Multiple Coronavirus Disease 2019 (COVID-19) vaccines appear to be safe and efficacious, but only high-income countries have the resources to procure sufficient vaccine doses for most of their ...eligible populations. The World Health Organization has published guidelines for vaccine prioritisation, but most vaccine impact projections have focused on high-income countries, and few incorporate economic considerations. To address this evidence gap, we projected the health and economic impact of different vaccination scenarios in Sindh Province, Pakistan (population: 48 million).
We fitted a compartmental transmission model to COVID-19 cases and deaths in Sindh from 30 April to 15 September 2020. We then projected cases, deaths, and hospitalisation outcomes over 10 years under different vaccine scenarios. Finally, we combined these projections with a detailed economic model to estimate incremental costs (from healthcare and partial societal perspectives), disability-adjusted life years (DALYs), and incremental cost-effectiveness ratio (ICER) for each scenario. We project that 1 year of vaccine distribution, at delivery rates consistent with COVAX projections, using an infection-blocking vaccine at $3/dose with 70% efficacy and 2.5-year duration of protection is likely to avert around 0.9 (95% credible interval (CrI): 0.9, 1.0) million cases, 10.1 (95% CrI: 10.1, 10.3) thousand deaths, and 70.1 (95% CrI: 69.9, 70.6) thousand DALYs, with an ICER of $27.9 per DALY averted from the health system perspective. Under a broad range of alternative scenarios, we find that initially prioritising the older (65+) population generally prevents more deaths. However, unprioritised distribution has almost the same cost-effectiveness when considering all outcomes, and both prioritised and unprioritised programmes can be cost-effective for low per-dose costs. High vaccine prices ($10/dose), however, may not be cost-effective, depending on the specifics of vaccine performance, distribution programme, and future pandemic trends. The principal drivers of the health outcomes are the fitted values for the overall transmission scaling parameter and disease natural history parameters from other studies, particularly age-specific probabilities of infection and symptomatic disease, as well as social contact rates. Other parameters are investigated in sensitivity analyses. This study is limited by model approximations, available data, and future uncertainty. Because the model is a single-population compartmental model, detailed impacts of nonpharmaceutical interventions (NPIs) such as household isolation cannot be practically represented or evaluated in combination with vaccine programmes. Similarly, the model cannot consider prioritising groups like healthcare or other essential workers. The model is only fitted to the reported case and death data, which are incomplete and not disaggregated by, e.g., age. Finally, because the future impact and implementation cost of NPIs are uncertain, how these would interact with vaccination remains an open question.
COVID-19 vaccination can have a considerable health impact and is likely to be cost-effective if more optimistic vaccine scenarios apply. Preventing severe disease is an important contributor to this impact. However, the advantage of prioritising older, high-risk populations is smaller in generally younger populations. This reduction is especially true in populations with more past transmission, and if the vaccine is likely to further impede transmission rather than just disease. Those conditions are typical of many low- and middle-income countries.
The health impact of changes in particulate matter with an aerodynamic diameter <2.5 μm (PM2.5) pollution associated with the COVID-19 lockdown has aroused great interest, but the estimation of the ...long-term health effects is difficult because of the lack of an annual mean air pollutant concentration under a whole-year lockdown scenario. We employed a time series decomposition method to predict the monthly PM2.5 concentrations in urban cities under permanent lockdown in 2020. The premature mortality attributable to long-term exposure to ambient PM2.5 was quantified by the risk factor model from the latest epidemiological studies. Under a whole-year lockdown scenario, annual mean PM2.5 concentrations in cites ranged from 5.4 to 68.0 μg m−3, and the national mean concentration was reduced by 32.2% compared to the 2015–2019 mean. The Global Exposure Mortality Model estimated that 837.3 (95% CI: 699.8–968.4) thousand people in Chinese cities would die prematurely from illnesses attributable to long-term exposure to ambient PM2.5. Compared to 2015–2019 mean levels, 140.2 (95% CI: 122.2–156.0) thousand premature deaths (14.4% of the annual mean deaths from 2015 to 2019) attributable to long-term exposure to PM2.5 were avoided. Because PM2.5 concentrations were still high under the whole-year lockdown scenario, the health benefit is limited, indicating that continuous emission-cutting efforts are required to reduce the health risks of air pollution. Since a similar scenario may be achieved through promotion of electric vehicles and the innovation of industrial technology in the future, the estimated long-term health impact under the whole year lockdown scenario can establish an emission–air quality–health impact linkage and provide guidance for future emission control strategies from a health protection perspective.
