Urban policy, space and wellbeing: a move towards LGBTQIA+ inclusive planning.

Public spaces influence the health and safety of lesbian, gay, bisexual, trans, queer, intersex, asexual and other sexual and gender-diverse (LGBTQIA+) communities. However, there is minimal research to demonstrate the link between inclusive urban policy and planning and the wellbeing of LGBTQIA+ communities. Consequently, in this perspective, we reflect on our project, which offered foundational work for understanding LGBTQIA+ experiences of public spaces in Australia's three most populous urban centres - Sydney, Melbourne and Brisbane. Our desk-based research approach provides a five-point evaluative framework to assess how local government areas (LGAs) accommodate LGBTQIA+ communities. We then present a recommendations framework for creating more inclusive local areas and public spaces. We propose that 'usualising' queerness in public spaces can lead to increased health and wellbeing for LGBTQIA+ communities.

Urban environmental exposures during the first 2000 days of life as a foundation for health across the life-course: a scoping review.

OBJECTIVES: By 2030, 60% of the global population is expected to live in urban areas. Exposure to urban environments during the first 2000 days of life can have positive or negative health outcomes across the life course. Understanding the types of urban exposures that influence health outcomes is needed to guide research priorities for public health and urban planning. This review aims to summarise the published research examining the health outcomes of all urban environmental exposures during the first 2000 days of life, identify the quantity and characteristics of research in this area, methods used, and knowledge gaps. METHODS: We conducted a scoping review using the JBI methodology for scoping reviews. Eight databases were searched for peer-reviewed primary studies. Inclusion criteria were studies that measured maternal, infant and child exposure to everyday urban environment features and conditions in cities/metropolitan areas during the first 2000 days of life and reported offspring health outcomes across the life course, including embryo, fetal/newborn, infant, child, adolescent, and adult outcomes. We used Covidence software for data screening and extraction. Study characteristics and findings were summarised using tables and narrative synthesis. RESULTS: We reviewed 235 articles, which included studies conducted across 41 countries, the majority in the US (n = 63). A broad range of environmental exposures were studied, spanning seven categories: air pollution; energy-based pollution; atmosphere, chemical and metal exposure; neighbourhood-built and natural environment features; neighbourhood community conditions; and residential living conditions. Air pollution was the most studied exposure type (n = 153 studies). Health outcomes were reported for all life stages except adults, with fetal/newborn outcomes the most studied life stage (n = 137). CONCLUSIONS: We found that most research investigating urban environmental exposures in the first 2000 days and health outcomes across the life course focused on air pollution exposures and fetal/newborn health outcomes, using correlational retrospective cohort designs. Few studies included multiple environmental exposures. There is a clear need for more longitudinal research to determine the health impacts of multiple urban environmental exposures across the life course. This will assist in developing urban design and planning strategies and population health to mitigate health risks across the life course.

A participatory system map of the adverse influence of urban environments on population health: integrating urban development and preventive health expertise.

OBJECTIVES: A growing number of urban development and public health professionals are developing expertise in how urban environments influence population health to support preventive health (PH) planning, implementation and outcomes. This study aimed to address the growing interest among these experts in Sydney, Australia, to move beyond silo-based approaches to PH planning and urban development by developing a preliminary mapping of the complex adaptive system. This is a network of agents and parts that collectively relate and interact, where they seek to intervene by meshing the disparate knowledge of their multidisciplinary expertise. This mapping will help experts to better integrate PH approaches by linking primordial and primary prevention within urban environments, collectively prioritising areas for intervention within the complex adaptive system, and developing a better understanding of relations between multiple factors at play within it. METHODS: The system map was developed using a unique participatory system-mapping (PSM) process involving a modified Delphi technique consisting of three rounds between October 2019 and August 2020 and 15 urban development and public health experts engaged in PH in Sydney's urban environment. RESULTS: The final system map encompassed features of the local environment, determinants of health and wellbeing in urban environments, pre-clinical health and wellbeing impacts, and clinical health outcomes, providing a comprehensive map of the adverse effects of urban environments on population health. There was a high level of agreement among experts on the final system map. While experts from different disciplines generally agreed on priority areas for intervention, consensus was higher among those from similar disciplinary backgrounds. CONCLUSIONS: The study highlights how the collective intelligence of experts from diverse disciplines can generate PSM. Furthermore, it illustrates how using systems mapping can help experts interested in complex public health problems to take a broader view of the complex adaptive system for PH planning, support collaborative prioritisation, and offer valuable insights for targeted interventions.

Developing a climate change inequality health impact assessment for health services.

