Over the past two decades, geographical accessibility of urban resources for population living in residential areas has received an increased focus in urban health studies. Operationalising and ...computing geographical accessibility measures depend on a set of four parameters, namely definition of residential areas, a method of aggregation, a measure of accessibility, and a type of distance. Yet, the choice of these parameters may potentially generate different results leading to significant measurement errors. The aim of this paper is to compare discrepancies in results for geographical accessibility of selected health care services for residential areas (i.e. census tracts) computed using different distance types and aggregation methods.
First, the comparison of distance types demonstrates that Cartesian distances (Euclidean and Manhattan distances) are strongly correlated with more accurate network distances (shortest network and shortest network time distances) across the metropolitan area (Pearson correlation greater than 0.95). However, important local variations in correlation between Cartesian and network distances were observed notably in suburban areas where Cartesian distances were less precise.Second, the choice of the aggregation method is also important: in comparison to the most accurate aggregation method (population-weighted mean of the accessibility measure for census blocks within census tracts), accessibility measures computed from census tract centroids, though not inaccurate, yield important measurement errors for 5% to 10% of census tracts.
Although errors associated to the choice of distance types and aggregation method are only important for about 10% of census tracts located mainly in suburban areas, we should not avoid using the best estimation method possible for evaluating geographical accessibility. This is especially so if these measures are to be included as a dimension of the built environment in studies investigating residential area effects on health. If these measures are not sufficiently precise, this could lead to errors or lack of precision in the estimation of residential area effects on health.
This paper explores perspectives of Inuit elders on the relationships between aging, health and place. Their views are important to consider in the context of a growing proportion and number of older ...people in Arctic communities, a new sociological condition. Developing policies and programs to promote healthy aging in Inuit communities is challenging as there is little known about the social and living conditions that promote healthy aging in the Arctic. In this study twenty Inuit aged between 50 to 86, from one community in Nunavut, participated to in-depth qualitative interviews. Themes discussed included aging and health, housing conditions, community conditions, land-based activities, medical and leisure travel outside of the community, and mobility and accessibility. Preliminary analyses of the qualitative data were validated in the community through a focus group with four participants and an interpreter. Interviews and the focus group transcripts were analysed using thematic content analyses and NVivo 12 qualitative data analysis program (QSR International Pty Ltd.
2017
). Participants reported that spending time with children, having social support, living in houses adapted to aging health conditions, having access to community activities and services, and time spent on the land were the main resources supporting their health. Several factors limited the availability of these resources. These include: lack of accessibility to resources; structural factors impacting their availability; and natural and social changes in interpersonal relationships. Participants also stressed the importance of being able to grow old in their own community. Knowledge generated in this project contributes to policies and programs targeting housing and community conditions to support healthy aging, and aging in place, in Inuit Nunangat.
This paper is the first of two linked progress reports on the application of ideas from complexity theory to health geography. In this paper we focus especially on research which seeks to explain ...variations in human health from a geographical perspective. We mainly discuss selected studies of geographies of human health which illustrate how ideas from complexity theory are applied empirically. In order to interpret more effectively the dynamic and recursive networks of relationships anticipated by complexity theory, future research will be required to go further in breaking down the divisions that are often assumed between research using different types of empirical methods. We comment on the potential to do this by means of advanced approaches to statistical and spatial modelling and by giving greater attention to the complementarity between these methods and qualitative techniques. We also discuss the emphasis in these examples on research which adopts an interdisciplinary strategy. Our conclusions refer forward to our companion report, which focuses more on studies of geographies of health care and health policy, emphasizing that complexity theory applied to health systems underlines the connections between health, health care and health policy.