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•Predicted PM2.5 under whole-year lockdown in China ranged from 5.4 to 68.0 μg m−3.•Predicted PM2.5 in 2020 decreased by 32.2% compared with the 2015–2019 means.•A 14.4% reduction of premature deaths was estimated under whole-year lockdown.
Health equity impact assessment POVALL, SUSAN L.; HAIGH, FIONA A.; ABRAHAMS, DEBBIE ...
Health promotion international,
12/2014, Volume:
29, Issue:
4
Journal Article
Peer reviewed
Open access
The World Health Organization's Commission on Social Determinants of Health has called for 'health equity impact assessments' of all economic agreements, market regulation and public policies. We ...carried out an international study to clarify if existing health impact assessment (HIA) methods are adequate for the task of global health equity assessments. We triangulated data from a scoping review of the international literature, in-depth interviews with health equity and HIA experts and an international stakeholder workshop. We found that equity is not addressed adequately in HIAs for a variety of reasons, including inadequate guidance, absence of definitions, poor data and evidence, perceived lack of methods and tools and practitioner unwillingness or inability to address values like fairness and social justice. Current methods can address immediate, 'downstream' factors, but not the root causes of inequity. Extending HIAs to cover macro policy and global equity issues will require new tools to address macroeconomic policies, historical roots of inequities and upstream causes like power imbalances. More sensitive, participatory methods are also required. There is, however, no need for the development of a completely new methodology.
In this study we examine the meteorological drivers resulting in concurrent high levels of ozone (O3) and particulate matter smaller than 2.5 μm in diameter (PM2.5) during two five-day air pollution ...episodes in 2006 (1st - 5th July and 18th – 22nd July) using an air quality model (AQUM) at 12 km horizontal resolution to simulate air pollutant concentrations. The resultant UK health burden associated with short-term exposure to simulated maximum daily 8-h O3 (MDA8 O3) and daily mean PM2.5 is estimated at the national and regional level.
Both episodes were found to be driven by anticyclonic conditions with light easterly and south easterly winds and high temperatures that aided pollution build up in the UK. The estimated total mortality burden associated with short-term exposure to MDA8 O3 is similar during the chosen episodes with about 70 daily deaths brought forward (summed across the UK) during the first and second episode, respectively. The estimated health burden associated with short-term exposure to daily mean PM2.5 concentrations differs between the first and second episode resulting in about 43 and 36 daily deaths brought forward, respectively. The corresponding percentage of all-cause mortality due to short-term exposure to MDA8 O3 and daily mean PM2.5 during these two episodes and across the UK regions, ranges from 3.4% to 5.2% and from 1.6% to 3.9%, respectively. The attributable percentage of all-cause mortality differs between the regions depending on the pollution levels in each episode, but the overall estimated health burdens are highest in regions with higher population totals. We estimate that during these episodes the short-term exposure to MDA8 O3 and daily mean PM2.5 is between 36-38% and 39–56% higher, respectively, than if the pollution levels represented typical seasonal-mean concentrations. This highlights the potential of air pollution episodes to have substantial short-term impacts on public health.
•Both air pollution episodes are driven by anticyclonic conditions, light E/SE winds and high temperatures.•The estimated mortality burden associated with short-term exposure to MDA8 O3 is up to 70 daily deaths brought forward.•The estimated mortality burden associated with short-term exposure to PM2.5 is up to 45 daily deaths brought forward.•The corresponding percentage of all-cause mortality due to short-term exposure to MDA8 O3 ranges from 3.4% to 5.2%.•The corresponding percentage of all-cause mortality due to short-term exposure to daily mean PM2.5 ranges from 1.6% to 3.9%•Short-term exposure to O3 and PM2.5 is between 36-56% higher during these episodes compared to summer air pollution levels
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•Policies on anthropogenic emissions dominate health impacts of air pollution.•O3 simulated at 3 km resolution for 2030, 2040 and 2050 emissions pathways.•Hospitalisations calculated ...with latest UK health impact assessment recommendations.•7078 increase in respiratory hospitalisations by 2050 for current policy c.f. 2018.•Estimated increases are 2–3 times lower if population growth is not included.
