeneity across cities.
30:35You can see this in these pictures here.
30:37Now, some of it is due to the distribution of temperature.
30:40So depending on the temperature distribution,
30:42the shape of the curve is gonna be different,
30:44but there are also other factors
30:46that may be affecting these,
30:48even within similar temperature distributions
30:50that may be buffering or enhancing the impact of heat.
30:54And so that's one of the things that we wanna look at.
30:57We've delved into it a little bit,
30:59and I'll show you that in a minute,
31:00but there's a lot more to do.
31:04We also created sort of aligned
31:06with our dissemination and strategy.
31:09We also created an interactive app
31:12where people can take a look for their city
31:17and explore these curves in more detail for their city,
31:21including how many deaths were attributable to heat
31:25during X period or other aspects
31:28that they may wanna look at.
31:31So we did look at some effect modification
31:33of the excessive death fraction for heat.
31:39And one of the things that we were very interested in
31:41is greenness.
31:42So we found a little bit, but not a very strong signal.
31:46It's something that we wanna look at
31:47with more spatially resolved data,
31:51because this is done at the city level.
31:54So we found that for arid climate zone cities,
31:57there was a little bit of a signal,
31:59confidence intervals are including the null here,
32:01but we found a little bit of a signal
32:03that higher greenness was associated
32:06with a lower excess death fraction.
32:11Sorry, this should say excess death fractions
32:14stratified by greenness level.
32:17There was also some signal that effects were stronger
32:21when green space was more distributed
32:24as opposed to when it was all centrally located
32:26in one part of the city.
32:27This is something we wanna look into.
32:28This is very important policy-wise,
32:30because you can recommend greenness,
32:32but where, how should it be distributed in the city?
32:35And so some of these cities are quite green
32:39because they have green in the periphery, for example,
32:42in the peripheral areas, which are not very built up.
32:45And so this may be, it's not really telling us much,
32:51and we need to sort of look into this in more detail.
32:54So one of the things that the Berkeley team
32:56has done actually, because they have led
32:58a lot of the exposure characterization on greenness
33:01is developed a large suite
33:03of very sophisticated greenness measures
33:05that we hope to explore more in the next phase of SALURBAL.
33:09We also looked at effect modification
33:12by area SES, area socioeconomic characteristics,
33:16and we did not find very much, actually.
33:20A few signals, for example,
33:24higher secondary education in the city
33:27was associated with less excess deaths due to cold,
33:31but for heat, we didn't really find very much at all.
33:34In fact, even some paradoxical findings
33:36in the direction opposite to what we had hypothesized.
33:39So we really wanna look at this at the neighborhood level,
33:43because we really think,
33:44there's a lot of temperature heterogeneity
33:47within these cities.
33:48So even that we're not capturing differences in temperature
33:55within the cities, for example, at night, for example,
33:58which we know varies a lot,
34:00and we're not really capturing effect modification by SES
34:04at a finer level, at the neighborhood level.
34:06So we think we might see more if we do that.
34:09This is at a very high level of aggregation.
34:12So in some ways, it's not surprising
34:14that we weren't seeing very much yet.
34:19We've also looked at ambient temperature and birth weight.
34:21This is another area that has received a lot of attention.
34:25And these figures show the prevalence of low birth weight
34:30by temperature across cities in three countries,
34:33Brazil, Mexico, and Chile.
34:34And as you can see that in Brazil and Mexico,
34:38we saw the expected relationship,
34:40higher temperatures,
34:46more low birth weight.
34:50And for Chile, we didn't see much at all.
34:53In fact, the opposite,
34:54but you can see the temperature distributions in Chile,
34:57of course, are much more shifted towards the left.
35:00So, and this is a huge analysis,
35:03there's about 15 million births across 165 cities.
35:06So we're continuing to explore this.
35:07This shows the result by month of pregnancy.
35:13And you can see for Brazil and Mexico,
35:15especially in the latter months of pregnancy,
35:18the effect seems to be a bit stronger.
35:20For Chile, we see nothing at all.
35:24So looking at effects of climate change
35:27on infant and child health is a huge area,
35:29I think that we need to focus more on.
35:34Very recently, and this is a work under development
35:39led by Josiah Kephart,
35:40we're looking at flood exposures and across our cities.