Elder Inuit define health as holistic and multifaceted, which contrasts with health-related research where single factor indicators are usually used to measure health in an Inuit context. As the ...number of Inuit elders is growing, indicators derived from an Inuit definition of health are important if health systems are to be inclusive of the realities of Indigenous Peoples and culture. This study explored and operationalised a model of Inuit health in aging that draws from physical, emotional, spiritual, and interpersonal components identified as salient by participants in this research. Qualitative data gathered through two workshops with 21 participants were analysed to identify key dimensions of health from an Inuit perspective. Quantitative data were retrieved from Statistics Canada Aboriginal Peoples Survey (APS; 2006) with a weighted sample of 4450 Inuit aged ≥ 50 years residing across Inuit Nunangat. Using measures corresponding to the dimensions identified previously, Latent Class Analyses were applied to group survey participants into health profiles to create a holistic indicator of health. Multinomial regressions were conducted with related health and social measures to assess the concurrent validity of the indicator. Health was conceptualised along eight themes: general health balance, mental health, spirituality, not experiencing many activity limitations, being loved and having positive relationships, speaking Inuktitut, and being free of addiction. The holistic indicator grouped participants into three health profiles: (1) good health for most variables; (2) very good perceived and physical health, but poor mental health; and (3) poor health for most variables. Using mixed methods to bridge the concept of health defined in qualitative workshops with quantitative health indicators can contribute to the definition and description of a culturally relevant and sociologically complex understanding of healthy aging in an Inuit context.
A better knowledge of the social determinants of health (SDH) promoting healthy ageing in Inuit communities is needed to adapt health and social policies and programs. This study aims to identify SDH ...associated with healthy ageing. Using the 2006 Aboriginal Peoples Survey (n = 850 Inuit aged ≥50 years), we created a holistic indicator including multiple dimensions of health and identified three groups of participants: those in 1) good 2) intermediate and 3) poor health. Sex and age-adjusted multinomial regression models were applied to assess the associations between this indicator and SDH measured at the individual, household and community scales. In comparison to APS respondents in the "Poor health" profile, those in the "Good health" profile were more likely to have a higher individual income, to participate in social activities, and to have stronger family ties in the community ; those in the "Intermediate health" profile were less likely be in a relationship, more likely to live in better housing conditions, and in better-off communities. Results indicate that SDH associated with the "Good health" profile related more to social relationships and participation, those associated with the "Intermediate health" profile related more to economic and material conditions.
Objectives
In 2014–2015, over 400 social housing units were constructed in selected communities in Nunavik and Nunavut, two Inuit regions in northern Canada where housing shortages and poor quality ...housing are endemic and undermine population health. This paper presents results from a before-and-after study examining the effects of rehousing, i.e., relocating to a newly constructed or pre-existing social housing unit, on psychosocial health and asthma-related symptoms for Inuit adults.
Methods
Baseline data were collected 1–6 months before, and follow-up data 15–18 months after rehousing. Of the 289 participants at baseline, 186 were rehoused. Of the 169 participants eligible at follow-up, 102 completed the study. Self-reported health measures included psychological distress, perceived stress in daily life, perceived control over one’s life, and asthma-related symptoms. Data are analyzed using multilevel models for longitudinal data.
Results
After adjusting for age, sex, and region of residence, participants reported significantly lower levels of psychological distress and perceived stress in daily life, and improved sense of control over their lives 15 to 18 months after rehousing. Participants were also significantly less likely to report asthma-related symptoms at follow-up.
Conclusion
Significant positive health impacts are observed for adults who relocated to newly constructed or pre-existing social housing units. Increasing investments to redress the housing situation across Inuit Nunangat is required, not only to improve living conditions but also to improve the health and well-being of the population.
ObjectiveTo evaluate sex-specific and age-specific associations of active living environments (ALEs) with premature cardiometabolic mortality.DesignPopulation-based retrospective cohort ...study.SettingResidential neighbourhoods (1000-metre circular buffers from the centroids of dissemination areas) across Canada for which the Canadian ALE Measure was derived, based on intersection density, points of interest and dwelling density.Participants249 420 survey respondents from an individual-level record linkage between the Canadian Community Health Survey (2000–2010) and the Canadian Mortality Database until 2011, comprised of older women (65–85 years), older men (65–81 years), middle-aged women (45–64 years) and middle-aged men (45–64 years).Primary outcome measuresPremature cardiometabolic mortality and average daily energy expenditure attributable to walking. Multivariable proportional hazards regression models were adjusted for age, educational attainment, dissemination area-level median income, smoking status, obesity, the presence of chronic conditions, season of survey response and survey cycle.ResultsSurvey respondents contributed a total of 1 451 913 person-years. Greater walking was observed in more favourable ALEs. Walking was associated with lower cardiometabolic death in all groups except for middle-aged men. Favourable ALEs conferred a 22% reduction in death from cardiometabolic causes (HR 0.78, 95% CI 0.63 to 0.97) for older women.ConclusionsOn average, people walk more in favourable ALEs, regardless of sex and age. With the exception of middle-aged men, walking is associated with lower premature cardiometabolic death. Older women living in neighbourhoods that favour active living live longer.