Exposure to ambient ozone (O3) O3 is associated with impacts on human health. O3 is a secondary pollutant whose concentrations are determined inter alia by emissions of precursors such as oxides of nitrogen (NOx) and volatile organic compounds (VOCs), and thus future health burdens depend on policies relating to climate and air quality. While emission controls are expected to reduce levels of PM2.5 and NO2 and their associated mortality burdens, for secondary pollutants like O3 the picture is less clear. Detailed assessments are necessary to provide quantitative estimates of future impacts to support decision-makers. We simulate future O3 across the UK using a high spatial resolution atmospheric chemistry model with current UK and European policy projections for 2030, 2040 and 2050, and use UK regional population-weighting and latest recommendations on health impact assessment to quantify respiratory emergency hospital admissions associated with short-term effects of O3. We estimate 60,488 admissions in 2018, increasing by 4.2%, 4.5% and 4.6% by 2030, 2040 and 2050 respectively (assuming a fixed population). Including future population growth, estimated emergency respiratory hospital admissions are 8.3%, 10.3% and 11.7% higher by 2030, 2040 and 2050 respectively. Increasing O3 concentrations in future are driven by reduced nitric oxide (NO) in urban areas due to reduced emissions, with increases in O3 mainly occurring in areas with lowest O3 concentrations currently. Meteorology influences episodes of O3 on a day-to-day basis, although a sensitivity study indicates that annual totals of hospital admissions are only slightly impacted by meteorological year. While reducing emissions results in overall benefits to population health (through reduced mortality due to long-term exposure to PM2.5 and NO2), due to the complex chemistry, as NO emissions reduce there are associated local increases in O3 close to population centres that may increase harms to health.
Resumen El objetivo de este trabajo es explorar los sentimientos y expectativas que genera el COVID-19 en Argentina durante la primera etapa de la pandemia. Se aplicó una encuesta de la Organización ...Mundial de la Salud adaptada al contexto local. Se incluyeron preguntas abiertas para indagar sentimientos de las personas frente al COVID-19, y se realizó un análisis de contenido. Como resultados se advierte que la población encuestada siente incertidumbre, miedo y angustia, pero también emerge un sentimiento de responsabilidad y cuidado frente al COVID-19. Así mismo se destacan sentimientos positivos para la sociedad como una valoración de la interdependencia social. Los resultados arribados señalan que el impacto en la salud mental es desigual según el género, el nivel educativo alcanzado y el confort percibido en el hogar. El estudio permite concluir que las dimensiones emocionales y vinculares de las personas resultan aspectos centrales ante la pandemia del COVID-19 en Argentina. Es recomendable que estas dimensiones, así como y su impacto subjetivo y social diferencial entre los diversos grupos poblacionales, sean consideradas en la planificación de políticas para afrontar el COVID-19.
Abstract The scope of this work is to explore the feelings and expectations that COVID-19 has generated in Argentina during the first stage of the pandemic. A survey of the World Health Organization adapted to the local context was applied. Open-ended questions were included to study people's feelings about COVID-19, and content analysis was subsequently conducted. In terms of results, it is revealed that the population surveyed feels uncertainty, fear and anguish, albeit a feeling of responsibility and care in the face of COVID-19 also emerges. Moreover, positive feelings regarding society stand out as an achievement of social interdependence. The results obtained show that the impact on mental health differs in accordance with gender, educational level, and perceived comfort in the home. The study concludes that the emotional and bonding dimensions of people are central to confronting the COVID-19 pandemic in Argentina. It is recommended that these dimensions, as well as their subjective and differential social impact among the different population groups, should be considered in the planning of policies to address the COVID-19 pandemic.
Car-dependent city planning has resulted in high levels of environmental pollution, sedentary lifestyles and increased vulnerability to the effects of climate change. The Barcelona Superblock model ...is an innovative urban and transport planning strategy that aims to reclaim public space for people, reduce motorized transport, promote sustainable mobility and active lifestyles, provide urban greening and mitigate effects of climate change. We estimated the health impacts of implementing this urban model across Barcelona.
We carried out a quantitative health impact assessment (HIA) study for Barcelona residents ≥20 years (N = 1,301,827) on the projected Superblock area level (N = 503), following the comparative risk assessment methodology. We 1) estimated expected changes in (a) transport-related physical activity (PA), (b) air pollution (NO2), (c) road traffic noise, (d) green space, and (e) reduction of the urban heat island (UHI) effect through heat reductions; 2) scaled available risk estimates; and 3) calculated attributable health impact fractions. Estimated endpoints were preventable premature mortality, changes in life expectancy and economic impacts.
We estimated that 667 premature deaths (95% CI: 235–1,098) could be prevented annually through implementing the 503 Superblocks. The greatest number of preventable deaths could be attributed to reductions in NO2 (291, 95% PI: 0–838), followed by noise (163, 95% CI: 83–246), heat (117, 95% CI: 101–137), and green space development (60, 95% CI: 0–119). Increased PA for an estimated 65,000 persons shifting car/motorcycle trips to public and active transport resulted in 36 preventable deaths (95% CI: 26–50). The Superblocks were estimated to result in an average increase in life expectancy for the Barcelona adult population of almost 200 days (95% CI: 99–297), and result in an annual economic impact of 1.7 billion EUR (95% CI: 0.6–2.8).
