Exploring ownership of change and health equity implications in neighborhood change processes: A community-led approach to enhancing just climate resilience in Everett, MA.

Traditional planning processes have perpetuated the exclusion of historically marginalized communities, imposing vulnerability to climate (health) crises. We investigate how ownership of change fosters equitable climate resilience and community well-being through participatory action research. Our study highlights the detrimental effects of climate gentrification on community advocacy for climate security and health, negatively impacting well-being. We identify three key processes of ownership of change: ownership of social identity, development and decision-making processes, and knowledge. These approaches emphasize community-led solutions to counter climate health challenges and underscore the interdependence of social and environmental factors in mental health outcomes in climate-stressed communities.

"The trauma machine expands faster than our services": Health risks for unhoused people in an early-stage gentrifying area.

While homelessness continues to be a prevalent problem throughout the United States, many urban neighborhoods are also concurrently experiencing an influx of affluent neighbors through gentrification, exposing the stark inequalities in housing access nationwide. Gentrification-induced changes in neighborhood dynamics have also been shown to affect the health of low-income and non-white groups, with high risks of trauma from displacement and exposure to violent crime and criminalization. This study addresses risk factors for health among the most vulnerable, unhoused individuals, and provides a detailed case study on the potential exposures to emotional and physical traumas for unhoused people in early-stage gentrifying areas. By conducting 17 semi-structured interviews with people who work with the unhoused community - health providers, nonprofit employees, neighborhood representatives, and developers - in Kensington, Philadelphia, we analyze how early-stage gentrification impacts the risks for negative health consequences among unhoused groups. Results show that gentrification impacts the health of unhoused people in four main areas that, all together, create what we identify as a "trauma machine" - that is compounding traumas for unhoused residents by 1) reducing and compromising spaces of safety from violent crime, 2) decreasing public services, 3) threatening the quality of healthcare, and 4) increasing the likelihood of displacement and associated trauma.

Promoting Health Equity Through Preventing or Mitigating the Effects of Gentrification: A Theoretical and Methodological Guide.

Public health researchers are increasingly questioning the consequences of gentrification for population health and health equity, as witnessed in the rapid increase in public health publications on the health (equity) effects of gentrification. Despite methodological challenges, and mixed results from existing quantitative research, qualitative evidence to date points to the role of gentrification processes in exacerbating health inequities. Here we discuss past methodological and theoretical challenges in integrating the study of gentrification with public health research. We suggest taking an interdisciplinary approach, considering the conceptualization of gentrification in measurement techniques and conceiving this process as a direct exposure or as a part of broader neighborhood changes. Finally, we discuss existingpolicy approaches to mitigating and preventing gentrification and how these could be evaluated for effectiveness and as public health promotion and specifically as interventions to promote health equity.

The right to the unhealthy deprived city: An exploration into the impacts of state-led redevelopment projects on the determinants of mental health.

Research shows mental health is impacted by poor-quality physical and social-environmental conditions. Subsequently state-led redevelopment/regeneration schemes focus on improving the physical environment, to provide better social-environmental conditions, addressing spatial and socioeconomic inequities thus improving residents' health. However, recent research suggests that redevelopment/regeneration schemes often trigger gentrification, resulting in new spatial and socioeconomic inequalities that may worsen health outcomes, including mental health, for long-term neighborhood residents. Using the right to the city and situating this within the framework of accumulation by dispossession and capitalist hegemony, this paper explores the potential mechanisms in which poor mental health outcomes may endure in neighborhoods despite the implementation of redevelopment/regeneration projects. To do so, we explored two neighborhoods in the city of Glasgow - North Glasgow and East End - and conducted a strong qualitative study based on 25 in-depth semi-structured interviews with key stakeholders. The results show that postindustrial vacant and derelict land spaces and socioeconomic deprivation in North and East Glasgow are potential mechanisms contributing to the poor mental health of its residents. Where redevelopment/regeneration projects prioritize economic goals, it is often at the expense of social(health) outcomes. Instead, economic investment instigates processes of gentrification, where long-term neighborhood residents are excluded from accessing collective urban life and its (health) benefits. Moreover, these residents are continually excluded from participation in decision-making and are unable to shape the urban environment. In summary, we found a number of potential mechanisms that may contribute to enduring poor mental health outcomes despite the existence of redevelopment/regeneration projects. Projects instead have negative consequences for the determinants of mental health, reinforcing existing inequalities, disempowering original long-term neighborhood residents and only providing the "right" to the unhealthy deprived city. We define this as the impossibility to benefit from material opportunities, public spaces, goods and services and the inability to shape city transformations.