OBJECTIVES: To develop a Climate Change Inequality Health Impact Assessment (CCIHIA) framework for health services; to provide a systematic process for assessing potential unequal health impacts of climate change on vulnerable and marginalised populations and places; to support effective planning to address these impacts; and to develop contextually appropriate local strategies. Type of program: A collaborative interdisciplinary scoping research project involving two universities and two local health districts (LHDs) in New South Wales (NSW) to develop a CCIHIA framework. This work builds upon the health impact assessment (HIA) approach, which systematically assesses proposals' potential health and equity impacts by involving stakeholders in developing responses. METHODS: The project involved four main activities: understanding stakeholder requirements; conceptualising climate change vulnerability; considering the role of health services; and integrating findings into a conceptual framework. RESULTS: Stakeholders identified key functions that should be addressed across the framing, process and utility of the CCIHIA framework. The resulting conceptual framework outlines contexts and social stratification, the differential impacts of climate change (including factors influencing unequal impacts) and the health system's position, and also identifies key potential points of intervention. LESSONS LEARNT: The challenge of addressing the complexity of factors and resulting health impacts is reflected within the CCIHIA framework. While there are many intervention points within this framework for health services to address, many factors influencing unequal impacts are created outside the health sector's direct control. The framework's development process reflected the focus on collaboration and the interdisciplinary nature of climate change response. Ultimately, the CCIHIA framework is an assessment tool and an approach for prioritising inclusive, cross-cutting, multisector working, and problem-solving.

Respiratory pandemics, urban planning and design: A multidisciplinary rapid review of the literature.

COVID-19 is the most recent respiratory pandemic to necessitate better knowledge about city planning and design. The complex connections between cities and pandemics, however challenge traditional approaches to reviewing literature. In this article we adopted a rapid review methodology. We review the historical literature on respiratory pandemics and their documented connections to urban planning and design (both broadly defined as being concerned with cities as complex systems). Our systematic search across multidisciplinary databases returned a total of 1323 sources, with 92 articles included in the final review. Findings showed that the literature represents the multi-scalar nature of cities and pandemics - pandemics are global phenomena spread through an interconnected world, but require regional, city, local and individual responses. We characterise the literature under ten themes: scale (global to local); built environment; governance; modelling; non-pharmaceutical interventions; socioeconomic factors; system preparedness; system responses; underserved and vulnerable populations; and future-proofing urban planning and design. We conclude that the historical literature captures how city planning and design intersects with a public health response to respiratory pandemics. Our thematic framework provides parameters for future research and policy responses to the varied connections between cities and respiratory pandemics.

Halfway Around The World, Echoes Of Physician Moral Injury.

A physician seeks respite from the injustice of US care delivery but encounters familiar signals of system failure abroad.

Sociodemographic predictors of residents worry about contaminated sites.

The management and remediation of contaminated environments increasingly involves engagement with affected local residents. Of late, risk communication tools and guidelines have drawn attention to the stress and concern of residents as a result of heightened awareness of localised contamination and the need to address these less visible impacts of contamination when engaging with affected communities. Despite this emerging focus, there is an absence of research exploring the factors that predict resident worry about neighbourhood contamination. This paper aims to address this shortcoming by drawing on data from a cross-sectional survey of 2009 adult residents in neighbourhoods near 13 contaminated sites across Australia. Analyses used ordered logistic regression to determine the sociodemographic, environmental, and knowledge-based factors that influence residents' degree of worry. The findings suggest age, gender and income significantly affect residents' degree of worry. Being knowledgeable about the contaminant was associated with lower degrees of worry. Conversely, having a stronger sense of place within a neighbourhood predicted higher degrees of worry. Type of contaminant also impacted resident worry, with residents being less likely to worry about hydrocarbon, asbestos and waste than other types of contaminants. Our analyses suggest resident worry can be reduced through improving access to accurate information and the development of specific risk reduction strategies tailored to each neighbourhood and aimed at the heterogeneous distribution of worry amongst residential populations.

Factors influencing residents' acceptance (support) of remediation technologies.

An increasing diversity of technologies are being used to remediate contaminated sites, yet there remains little understanding of the level of acceptance that residents living near these sites hold for these technologies, and what factors influence their level of acceptance. This lack of understanding hinders the remediation industry's ability to effectively engage with these residents about remediation technology selection, at a time when such engagement is become part and parcel of remediation policy and practice. The study develops on wider research into public acceptance of technologies, using data from a telephone survey of 2009 residents living near thirteen contaminated sites across Australia. Within the survey acceptance is measured through residents' level of support for the application of remediation technologies in their local area. Firstly, a regression analysis of closed-ended questions, and coding of open-ended questions are combined to identify the main predictors of residents' support for remediation technologies. Secondly, coding of open-ended questions was analysed using Crawford and Ostrom's Institutional Grammar Tool to identify norms and sanctions guiding residents' willingness to negotiate their support. The research identifies factors associated with the residents' personal and demographic characteristics, their physical context and engagement with institution during remediation processes, and the technologies themselves which predict residents' level of support for the application of remediation technologies. Bioremediation technologies had higher levels of support than chemical, thermal and physical technologies. Furthermore, the paper identifies a core set of norms and sanctions residents use to negotiate their level of support for remediation technologies.