35:46This is almost 45,000 neighborhoods
35:50in 276 cities from eight countries.
35:53And we observed a very clear patterning
35:57by neighborhood SES of exposures to floods.
35:59Whereas the lowest SES neighborhoods
36:01clearly had more experienced more floods
36:04than higher SES neighborhoods
36:07with a quite remarkable dose response.
36:09Actually, I was quite surprised to see this.
36:12And we've also looked at, this is all preliminary work,
36:16odds ratios of neighborhood flooding
36:18associated with neighborhood features.
36:20And we see, of course, the education signal,
36:23higher education, less floods.
36:26Greenness is associated with more floods.
36:28This may have to do with the peripheral location
36:31of these cities, we're not sure.
36:32We need to explore this.
36:32Coastal neighborhoods, of course, a huge effect.
36:36And so we're following up on
36:39some of these exposures as well.
36:43Distance from the city center,
36:44neighborhoods farther from the city center,
36:47greater risk as well.
36:50And so our next phase is to look at the impact
36:54of these flood exposures
36:55on some of the health outcome data that we have.
37:00So this is just a quick summary
37:03of some of the SALURBAL findings relevant to climate change,
37:09large inequities in health across and within cities,
37:12especially across small areas.
37:14Pre-existing, which of course will be further,
37:18it's very possible they are magnified by climate change
37:22and also by climate change exposures
37:25and also interact potentially
37:28with climate change exposures.
37:31Substantial air quality issues,
37:34substantial exposures and policy relevant factors
37:37linked to levels.
37:40Multifaceted impacts of urban mobility on health
37:43and a great opportunity for intervention.
37:45Many across Latin America,
37:47there's a lot of interest, for example,
37:49in electrifying bus fleets as a policy initiative.
37:53Many of the cities are highly dependent on bus fleets.
37:57And so that has, you can think of multiple,
38:00multiple climate and health connections there as well.
38:04So I'll tell you a little bit about what we're planning
38:07for the future as part of SALURBAL Climate
38:09and temperature and floods
38:11really as emerging health threats in the region.
38:16So these are the things that we're building on
38:18with SALURBAL Climate.
38:20I also wanted to share with you
38:22some of the dissemination work that we do in SALURBAL.
38:26This shows data briefs and webinars.
38:29So we produced a number of data briefs
38:32just describing our data or key aspects of the data
38:35or highlighting problems in the data
38:37like mortality statistics
38:38and encouraging strategies to improve.
38:42We also did a brief in collaboration
38:44with the Ubuntu Center
38:45at the Dornsife School of Public Health
38:47on race and racism in health data,
38:52under-emphasized areas,
38:54certainly in the region that deserves a lot more attention.
38:58And we also do dissemination webinars
39:01in Spanish, Portuguese, and English.
39:05We've also done policy briefs
39:07which are more targeted at specific policies
39:10and in-person events.
39:11Here's one policy brief on the Transmicable study
39:15that I showed you.
39:17And we do a lot of,
39:19each of our meetings has a policymaker day
39:23in which we engage with the local teams
39:26to talk to local officials
39:28about the study and what we're finding.
39:32And media, as I mentioned,
39:34I just wanted to highlight,
39:35it's been really interesting to see
39:38the things that got traction.
39:40Certainly the differences in life expectancy across cities,
39:43a simple descriptive analysis got huge impact
39:47as did the very high NO2 exposures
39:50and also the temperature impacts on mortality
39:54and low birth weight
39:55also got a lot of attention in the press.
39:57So there's clearly a lot of interest
40:00in the public in these topics.
40:05One of the things we wanna do
40:07as part of SALURBAL Climate
40:08is do more specific outreach to journalists specifically
40:12and perhaps, and we're also even planning up some workshops
40:15with journalists to facilitate understanding
40:19the information and its implications.
40:24And we also have,
40:27we partner with a number of different organizations,
40:30intergovernmental organizations,
40:31Pan American Health Organization,
40:33we've attended meetings of a network of mayors
40:36that PAHO hosts.
40:38We've also developed a really great partnership
40:41with the Inter-American Development Bank,
40:43which is a development bank in Latin America
40:45that supports a lot of transportation and housing work.
40:49They actually did a documentary on our study,
40:51so you can watch it there.