The Barcelona Superblocks were estimated to help reduce harmful environmental exposures (i.e. air pollution, noise, and heat) while simultaneously increase PA levels and access to green space, and thereby provide substantial health benefits. For an equitable distribution of health benefits, the Superblocks should be implemented consistently across the entire city. Similar health benefits are expected for other cities that face similar challenges of environmental pollution, climate change vulnerability and low PA levels, by adopting the Barcelona Superblock model.
•The Barcelona Superblock model provides a paradigm shift towards people-centered city planning•The model aims to reclaim public space, reduce motorized transport, promote active mobility provide greening and cooling•Almost 700 premature deaths could be prevented annually with the Barcelona Superblocks•Health pathways were air pollution, noise and heat reductions and increases in green space and transport physical activity•The Superblocks could be scaled-up to other cities to reduce the health burden related to car-centered city planning
Wildland fires degrade air quality and adversely affect human health. A growing body of epidemiology literature reports increased rates of emergency departments, hospital admissions and premature ...deaths from wildfire smoke exposure.
Our research aimed to characterize excess mortality and morbidity events, and the economic value of these impacts, from wildland fire smoke exposure in the U.S. over a multi-year period; to date no other burden assessment has done this.
We first completed a systematic review of the epidemiologic literature and then performed photochemical air quality modeling for the years 2008 to 2012 in the continental U.S. Finally, we estimated the morbidity, mortality, and economic burden of wildland fires.
Our models suggest that areas including northern California, Oregon and Idaho in the West, and Florida, Louisiana and Georgia in the East were most affected by wildland fire events in the form of additional premature deaths and respiratory hospital admissions. We estimated the economic value of these cases due to short term exposures as being between $11 and $20B (2010$) per year, with a net present value of $63B (95% confidence intervals $6–$170); we estimate the value of long-term exposures as being between $76 and $130B (2010$) per year, with a net present value of $450B (95% confidence intervals $42–$1200).
The public health burden of wildland fires—in terms of the number and economic value of deaths and illnesses—is considerable.
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•Wildland fires adversely affect air quality and health in the U.S.•Between 2008 and 2012, fires increased PM2.5 levels in the Northwest and Southeast.•We estimate thousands of premature deaths and illnesses from these episodes.•The economic value of these impacts is in the tens to hundreds of billions of US$.
Health Impact Assessments (HIAs) motivate effective measures for safeguarding public health. There is consensus that HIAs in low and middle-income countries (LMICs) are lacking, but no study ...systematically focuses on those that have been successfully conducted across all regions of the world, nor do they highlight factors that may enable or hinder their implementation. Our objectives are to (1) systematically review, geographically map, and characterize HIA activity in LMICs; and (2) apply a process evaluation method to identify factors which are important to improve HIA implementation in LMICs. A systematic review of peer-reviewed HIAs in 156 LMICs was performed in Scopus, Medline, Web of Science, Sociological abstracts, and LILACs (Latin American and Caribbean Health Sciences) databases. The search used PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and covered HIAs across all type of interventions, topics, and health outcomes. HIAs were included if they reported a clear intervention and health outcome to be assessed. No time restriction was applied, and grey literature was not included. The eligible studies were subjected to six process evaluation criteria. The search yielded 3178 hits and 57 studies were retained. HIAs were conducted in 26 out of 156 countries. There was an unequal distribution of HIAs across regions and within LMICs countries. The leading topics of HIA in LMICs were air pollution, development projects, and urban transport planning. Most of the HIAs reported quantitative approaches (72%), focused on air pollution (46%), appraised policies (60%), and were conducted at the city level (36%). The process evaluation showed important variations in the way HIAs have been conducted and low uniformity in the reporting of six criteria. No study reported the time, money, and staff used to perform HIAs. Only 12% of HIAs were based on participatory approaches; 92% of HIAs considered multiple outcomes; and 61% of HIAs provided recommendations and fostered cross-national collaboration. The limited transparency in process, weak participation, and inconsistent delivery of recommendations were potential limitations to HIA implementation in low and middle-income countries. Scaling and improving HIA implementation in low and middle-income countries in the upcoming years will depend on expanding geographically by increasing HIA governance, adapting models and tools in quantitative methods, and adopting better reporting practices.
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