Built environment interventions for human and planetary health: integrating health in climate change adaptation and mitigation.

OBJECTIVES: Human-generated climate change is causing adverse health effects through multiple direct pathways (e.g. heatwaves, sea-level rise, storm frequency and intensity) and indirect pathways (e.g. food and water insecurity, social instability). Although the health system has a key role to play in addressing these health effects, so too do those professions tasked with the development of the built environment (urban and regional planners, urban designers, landscapers and architects), through improvements to buildings, streets, neighbourhoods, suburbs and cities. This article reports on the ways in which urban planning and design, and architectural interventions, can address the health effects of climate change; and the scope of climate change adaptation and mitigation approaches being implemented by the built environment professions. Type of program or service: Built environment adaptations and mitigations and their connections to the ways in which urban planning, urban design and architectural practices are addressing the health effects of climate change. METHODS: Our reflections draw on the findings of a recent review of existing health and planning literature. First, we explore the ways in which 'adaptation' and 'mitigation' relate to the notion of human and planetary health. We then outline the broad scope of adaptation and mitigation interventions being envisioned, and in some instances actioned, by built environment professionals. RESULTS: Analysis of the review's findings reveals that adaptations developed by built environment professions predominantly focus on protecting human health and wellbeing from the effects of climate change. In contrast, built environment mitigations address climate change by embracing a deeper understanding of the co-benefits inherent in the interconnectedness of human health and wellbeing and the health of the ecosystem on which it depends. In the final section, we highlight the ethical transition that these approaches demand of built environment professions. LESSONS LEARNT: Built environment interventions must move beyond simple ecological sustainability to encouraging ways of life that are healthy for both humans and the planet. There are key challenges facing this new approach.

Evaluating residents' preferences for remediation technologies: A choice experiment approach.

The choice of technologies used to remediate contaminated environments is increasingly made through engagement with a multitude of stakeholders including affected residents. Despite this, little is known about how residents perceive remediation technology applications. In this study a choice experiment is designed to explore ways of understanding and measuring residents' preferences for different remediation technologies approaches using a sample of 944 residents in New South Wales, Australia. Analysis reveals that the residents' acceptability of remediation technologies can be explained by both the efficacy of the technology in improving the environmental quality of the community, and the reputational value of the technology. In particular it is found that residents prefer Monitor Natural Attenuation and Bioremediation to other remediation technologies. In particular they are willing to pay an increase in yearly taxes of $44.60 and $41.15 respectively for implementing such technologies instead of alternative remediation technologies like Chemical remediation.

Engaging with residents' perceived risks and benefits about technologies as a way of resolving remediation dilemmas.

In recent decades the diversity of remediation technologies has increased significantly, with the breadth of technologies ranging from dig and dump to emergent technologies like phytoremediation and nanoremediation. The benefits of these technologies to the environment and human health are believed to be substantial. However, they also potentially constitute risks. Whilst there is a growing body of knowledge about the risks and benefits of these technologies from the perspective of experts, little is known about how residents perceive the risks and benefits of the application of these technologies to address contaminants in their local environment. This absence of knowledge poses a challenge to remediation practitioners and policy makers who are increasingly seeking to engage these affected local residents in choosing technology applications. Building on broader research into the perceived benefits and risks of technologies, and data from a telephone survey of 2009 residents living near 13 contaminated sites in Australia, regression analysis of closed-ended survey questions and coding of open-ended questions are combined to identify the main predictors of resident's perceived levels of risk and benefit to resident's health and to their local environment from remediation technologies. This research identifies a range of factors associated with the residents' physical context, their engagement with institutions during remediation processes, and the technologies which are associated with residents' level of perceived risk and benefit for human health and the local environment. The analysis found that bioremediation technologies were perceived as less risky and more beneficial than chemical, thermal and physical technologies. The paper also supports broader technology research that reports an inverse correlation between levels of perceived risks and benefits. In addition, the paper reveals the types of risks and benefits to human health and the local environment that residents most commonly associate with remediation technologies.

Using residents' worries about technology as a way of resolving environmental remediation dilemmas.

The choice of technologies used to remediate contaminated environments are increasingly made via engagement with affected local residents. Despite this, little is known about how residents perceive remediation technology applications. Building on the findings of broader technology worry research, and drawing on data from a telephone survey of 2009 residents living near thirteen contaminated sites in Australia, regression analysis of closed-ended survey questions and coding analysis of open-ended survey questions are combined to identify the main predictors of worries concerning particular remediation technologies, and how worry affects them. This suggests respondents are more worried about the application of chemical remediation technologies than the application of physical and thermal technologies, which in turn caused more worry than the application of biotechnology. The paper suggests that these worries can be reduced via direct engagement with residents about remediation technologies, suggesting that such engagement can provide knowledge that improves remediation technology decisions.