About half of Nunavik Inuit live in overcrowded households compared to very few Canadians from the general population. Living in overcrowded households is associated with greater risks of suffering ...from mental health problems for Canadian adolescents. The present work aims at studying prospectively the hypothesised relationship between household overcrowding at childhood and psychological distress during adolescence among Nunavik Inuit, as well as the hypothesised relationship between these phenomena when they are both measure at adolescence. Recruited as part of the Nunavik Child Development Study, 220 participants were met at 11 years old in average and then when they were 18 years old in average. Household overcrowding was assessed using the people per room ratio. Psychological distress symptoms were operationalised at adolescence using depressive symptoms and suicidal thoughts. The results did not show that childhood household crowding had a long-term effect on psychological distress. An absence of moderation by sex of the association was also found in the present study. Despite those results, household crowding could be a risk factor only when in interaction with other elements related with poverty or housing or could be experienced as a difficulty for adolescents on other aspects than depressive symptoms and suicidal thoughts.
Bicycle helmet use is recognized as an effective way to prevent head injuries in cyclists. A number of countries have introduced legislation to make helmets mandatory, but many object to this type of ...measure for fear that it could discourage people, particularly teenagers, from cycling. In 2011, the City of Sherbrooke adopted a bylaw requiring minors to wear a bicycle helmet. The objective of this study was to assess the impact of this bylaw on cycling and bicycle helmet use.
The impact of the bylaw was measured by comparing the evolution of bicycle helmet use among youth aged 12 to 17 years in the Sherbrooke area (n = 248) and in three control regions (n = 767), through the use of logistic regression analyses.
Cycling rates remained stable in the Sherbrooke area (going from 49.9% to 53.8%) but decreased in the control regions (going from 59.1% to 46.3%). This difference in evolution shows that cycling rates increased in the Sherbrooke area after the adoption of the bylaw, compared to the control regions (odds ratio OR of the interaction term: 2.32; 95% confidence interval CI: 1.01-5.35). With respect to helmet use, a non-statistically significant upward trend was observed in the Sherbrooke area (going from 43.5% to 60.6%). This figure remained stable in the control regions (going from 41.5% to 41.9%). No significant difference was observed in the evolution of helmet use between the two groups (OR of the interaction term of 2.70; 95% CI: 0.67-10.83).
After the bylaw was adopted, bicycle use among youth aged 12 to 17 years in the Sherbrooke area remained stable and helmet used increased, though not significantly.
Despite abundant evidence that socio-economic status (SES) is a fundamental determinant of health, there is a dearth of research examining association between SES, measured at the individual and ...community levels, and cardiovascular risk factors and morbidity among indigenous populations.
To examine the influence of individual-level and community-level SES on systolic and diastolic blood pressure among Greenlandic Inuit.
Multilevel analysis of cross-sectional data from the Inuit Health in Transition - Greenland Survey, to which 3,108 Greenlandic Inuit aged 18 years and older participated. Blood pressure is measured using an automatic device, according to standardized protocol. Individual SES is measured by education. Community socio-economic conditions are measured using combined information on average disposable household income and settlement type.
Education was not significantly associated with blood pressure. There was an inverse U-shape association between community socio-economic conditions and blood pressure with significantly lower SBP and DBP among participants living in remote traditional villages characterized by lower average disposable household income and in affluent more urbanized towns. Sex-stratified analyses demonstrate the salience of community conditions for men.
The association observed between blood pressure and community-level socio-economic conditions suggests that public health and social policies, programmes and interventions aiming to improve living conditions might improve cardiovascular health in Greenland. Studies are required to further examine social gradients in cardiovascular risk factors and morbidity among indigenous populations using different measures of SES.
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