Integrating justice in Nature-Based Solutions to avoid nature-enabled dispossession.

Heavily featured over the last few years in global research and policy agreements, Nature-Based Solutions (NBS) remain however exposed to much debate over the ways their current design and ability to achieve both environmental goals and social needs. As they become mainstream climate mitigation and adaptation options, their capacity to deliver expected benefits, especially when contemplating equity and justice, is at least uncertain. Through a critical review of existing debates and perspectives on NBS, this paper questions their uptake and points at the frequent embeddedness of NBS in speculative and elite-based development paths in both urban and rural areas. We present an alternative, justice-oriented approach to NBS so that projects can avoid nature-enable dispossession and instead build nature-inspired justice that prioritizes the needs, identities, and livelihoods of the most ecologically and socially vulnerable residents.

Residential Proximity to Urban Play Spaces and Childhood Overweight and Obesity in Barcelona, Spain: A Population-Based Longitudinal Study.

Findings on the relationship between play spaces and childhood overweight and obesity are mixed and scarce. This study aimed to investigate the associations between residential proximity to play spaces and the risk of childhood overweight or obesity and potential effect modifiers. This longitudinal study included children living in the city of Barcelona identified in an electronic primary healthcare record database between 2011 and 2018 (N = 75,608). Overweight and obesity were defined according to the WHO standards and we used 300 m network buffers to assess residential proximity to play spaces. We calculated the risk of developing overweight or obesity using Cox proportional hazard models. A share of 29.4% of the study population developed overweight or obesity, but we did not find consistent associations between play space indicators and overweight or obesity. We did not find any consistent sign of effect modification by sex, and only some indications of the modifying role of area socioeconomic status and level of exposure. Although it is not possible to draw clear conclusions from our study, we call for cities to continue increasing and improving urban play spaces with an equitable, healthy, and child-friendly perspective.

The Differences by Sex and Gender in the Relationship Between Urban Greenness and Cardiometabolic Health: A Systematic Review.

In an increasingly urbanized world, where cardiometabolic issues in cities have raised public health concerns, urban greenness is known to be beneficial for some of the most common health issues. However, the examination of the contribution of sex and gender regarding the benefits of urban greenness for people's cardiometabolic health is lacking. For that reason, we conducted a systematic review of previous literature on the topic following the PRISMA methodology. Additionally, we assessed the quality of the included articles, which we found satisfactory as most papers were of very good or good quality. We explored the relationship between urban greenness exposure and cardiovascular risk factors, cardiovascular diseases, and mortality from cardiovascular diseases. Results suggest that urban greenness is protective against cardiovascular risk factors, diseases, and mortality. When stratifying results by sex and gender, findings point to urban greenness being more beneficial for women and females in stroke and cardiovascular risk factors, except for hypertension and lipid accumulation product. On the other hand, males were more protected by urban greenness in terms of cardiovascular diseases and CVD-related mortality, thus proving that sex and gender health inequalities exist. Furthermore, looking towards the future, research needs to use the proper terminology for sex and gender and policy makers should design urban greenness with a gender perspective.

Green gentrification in European and North American cities.

Although urban greening is universally recognized as an essential part of sustainable and climate-responsive cities, a growing literature on green gentrification argues that new green infrastructure, and greenspace in particular, can contribute to gentrification, thus creating social and racial inequalities in access to the benefits of greenspace and further environmental and climate injustice. In response to limited quantitative evidence documenting the temporal relationship between new greenspaces and gentrification across entire cities, let alone across various international contexts, we employ a spatially weighted Bayesian model to test the green gentrification hypothesis across 28 cities in 9 countries in North America and Europe. Here we show a strong positive and relevant relationship for at least one decade between greening in the 1990s-2000s and gentrification that occurred between 2000-2016 in 17 of the 28 cities. Our results also determine whether greening plays a "lead", "integrated", or "subsidiary" role in explaining gentrification.

Healthy cities after COVID-19 pandemic: the just ecofeminist healthy cities approach.

The COVID-19 pandemic crisis has compromised the 'healthy cities' vision, as it has unveiled the need to give more prominence to caring tasks while addressing intersectional social inequities and environmental injustices. However, much-needed transdisciplinary approaches to study and address post-COVID-19 healthy cities challenges and agendas have been scarce so far. To address this gap, we propose a 'just ecofeminist healthy cities' research approach, which would be informed by the caring city, environmental justice, just ecofeminist sustainability and the healthy cities paradigms and research fields. Our proposed approach aims to achieve the highest standards of human health possible for the whole population-yet putting the health of socially underprivileged residents in the centre-through preserving and/or improving the existing physical, social and political environment. Importantly, the proposed approach recognises all spheres of daily life (productive, reproductive, personal and political) and their connections with inequities, justice and power dynamics. Last, the just ecofeminist healthy cities approach understands human health as interconnected with the health of non-human animals and the ecosystem. We illustrate the proposed new approach focusing on the implications for women's health and public green spaces research and propose principles and practices for its operationalisation.