The norms, rules and motivational values driving sustainable remediation of contaminated environments: A study of implementation.

Efforts to achieve sustainability are transforming the norms, rules and values that affect the remediation of contaminated environments. This is altering the ways in which remediation impacts on the total environment. Despite this transformation, few studies have provided systematic insights into the diverse norms and rules that drive the implementation of sustainable remediation at contaminated sites, and no studies have investigated how values motivate compliance with these norms and rules. This study is a systematic analysis of the rules, norms and motivational values embedded in sustainable remediation processes at three sites across Australia, using in-depth interviews conducted with 18 participants between 2011 and 2014, through the application of Crawford and Ostrom's Institutional Grammar and Schwartz's value framework. These approaches offered methods for identifying the rules, norms, and motivational values that guided participants' actions within remediation processes at these sites. The findings identify a core set of 16 norms and 18 rules (sanctions) used by participants to implement sustainable remediation at the sites. These norms and rules: define the position of participants within the process, provide means for incorporating sustainability into established remediation practices, and define the scope of outcomes that constitute sustainable remediation. The findings revealed that motivational values focused on public interest and self-interest influenced participants' compliance with norms and rules. The findings also found strong interdependence between the norms and rules (sanctions) within the remediation processes and the normative principles operating within the broader domain of environmental management and planning. The paper concludes with a discussion of: the system of norms operating within sustainable remediation (which far exceed those associated with ESD); their link, through rules (sanctions) to contemporary styles of regulatory enforcement; and the underlying balance of public-interest values and self-interest values that drives participants' involvement in sustainable remediation.

Amongst the ruins.

Through the reflections of interviewees from New York, Montreal, and Sydney, this article investigates the affective qualities of urban ruins and the role they have played in gay male experience and identity construction from 1970 to 2000. Along with other places on the margins of regulated space, urban ruins operate as points of transition--passages from reason to myth at the interstices of ordered urban space. The article argues that the sensual feelings and memories conjured by these ruins enable alternative modes of being for gay men that stand in contrast to the more regimented modes of everyday life.

Sex worker victimization, modes of working, and location in New South Wales, Australia: a geography of victimization.

This article examines the association among victimization, modes of sex working, and the locations used by sex workers through an analysis of "Ugly Mug" reports detailing 528 crime acts in 333 reported incidents in New South Wales (NSW), Australia. These forms, voluntarily lodged between 2000 and 2008 by members of NSW's estimated 10,000 sex worker population, suggest that street-based work has a higher victimization rate than other modes of working, including escort work, work in commercial premises, and private work. Although this ostensibly supports the commonly held view that "outdoor" working is more dangerous than "indoor" work, this analysis suggests that most instances of victimization actually occur in private spaces. Hence, it is argued that risks of victimization in sex work are influenced by a variety of environmental characteristics relating to concealment, control, and isolation, suggesting that not all off-street locations are equally safe. We conclude with recommendations for policy regarding sex work.

Spiritual dimensions of self-transformation in Sydney's gay bathhouses.

Interview-based research among patrons and proprietors of Sydney's gay bathhouses, asking about experiences of homosexual being from the 1960s to the early 1980s generated intriguing findings. Despite the apparent disconnect between traditional religious affiliation and the outlaw gay lifestyle of the bathhouses, a majority of interviewees asserted that spirituality and self-transformation was as important to them as sexual exploration and liberation from societal restraints (both as motivations for and outcomes of the bathhouse experience). Some of those interviewed adhered to mainstream religion (including Christianity and Judaism), but a significant number expressed a commitment to eclectic, personalized spiritual paths. Interestingly, both groups described the bathhouses as "churches" and "temples," the activities that took place there as both collective and individual "rituals," and attributed their spiritual growth and development to their experiences in the bathhouses.

Hepatocellular carcinoma with intracavitary cardiac involvement: a case report and review of the literature.

A 71-year-old man with hepatocellular carcinoma (HCC) presented with intracavitary cardiac involvement detected incidentally on surveillance computed tomography. Tumor with associated thrombus was found to extend from the liver through the inferior vena cava into the right atrium. This intracardiac mass prolapsed intermittently into the right ventricle, causing functional tricuspid stenosis. The mass was resected but recurred after 4 months, eventually causing refractory right-sided heart failure. This case illustrates how intracavitary cardiac involvement of HCC can develop insidiously and confer significant hemodynamic compromise. A review of the published research, including postmortem studies, demonstrates that the frequency of intracardiac mass lesions in HCC is not insignificant. In conclusion, early detection and diagnosis may have increasing importance in the advent of new therapies for treating advanced HCC.