Public Health Framework for Smart Cities within the Comprehensive Approach to Sustainability in Europe: Case Study of Diabetes

European cities should address the climate change challenges, improving quality of life and reducing costs. They need potential smart and digital approaches. Public health (PH) has recognized climate change as a major challenge. The development of urban policies should be guided by evidence-based PH practices. The environmental health determinants and the climate crisis now represent a clear PH threat. The core of the Smart City is sustainability, and its basic condition is active PH. The inclusion of public health into the pillars of the Smart City concept to contribute toward mitigating PH crises, such as the COVID-19 pandemic, is a framework for action. Design Science Research Methodology (DSRM) is used to elicit a Smart Public Health City (SPHEC) framework. A set of PH and smart city experts participated in the DSRM process, using diabetes as a case study. The European Green Deal served as a blueprint for this transformational change toward a healthier and more sustainable city. The SPHEC framework was defined by elucidating clearly the several dimensions of the PH functions within a digital city, via the identification of a set of digital PH services that are required to support the SPHEC framework. This allows for an assessment of the actual benefits that are obtained with the digital health services, and provides evidence for guiding decision-making. The role of digital PH services emerges from the analysis of the SPHEC framework, through the development of proper digital health services within the smart city, strengthening capacity and resilience in future climate emergencies, and motivating policy makers to take this challenge more seriously. © 2023 by the authors.

Introducing walkable cities as a Public Health intervention : Vlatka Matkovic

COVID-19 pandemic yet again showed that health crises and epidemics are introducing urban planning as a public health response. Globally, we saw a renewed interest in urban environment and healthy living and the changes in urban environments which can make for a healthier living. Even before the pandemic, various urban concepts and models that take as basis a health-oriented, holistic approach are being implemented in many cities. To name a few: car-free centres or neighbourhoods, the so-called ‘Superblocks’, neighbourhoods with low-speed traffic, walkable and cyclable cities aiming at all amenities being easy reach so-called ‘15 Minutes city’. COVID-19 crisis only accelerated many of these initiatives and brought them to global level need and attention. Such interventions are being introduced to demotivate the use of polluting cars, to ease up and to promote healthy and active transportation such as walking and cycling. As a consequence, those interventions not only are hoped to lead to an increase in physical activity, but also better air quality, reduction of noise. Cities have accelerated urban transformations of the space for active transportation such as the introduction of more cycling lanes in their networks, transforming ‘car’ streets to mix use streets, etc. Particularly during the pandemic, the streets that were previously dominated by car use, parking lots, parking spaces, and car lanes have shifted their focus to the pedestrians, healthy and active mobility. Though, not so optimistic continuation of the speed of the changes in urban planning are seen at the end of the pandemic. It is still clear that spaces for people, spaces promoting mental health such as green spaces, green islands, green pedestrian streets and healthy mobility, are missing. Lockdown measures of reducing the car traffic and increasing the walkable spaces for citizens were primarily imposed to save public health but had one important co-benefit - improved air quality in many areas.

Urban places and Mental Health challenges (lessons learned from Covid-19 crisis) : Marija Jevtic

Nature deprivation under COVID-19 lead to reduced well-being. Urban design interventions were also identified as an important contributor to the restoration of community confidence, choice, and safety. Factors related to sociodemographic, housing and lockdown were linked to changes in exposure to nature during the pandemic lockdown. Changes in exposure to nature and mental health outcomes during the COVID-19 lockdown were strongly linked. Especially young people had an increased number of mental health problems. Children and youth were more bored and worried in comparison with the pre-pandemic period. The educational institutions worldwide were closed or changed to online education during the pandemic, leading to great disturbance in students’ education and outdoor events. All “green infrastructure” (GI) resources (including parks, gardens etc.) received great attention as “essential infrastructure” supporting well-being. But, the quality, functionality and position of GI in urban areas showed inequality in distribution. Frequently, societies with greater ethnic diversity, lower income and larger health inequality suffered from unsatisfactory or lack of access. GI is important in decision-making to address inequality. This work will also present an open-air activity for all generations: A reflective walk through the oldest part of Novi Sad (EU Capital of Culture 2022), as a part of Project Reflective citizens in Novi Sad. This walking tour was led by pupils from primary school - where all generations spend useful time in open space and a safe atmosphere walking tour, learning and listening about the cultural history of the oldest part of the city. It is vital to enhance urban planning and design practices in making healthier and more resilient communities. It is necessary to underline the importance of planning green spaces that need time to form in urban areas, and which have proven to be very important for mental health in the midst of the pandemic crisis.