40:54And also with other non-governmental organizations
40:57like the World Resources Institute,
40:58we recently got funding to work with them
41:02in a small number of cities to use data.
41:06The goal is to get used,
41:08put together some data quickly to impact action
41:12in a very short timeframe.
41:14So which is that study is just about to launch now.
41:19So that brings me to SALURBAL Climate,
41:21which I wanna tell you a little bit about.
41:27We were renewed by the Wellcome Trust just last November
41:33after a competitive process to continue SALURBAL
41:39with a focus on climate change and health.
41:41And so our goal is really to leverage and expand
41:46the SALURBAL team, the data resource and the partnerships
41:51to generate new and also context-relevant knowledge,
41:55which is very important to support action.
42:01And support actions to prevent
42:02the further health impacts of climate change
42:04and also protect from changes that have already occurred
42:07and to build regional capacity
42:09for continued learning and action into the future.
42:12And of course, this is very aligned
42:14with the work that we've already been doing in SALURBAL.
42:18And so we have four aims,
42:20which I'm gonna tell you a little bit about.
42:23The first aim is to generate locally relevant evidence
42:27on climate change and health equity impacts.
42:29Because locally relevant evidence is a part,
42:32as we've seen in SALURBAL, is a powerful driver of action.
42:35And there's a lot of evidence that data
42:39from the Latin American region is very lacking
42:41in terms of climate change and health.
42:43What are we gonna do?
42:44Well, we're gonna document the magnitude of exposures,
42:47just descriptive information, how many cities,
42:50how many people are exposed to heat waves across the region
42:53or how many people were exposed to air pollutants
42:59linked to wildfires over the past X number of years.
43:02Descriptive data globally,
43:04but also by measures of social disadvantage, for example.
43:10So just describing exposures
43:12and also looking at health impacts as well, of course.
43:16So going beyond heat to also look at floods, air quality,
43:20interactions of air quality with other things,
43:22wildfires, drought and storms,
43:24and also with a strong equity focus
43:26because inequities are so important in the region.
43:30So we're going to leverage and explore,
43:32leveraging and expanding the existing SALURBAL resource
43:35and disseminating findings by building on the data portal
43:38that we have and using interactive tools, webinars,
43:43and stakeholder engagement.
43:46So that's the first aim which we've already started on.
43:53A second aim is to look specifically
43:55at mitigation and adaptation strategies.
43:59Why?
44:00Because many cities in the region
44:01are already taking innovative actions.
44:03Sometimes it's not because of climate change,
44:05it's just for other reasons,
44:06but taking advantage of those actions
44:08that they're already taking to evaluate them.
44:11And because we've seen that evidence on policy impact
44:14is really needed to support policy change.
44:17And so we will be investigating the health inequity impacts
44:22of planned and feasible mitigation or adaptation strategies.
44:25So things that are already in the works
44:28or things that are really feasible in the region,
44:30not pie in the sky things,
44:32but things that can really happen.
44:33And we're going to be using two complementary approaches
44:38for this health impact assessment
44:42in the sense in which it's described by WHO,
44:44which is a stakeholder engaged, equity focused,
44:49ex-ante sort of evaluation of a proposed program or project.
44:55And so we'll be doing that in two locations initially
44:59in Santiago and Bogota.
45:01Both cities have proposed important
45:05urban greening corridor kind of projects.
45:09And so the institutions in both Universidad Catolica
45:15in Chile and the Universidad de los Andes in Bogota
45:19are working with their cities on this.
45:22So this gives us great depth
45:23and we hope to develop a methodology
45:25so that this becomes sort of an exemplar approach
45:28that can then be used in other cities.
45:30And then combined with that comparative risk assessment,
45:35which is sometimes also confusingly called
45:37health impact assessment,
45:38but we try to keep them separate.
45:40Comparative risk assessment,
45:41which is more of a modeling exercise
45:44across multiple cities using existing evidence
45:48tried to estimate the impacts of a particular policy
45:51like electrifying bus fleets
45:53using evidence from other sources.
45:54It's a very quantitative modeling exercise.
45:58And so one gives us more depth,
46:00the other one gives us sort of more breadth.
46:02And so that's what we are planning for our second aim,
46:08which is really about policies.