Sociodemographic determinants of intraurban variations in COVID-19 incidence: the case of Barcelona.

BACKGROUND: Intraurban sociodemographic risk factors for COVID-19 have yet to be fully understood. We investigated the relationship between COVID-19 incidence and sociodemographic factors in Barcelona at a fine-grained geography. METHODS: This cross-sectional ecological study is based on 10 550 confirmed cases of COVID-19 registered during the first wave in the municipality of Barcelona (population 1.64 million). We considered 16 variables on the demographic structure, urban density, household conditions, socioeconomic status, mobility and health characteristics for 76 geographical units of analysis (neighbourhoods), using a lasso analysis to identify the most relevant variables. We then fitted a multivariate Quasi-Poisson model that explained the COVID-19 incidence by neighbourhood in relation to these variables. RESULTS: Neighbourhoods with: (1) greater population density, (2) an aged population structure, (3) a high presence of nursing homes, (4) high proportions of individuals who left their residential area during lockdown and/or (5) working in health-related occupations were more likely to register a higher number of cases of COVID-19. Conversely, COVID-19 incidence was negatively associated with (6) percentage of residents with post-secondary education and (7) population born in countries with a high Human Development Index. CONCLUSION: Like other historical pandemics, the incidence of COVID-19 is associated with neighbourhood sociodemographic factors with a greater burden faced by already deprived areas. Because urban social and health injustices already existed in those geographical units with higher COVID-19 incidence in Barcelona, the current pandemic is likely to reinforce both health and social inequalities, and urban environmental injustice all together.

Gentrification pathways and their health impacts on historically marginalized residents in Europe and North America: Global qualitative evidence from 14 cities.

As global cities grapple with the increasing challenge of gentrification and displacement, research in public health and urban geography has presented growing evidence about the negative impacts of those unequal urban changes on the health of historically marginalized groups. Yet, to date comprehensive research about the variety of health impacts and their pathways beyond single case sites and through an international comparative approach of different gentrification drivers and manifestations remains scarce. In this paper, we analyze qualitative data on the pathways by which gentrification impacts the health of historically marginalized residents in 14 cities in Europe and North America. We build on 77 interviews with key neighborhood stakeholders. Data analysis indicates four main concurrent processes: Threats to housing and financial security; Socio-cultural displacement; Loss of services and amenities through institutional gentrification; and Increased risks of criminal behavior and compromised public safety. Gentrification is experienced as a chain of physical and emotional community and individual traumas - an overall shock for historically marginalized groups - because of permanent pressures of insecurity, loss, state of displaceability, and the associated exacerbation of socio-environmental disadvantages.

Mental Health Outcomes in Barcelona: The Interplay between Gentrification and Greenspace.

Greenspace is widely related to mental health benefits, but this relationship may vary by social group. Gentrification, as linked to processes of unequal urban development and conflict, potentially impacts health outcomes. This study explores the relationships between greenspace and mental health and between gentrification and mental health associations. It also further examines gentrification as an effect modifier in the greenspace-mental health association and SES as an effect modifier in the gentrification-mental health association. We used cross-sectional Barcelona (Spain) data from 2006, which included perceived mental health status and self-reported depression/anxiety from the Barcelona Health Survey. Greenspace exposure was measured as residential access to (1) all greenspace, (2) greenways and (3) parks in 2006. Census-tract level gentrification was measured using an index including changes in sociodemographic indicators between 1991 and 2006. Logistic regression models revealed that only greenways were associated with better mental health outcomes, with no significant relationship between mental health and parks or all greenspace. Living in gentrifying neighborhoods was protective for depression/anxiety compared to living in non-gentrifying neighborhoods. However, only residents of gentrifiable census tracts benefited from the exposure to greenways. SES was not found to be an effect modifier in the association between gentrification and mental health. Future research should tackle this study's limitations by incorporating a direct measure of displacement in the gentrification status indicator, accounting for qualitative aspects of greenspace and user's perceptions. Gentrification may undermine the health benefits provided by greenspace interventions.

Active use and perceptions of parks as urban assets for physical activity: A mixed-methods study.