The COVID-19 pandemic - related psychological distress and job burnout among Serbian pharmacy practitioners: a cross-sectional online study.

OBJECTIVE: The current COVID-19 pandemic has increased occupational stress for all healthcare providers, making job burnout one of the most common and largely unrecognized mental health issues among healthcare professionals. Besides physicians and nurses, pharmacy practitioners were "front-line" healthcare professionals with a critical and unique role in the public health crisis. Considering this, the aim of this study was to examine distress levels and the prevalence of job burnout among Serbian pharmacy practitioners in relation to the COVID-19 pandemic. SUBJECTS AND METHODS: This cross-sectional online study was conducted in April and May of 2020. A total of 176 pharmacy practitioners anonymously and voluntarily completed the two-section questionnaire, consisting of Copenhagen burnout inventory, CBI and 4DSQ Distress subscale. The two-section questionnaire was distributed online, among various social-media groups of pharmacy practitioners, as well as by personal contacts following the "snowball" sampling method. RESULTS: Results revealed moderately high burnout scores in our sample. The majority of the participants showed signs of personal-related job burnout, followed by work-related and client-related burnout. A strongly elevated distress level was obtained in almost two-thirds of study respondents. In addition, a significant and high correlation of all CBI subscales with distress was found, as well as medium correlations with sleep duration shortening as a mediator between distress and job burnout. CONCLUSIONS: Results of our study showed that job burnout significantly increased among pharmacy practitioners during the COVID-19 pandemic. Furthermore, we discovered that stress has an indirect impact on study participants' burnout via insufficient sleep.

SDGs in the Covid 19 Storm (Example on Climate Pact Ambassadors Role)

The Climate Pact was launched in December 2020, with hope that the upcoming vaccine would help us overcome the COVID-19 pandemic "storm". Even though humans are in the canter of the Covid pandemic storm, it is still important not to forget the climate change challenge, as it is a highly active "factory". Unfortunately, there is no vaccine for the climate change process and biodiversity crises. The Climate Pact is an opportunity to create a European-wide movement that supports, encourages and acknowledges individual climate achievements. According to SDG 13 (climate action), Climate Pact encourages actions such as: green areas, green transport, green buildings and green skills. Also, it is important to expand sustainable consumption and production, the quality of soil, healthy food and sustainable diets, oceans, and rural and coastal areas. Therefore, Climate Pact is a driver for Sustainable Development Goals, and it is based on the ideas and contributions of all interested individuals and various organisations. Climate Pact Ambassadors are representatives of civil society and citizens with the strength for action (despite the Covid 19 pandemic "storm") and collaboration among themselves as well as with researchers, academic citizens and policy makers to beat climate change and give contribution to SDG 13.

Presence of resistance in building resilience of Health workforce in the COVID-19 crisis