46:13Our third aim, which was not a name
46:16in the prior version of SALURBAL,
46:19but which we have made a name in SALURBAL Climate
46:22because we did so much of it and it's so important
46:26is field building and capacity strengthening
46:30because local perspectives are critical
46:32to rigorous science, we think.
46:34We think we can't get the science right
46:36if we don't have the regional scientists involved.
46:39That has been very clear in SALURBAL, I think.
46:42And because local researchers are best positioned
46:44to influence local policies.
46:45And so we do a lot of informal and formal training
46:49in this next phase of SALURBAL.
46:51We are formalizing some of the things
46:53that we did more informally in phase one,
46:55including researcher training,
46:59strengthening institutional capabilities
47:00to lead and conduct research
47:03and capacity strengthening for policy actors
47:06in civil society.
47:07This is kind of that workshop on journalists
47:09is one example of that.
47:11And so we'll be doing this by targeting individuals
47:14through funding for early career researchers.
47:17We are also launching something
47:18we call the SALURBAL Fellows
47:20through which we also hope to engage scientists
47:23from groups that are underrepresented.
47:28Institutional capacity building.
47:29So the institutions, many of these institutions
47:32have limited experience submitting and managing grants.
47:36And so we support them in many ways for that
47:40and we'll continue to do that as part of the next phase.
47:44And also more societal activities and public engagement.
47:48And our fourth aim is similar to the first phase
47:53of the project to support policy action more generally.
48:00Ensure that research addresses local priorities,
48:03deliver findings effectively,
48:05and strengthen capacity among stakeholders
48:08to advocate for policy change.
48:09So we have a number of strategies that we're using here.
48:12Information sharing, capacity strengthening
48:16for researchers on how to communicate with policymakers,
48:19for policymakers on how to understand the data
48:23and particularly their policy implications
48:26and other stakeholders in terms of how to interpret
48:29some of the findings, as well as some specific policy
48:32and community engagement activities
48:34through a bunch of different things.
48:38So these aims are of course all interrelated
48:42and reinforce each other.
48:46And we've just got started working on this a few months ago.
48:50So the team is really, really thrilled.
48:53And last but not least, I wanna tell you a little bit
48:56about our new center.
49:00So it's 10 of, right?
49:02Am I seeing that right?
49:03There's some glare.
49:05Yeah, so I just, a couple more minutes and I'll be done.
49:08So I just wanna tell you a little bit about our new center,
49:12which is very aligned, of course,
49:13with SALURBAL, but also builds and expands on it.
49:17And so really our ambition here is to leverage
49:20the power of cross-city comparisons,
49:22not only across SALURBAL, which I've already told you about,
49:25but also across work that we have been doing
49:28at the Urban Health Collaborative in the United States.
49:31As one example, we have a partnership
49:34with the Big Cities Health Coalition,
49:36which is an organization that brings together
49:40the health departments of the 35 biggest US cities
49:43and we've done a number of things with them over the years,
49:46including a data dashboard and consultations
49:49on various topics.
49:50And so we really want to expand the work with them
49:53to encompass climate change impacts in these cities
49:56and policy implications, but also to think about
49:59how all this kind of fits together
50:01and how we can learn across the region
50:05about impacts and about what works.
50:08So our center, which is focused on creation,
50:14translation and dissemination of evidence
50:16to support urban policies to address the health
50:17and equity impacts of climate change in cities.
50:20We have an administrative core,
50:22a research capacity building core,
50:24community engagement core,
50:25which is a policy engagement core really in our case.
50:29It's really about working with policymakers,
50:31some public engagement too,
50:32but primarily our community, our policymakers actually.
50:36And a research project,
50:38which I'll tell you a little bit more about in a minute.
50:41And this is a partnership with the Institute
50:45for Transportation at Berkeley, led by Daniel Rodriguez,
50:49who's also part of SALURBAL, INCAP in Central America,
50:52Instituto de Nutricion de Centroamerica de Panama
50:55and several institutions in Brazil.
50:58And it's an exploratory center, as you know,
51:01it's a three-year project that we're really trying
51:03to leverage all the strength
51:05that we already have in urban health
51:07and add to it a climate focus.