Parks are potential key urban assets for improved population health; however, their use is not equal among all social groups. Individual and contextual factors could influence residents' perceptions of parks and how they interact with and, eventually, benefit from them. The use of complementary methodologies provides a deeper understanding of the relationship between park use, physical activity (PA), and residents' perceptions. Thus, we designed a mixed-methods study to analyze differences in park use and PA, and the perceptions of parks as urban assets for PA. We selected six parks from three neighborhoods in Madrid (Spain) with different neighborhood socioeconomic status (NSES) for systematic social observation. We registered park users by age, PA level (low, medium, and high), gender, and NSES using the System for Observing Play and Recreation in Communities (SOPARC) audit tool adapted for iOS software (iSOPARC). We also conducted 37 semi-structured interviews and 29 focus groups to analyze residents' perceptions of parks as urban assets for PA in the same neighborhoods. We adopted a convergent-parallel design to analyze both quantitative and qualitative data, and to describe the convergence and divergence areas between them. Parks within the high-NSES were more visited, showing a higher proportion of people performing high PA (11.9%) as compared to residents of the middle (9.3%) and low-NSES (3.2%). Female visitors showed lower PA levels compared to men, especially for parks within high-NSES. The following issues were reported as influence urban park use and perceptions: park maintenance and area perception, works constraints, insecurity and crime, differential perceptions by age, and the availability of organized activities in the parks. Residents from high-NSES reported fewer barriers to park use compared to residents from the other areas, who reported limitations such as less leisure time due to job constrains or perceived insecurity in parks. Senior participants reported that having parks with organized activities and a design oriented towards different age-groups are valuable. Our study shows consistency between the fewer and less intense use of parks registered in the middle and low-NSES neighborhoods, and the more barriers for PA reported in this areas during the qualitative analysis. Mixed-methods provided an insight of the potential causes leading to the differences in park use and PA within cities, which is essential in terms of environmental justice and health equity. Thus, a mixed-methods comprehensive approach to public health problems can help designing public policies addressing relevant factors related to urban health inequities.

Exposure to nature and mental health outcomes during COVID-19 lockdown. A comparison between Portugal and Spain.

BACKGROUND: To control the spread of the SARS-CoV-2 virus, countries around the world implemented lockdowns with varying intensities. Lockdowns, however, have been associated with a deterioration of mental health, including post-traumatic stress symptoms, anger and anxiety. Exposure to nature might reduce stress and provide relaxation opportunities. OBJECTIVE: Firstly, we aimed to determine which sociodemographic, housing and lockdown-related characteristics were associated with changes in exposure to nature during the COVID-19 lockdown in Portugal and Spain. Secondly, we sought to estimate the associations of these changes with mental health, and test whether these associations differed according to sociodemographic characteristics and between the two countries, which experienced different restrictions and epidemiological situations. METHODS: A cross-sectional study was conducted between March 27 and May 6, 2020, using an online questionnaire to measure changes in exposure to nature (including private green space and other greenery, views of nature from home and public natural spaces); sociodemographic, housing and lockdown-related characteristics; stress levels (visual stress scale); psychological distress (General Health Questionnaire - 12 items) and somatization (somatization scale). Adjusted regression models were fitted to estimate associations. RESULTS: This study included 3157 participants (1638 from Portugal, 1519 from Spain). In Portugal, maintaining/increasing the use of public natural spaces during the lockdown was associated with lower levels of stress (adjusted beta -0.29; 95%CI -0.49, -0.08) and maintaining/increasing the frequency of viewing nature from home was associated with reduced psychological distress (0.27; -0.51, -0.03), somatization (-0.79; -1.39, -0.20), and stress levels (-0.48; -0.74, -0.23). In Spain, maintaining/increasing contact with private green space and greenery was associated with lower stress levels: for contact with indoor plants (-0.52; -0.96, -0.07) and for use of private community green spaces (-0.82; -1.61, -0.03). CONCLUSION: Exposure to nature was associated with better mental health outcomes during lockdowns, but the natural features associated with improved mental health differed between the two countries. Nature should be incorporated into urban planning interventions and housing design and exposure to nature should be promoted during lockdowns.

The relationship between residential proximity to outdoor play spaces and children's mental and behavioral health: The importance of neighborhood socio-economic characteristics.