In the extraordinary circumstances of the Covid pandemic, Group Analytic Society Belgrade (DGAB) devised and organized online support groups for health workers, health associates and student volunteers. Participation is devised to be voluntary, while respecting confidentiality and non-disclosure of content outside the group. Support groups for health workers aim to share experiences, feelings and mutual support that they invest in daily work. We assume that the groups as a space of integration understanding and common thinking, could impact the building of resilience of health workers in the given conditions of a pandemic crisis. Groups are organized two times a week - 1 h and 15' each. One may apply by filling out an online form, and choosing one of the offered dates, that provides access to the group once a week. Group leaders are experienced analysts, DGAB members and analysts in their final years of education. In the initial phase, they are open - it is enough to choose a day that suits the participant when filling out the application, and in the selected term to join via the link for the zoom meeting (the link is sent to the e-mail given in the application). The aim is to present challenges we encountered in forming the groups, from strong resistance in accepting the help offered, negating the need for support to the helplessness and hopelessness that any help is possible. Exploring ways to overcome noticed resistance and presenting experience in providing support to health professionals is vital to strengthen the capacity of human resources and health systems in general. The pandemic crisis has not only affected the conditions and needs of patients, but has created a need for complex approach and care for health workers (human resources), so health systems could achieve sustainability and overcome the crisis that has befallen them. Key messages The pandemic crisis has not only affected the conditions and needs of patients, but has created a need for complex approach and care for health professionals. Management of healthcare organizations should ensure to all health professionals support to overcome the crisis that has befallen them.

Looking for a healthy breath - the importance and potential of urban green spaces in the city: Case study of Novi Sad, Vojvodina Province, Serbia

Urban Green Spaces (UGS) are providing multiple health related ecosystem services (ES) to Public Health by improving quality of life (QoL) and well-being. The aim of research is to provide an insight of UGS in Novi Sad, and its potential to support public health, using publicly available data. Novi Sad, as the capital of Vojvodina Province (Republic of Serbia), region with the lowest percentage of forests, needs to provide enough UGS for healthy living. The best example for this goal is one of the greenest urban areas- Brussels with 79.00km2 of UGS. The results showed that City of Novi Sad has 39.02km2 of UGS, while lowest percentage of green areas is found in the city center core, and highest in family-oriented city blocks, which is characteristic even for green cities such as Brussels. Although the distribution and positioning of UGS in Novi Sad is well planned, additional actions for improvement of the amount, quality accessibility is needed, which is supported by the City Council for green spaces of Novi Sad. Considering the lack of the green spaces in the core center of Novi Sad, the potential for creation of new green areas in such urbanized environment lies in roof and vertical greening, and community-based gardens. In light of the biodiversity loss and the climate change, the importance of various policies that include sustainable development and growth as well as preserving nature and biodiversity (SDG8, SDG11, Green Deal, etc.) is rising. It is important to define natural, sustainable, and unobtrusive methods for public health, well-being and QoL improvement, which is also important in the circumstances of Covid pandemic. The introduction of more green areas and community-based gardening in cities would improve the ES of UGS. These actions would have indirect and direct positive effect on public and individual health of local population, as well as the potential to decrease the loss of biodiversity and the effects of climate change on microscale.

European Green deal and Climate Pact: A roadmap for digital public health

The Covid-19 pandemic crisis caused a serious ‘tectonic' disturbance in all sectors, especially pointed out weaknesses of the healthcare systems. The recently adopted European Green Deal (EGD). It should take into account the Covid-19 pandemic challenge and maintain its primary objectives. The pandemic crisis has shown not only individual health risks, but also global health threats (direct and indirect). The SARS-CoV-2 virus causes an insufficiently known infectious disease. The subsidiary health effects are still countless: mental health, health-economic costs, deadlock in the other diseases treatment, etc. One of the main messages regarding environment, is that society should find new economic models less damaging to the environment and to biodiversity, implying circular economy, a less consumerist and active society: e.g. a 4 days-working week. Covid-19 took us to the extreme of being confined at home, either working or taking care of our families. However, the Covid-19 global quarantine and confinement (and huge reduction of travelling, mainly flights) had a great impact on decrease of CO2 levels, on the quality of air and on biodiversity. Vulnerability and lack of efficient action in many countries, is a strong warning for Europe (and globally) to insist in strengthening public health and convert lessons learned into action. The Coronavirus, originating from destruction of wildlife and intensive animal farming, will bring more pandemics in the future. We need more public health consideration towards effects of climate change on public health. It is possible to keep economy functioning by promoting remote work supported by digital platforms and innovation for international networks. Strategically, the European recovery plan should be aligned with the EGD. These challenges open the way to digital health, and as such, can be defined a roadmap to tackle climate change.