51:09That's why there's a lot of emphasis on capacity building
51:13so that we can bring our expertise in health equity
51:16and urban health, learn from climate experts
51:19and think about how we can move,
51:21work together to improve the evidence
51:24and support meaningful action.
51:26The research project, which is led by Usama Bilal
51:31is really just building on some of the data I showed you
51:36earlier on neighborhood differences in health
51:38to understand heterogeneity in the impact
51:40of extreme heat on mortality across neighborhoods
51:43in selected cities in four countries.
51:45And so, we're interested in characterizing
51:48not only differential exposure to heat across neighborhoods,
51:51but also differential effects.
51:53So the effect modification piece.
51:56And so we have a number of aims
51:58from examining heterogeneity in effects by neighborhood
52:01to looking at the moderating effects,
52:03decomposing the impact of differential exposures
52:07versus differential effects
52:08and really develop sort of an exemplar or a paradigm
52:11that can then be applied to other exposures
52:13and other cities.
52:16And last but not least,
52:19this is sort of our ambition
52:21with both of these projects,
52:23SALURBAL Climate and the CCUH,
52:25the Center on Climate Change and Urban Health,
52:28we want to deliver data and evidence
52:31that's locally relevant.
52:33We want to support policy evaluation,
52:35capacity strengthening,
52:37and last but not least,
52:39meaningful policy impact that bridges the Americas.
52:44And that's it.
52:46Thank you so much for your attention.
52:48I look forward to your comments.
52:53<v ->Thank you so much.</v>
52:54So because of timing,
52:56I think we can have two very quick questions.
53:00So if any students have any questions,
53:03please feel free to raise your hand.
53:05We do have a lot of questions from online as well,
53:08but due to time, we'll just pick one.
53:10<v ->Okay, sure, go ahead.</v>
53:13<v ->Anyone wants to ask?</v>
53:15Yeah, please.
53:16<v ->Well, thank you so much for this insightful information.</v>
53:20And well, I am not actually doing a research,
53:23a research review about how the green space
53:26affects childhood obesity.
53:28And you just mentioned that we need to pay more attention
53:32on the cities.
53:33And I may be misunderstood by the mention
53:35that the cities might be isolated by roads more or-
53:42<v ->I think I may have said that the green space</v>
53:45is on the edges of cities.
53:47So it's not, it doesn't necessarily mean
53:50that there's a park nearby where people live.
53:52So I think thinking about the distribution of green space,
53:55I'm not sure if that's what you're referring to,
53:57but that's what I recall.
53:59Sure.
54:01<v ->So there's multiple questions online.</v>
54:03I'll just pick one from Freddie Morgan.
54:07Greetings from Chicago and congratulations on presentation.
54:11What would it be for sustainable transportation
54:15that would improve air quality in Latin America,
54:19knowing that each country has its own characteristics?
54:22<v ->What would be a sustainable?</v>
54:23You want my opinion?
54:24Get rid of cars.
54:26That's my opinion, (laughs) as much as possible.
54:32<v ->That's a good one.</v>
54:33Then maybe take another one.
54:34<v ->Yeah, sure.</v>
54:35<v ->So a very impressive work from K through 9.</v>
54:40She's asking about the publication of ZLUBA
54:44is both in English and some in Spanish.
54:46It's pretty rare for journals to facilitate the publication.
54:51A journal article (speaks faintly).
54:58<v ->Yeah, so that is a big challenge.</v>
55:00So there's a lot of pressure, of course,
55:03to publish in the top ranked journals, which are in English.
55:07So this is something we've discussed in the study a lot
55:09about should publications, where should they go,
55:12particularly for junior researchers?
55:14And there's no easy answer.
55:16I think over time we will see more journals
55:18in other languages.
55:19Unfortunately, I think right now it's still the case
55:23that a lot of the work has to be done in English.
55:25We translate, our meetings are multilingual
55:28and we do a lot of things.
55:29All of our dissemination is in Spanish and Portuguese,
55:33but a lot of the publications,
55:34we have published some things in Spanish
55:37and certainly the briefs are all multilingual too.
55:40But scientific publications, that's still an issue,
55:43I think, yeah.
55:44<v ->Thank you.</v>
55:45Thank you so much.
55:46Thanks again.
55:50And for students do not forget to sign the sheet
55:52and thank you all for joining online.
55:55Thank you.