Urban outdoor play spaces are reported to improve children's health. However, there is little empirical evidence on the impact of outdoor play spaces on childhood mental and behavioral health. To fill this gap, we investigated the associations between residential proximity to outdoor play spaces and the prevalence of diagnosed mental and behavioral disorders. We explored whether these associations differ by individual and area-level socio-economic status (SES). This cross-sectional study included 151 110 children who were 0-12 years old in 2014 and were visited in public primary health care centers in Barcelona (Spain). Each child's demographic and mental and behavioral disorders information was extracted for 2005-2014, including diagnoses on disorders of psychological development together with other four types of mental and behavioral disorders. The pediatrician diagnosed mental and behavioral disorders we explored in this study were: mood/affective; neurotic, stress-related and somatoform; psychological development; behavioral and emotional; and overall mental and behavioral disorders. We assessed 300 m network buffer residential proximity to overall outdoor play spaces (i.e., the overall sum of play spaces of any type), outdoor green play spaces, and to a diversity of outdoor play spaces. We used robust Poisson regression models to investigate the association between proximity to outdoor play spaces indicators and each health outcome. We tested interaction terms for indicators of proximity to outdoor play spaces and individual and area SES. For measures with significant interaction terms, we conducted stratified models. We found residential proximity to outdoor play spaces to be protective of disorders of psychological development. Proximity to overall outdoor play spaces, proximity to outdoor green play spaces and proximity to a greater diversity of outdoor play spaces were associated with a 4% (95% CI: 1,7), 4% (95% CI: 1,7) and 5% (95% CI: 2,9) lower prevalence rates of disorders of psychological development respectively. Most of the associations were found to be in the same direction-although more pronounced-in low SES areas, but in the opposite direction for children living in high SES areas. No differences in these associations were found by individual SES. Residential proximity to outdoor play spaces is protective of children's mental and behavioral health living in low SES areas.

Natural outdoor environments' health effects in gentrifying neighborhoods: Disruptive green landscapes for underprivileged neighborhood residents.

BACKGROUND: Cities are restoring existing natural outdoor environments (NOE) or creating new ones to address diverse socio-environmental and health challenges. The idea that NOE provide health benefits is supported by the therapeutic landscapes concept. However, several scholars suggest that NOE interventions may not equitably serve all urban residents and may be affected by processes such as gentrification. Applying the therapeutic landscapes concept, this study assesses the impacts of gentrification processes on the associations between NOE and the health of underprivileged, often long-term, neighborhood residents. METHODS: We examined five neighborhoods in five cities in Canada, the United States and Western Europe. Our case studies were neighborhoods experiencing gentrification processes and NOE interventions. In each city, we conducted semi-structured qualitative interviews on NOE interventions, equity/justice, gentrification and health (n = 117) with case study neighborhood residents, community-based organizations, neighborhood resident leaders and other stakeholders such as public agencies staff. RESULTS: Respondents highlighted a variety of interconnected and overlapping factors: the insufficient benefits of NOE to counterbalance other factors detrimental to health, the use of NOE for city branding and housing marketing despite pollution, unwelcomeness, increase of conflicts, threats to physical displacement for themselves and their social networks, unattractiveness, deficient routes, inadequate NOE maintenance and lack of safety in NOE. CONCLUSIONS: Our study demonstrated that underprivileged neighborhood residents were perceived to experience new or improved NOE as what we call "disruptive green landscapes" (i.e. non-therapeutic landscapes with which they were not physically or emotionally engaged) instead of as therapeutic landscapes.

Adapting the environmental risk transition theory for urban health inequities: An observational study examining complex environmental riskscapes in seven neighborhoods in Global North cities.

Theories of epidemiologic transition analyze the shift in causes of mortality due to changes in risk factors over time, and through processes of urbanization and development by comparing risk factors between countries or over time. These theories do not account for health inequities such as those resulting from environmental injustice, in which minority and lower income residents are more likely to be exposed to environmental hazards or have less access to environmental goods. Neighborhoods with histories of environmental injustice are also at risk for gentrification as they undergo environmental improvements and new greening projects. We aimed to understand how environmental injustice, urban renewal and green gentrification could inform the understanding of epidemiologic risk transitions. We examined 7 case neighborhoods in cities in the United States and Western Europe which were representative in terms of city region and type, which 1) had experienced a history of environmental injustice and 2) exhibited evidence of recent processes of urban renewal and/or gentrification. In each city, we conducted semi-structured qualitative interviews (n = 172) with city representatives, activists, non-profits, developers and residents. Respondents reported health implications of traditional (heavy pollutants, poor social conditions), transitional (decontamination, new amenities), new (gentrification, access to amenities), and emerging (displacement, climate-related risks, re-emergence of traditional exposures) exposures. Respondents reported renewed, complexified and overlapping exposures leading to poor mental and physical health and to new patterns of health inequity. Our findings point to the need for theories of environmental and epidemiologic risk transitions to incorporate analysis of trends 1) on a city-scale, acknowledging that segregation and patterns of environmental injustice have created unequal conditions within cities and 2) over a shorter and more recent time period, taking into account worsening patterns of social inequity in cities.