This research focuses on the ability of spatial decision-support tools (SDST) to transform urban ... more This research focuses on the ability of spatial decision-support tools (SDST) to transform urban regeneration processes through collaborative planning between authorities and communities. This article presents what was learned from the implementation of two SDST within planning authorities in Aotearoa, New Zealand. The first tool, Envision, enables the identification of suitable areas for urban regeneration; the second, ESP, focuses on the environmental and socio-economic assessment of regeneration scenarios at the neighbourhood scale. We use empirical observations from the implementation of these SDST in diverse planning authorities, to analyse the influence of local specificities and appropriate collaboration models for the development and adoption of the tools for decision-making and community engagement. We provide recommendations for future development and implementation of SDST to reinforce collaborative planning and local governance within urban regeneration processes.
Chronic Obstructive Pulmonary Disease is a progressive lung disease affecting the respiratory fun... more Chronic Obstructive Pulmonary Disease is a progressive lung disease affecting the respiratory function of every sixth New Zealander and over 300 million people worldwide. In this paper, we explored how the combination of social, demographical and environmental conditions (represented by increased winter air pollution) affected hospital admissions due to COPD in an urban area of Christchurch (NZ). We juxtaposed the hospitalisation data with dynamic air pollution data and census data to investigate the spatiotemporal patterns of hospital admissions. Spatial analysis identified high-risk health hot spots both overall and season specific, exhibiting higher rates in winter months not solely due to air pollution, but rather as a result of its combination with other factors that initiate deterioration of breathing, increasing impairments and lead to the hospitalisation of COPD patients. From this we found that socioeconomic deprivation and air pollution, followed by the age and ethnicity s...
Telephone triage is a health tool increasingly used to connect geographically distant populations... more Telephone triage is a health tool increasingly used to connect geographically distant populations. Such services are also utilised to address issues of Emergency Department (ED) overuse. New Zealand's tele-triage service, Healthline, has existed since 2001 but is yet to be the focus of analysis. This research sought to understand the role that travel time to ED had upon Healthline users' compliance with telephone advice. Additionally, the role of deprivation in Healthline (as a determinant of caller behaviour) was examined. Travel time to ED was found to influence the impact of Healthline advice upon callers but this was not confounded by deprivation. Those living closest to the ED were more likely to attend when advised to, and less likely to stay away if told to avoid the ED. Different time brackets showed stronger trends, suggesting that callers at varying distances from EDs may be more or less influenced by both travel time and Healthline advice.
This article explores the spatio-temporal variation of mood and anxiety treatments in the context... more This article explores the spatio-temporal variation of mood and anxiety treatments in the context of a severe earthquake sequence. The aim was to examine a possible earthquake exposure effect, identify populations at risk and areas with particularly large mood and anxiety treatment rate increases or decreases in the affected Christchurch urban area. A significantly stronger increase of mood and anxiety treatments among residents in Christchurch compared to others in New Zealand have been found, as well as children and elderly identified as especially vulnerable. Spatio-temporal cluster analysis and Bayesian spatio-temporal modelling revealed little changes in mood and anxiety treatment patterns for most parts of the city, whereas areas in the less affected north and northwest showed the strongest increases in risk. This effect may be linked to inner-city mobility activity as a consequence of the earthquakes, but also different levels of community cohesion after the disaster, which merit further research.
Australian and New Zealand journal of public health, Jan 15, 2016
Since 2012, all community care recipients in New Zealand have undergone a standardised needs asse... more Since 2012, all community care recipients in New Zealand have undergone a standardised needs assessment using the Home Care International Residential Assessment Instrument (interRAI-HC). This study describes the national interRAI-HC population, assesses its data quality and evaluates its ability to be matched. The interRAI-HC instrument elicits information on 236 questions over 20 domains; conducted by 1,800+ trained health professionals. Assessments between 1 July 2012 and 30 June 2014 are reported here. Stratified by age, demographic characteristics were compared to 2013 Census estimates and selected health profiles described. Deterministic matching to the Ministry of Health's mortality database was undertaken. Overall, 51,232 interRAI-HC assessments were conducted, with 47,714 (93.1%) research consent from 47,236 unique individuals; including 2,675 Māori and 1,609 Pacific people. Apart from height and weight, data validity and reliability were high. A 99.8% match to mortality...
ABSTRACT Background: As urbanization escalates globally, urban neighbourhood features which impro... more ABSTRACT Background: As urbanization escalates globally, urban neighbourhood features which improve physical and, more recently, mental health are of growing importance. One area of exploration is the role of visibility of green/blue space. Objective: To quantify visual exposure to green/blue space using novel spatial methodologies and to investigate whether visibility was associated with psychological stress (K-10) in a national adult sample. Methods: Novel visibility measurements were created for blue/green space to account for the distance, slope, aspect and relative elevation of visible areas from each population-weighted neighbourhood viewpoint. We fitted separate cluster robust linear regression models for K-10 scores and visibility measures, adjusted for age, sex, personal income, and neighbourhood population density, crime and deprivation. Results: We did not detect a significant association between total green space visibility and K-10 scores. By distance bands, we found that green space visibility only at distances 3-6km and 6-15km were associated with decreased psychological stress (β = -21, p = 0.01 and β = -0.15, p = 0.06). For blue space, we found increased visibility was associated with decreased psychological stress (β = -0.32, p <0.001). Personal income (in all models), neighbourhood deprivation and population density (in several models) also exhibited significant independent effects on K-10 scores. Conclusion: These results suggest that increased visibility of blue space generally and of distant green space have a salutogenic effect and may play a role in psychological stress reduction.
As urbanisation escalates globally, urban neighbourhood features which may improve physical and m... more As urbanisation escalates globally, urban neighbourhood features which may improve physical and mental health are of growing importance. Using a cross-sectional survey of adults and the application of novel geospatial techniques, this study investigated whether increased visibility of nature (green and blue space) was associated with lower psychological distress (K10 scores), in the capital city of Wellington, New Zealand. To validate, we also tested whether visibility of blue space was associated missing teeth in the same sample. Cluster robust, linear regression models were fitted to test the association between visibility of nature and K10 scores, adjusted for age, sex, personal income, neighbourhood population density, housing quality, crime and deprivation. Higher levels of blue space visibility were associated with lower psychological distress (β=-0.28, p<0.001). Importantly, blue space visibility was not significantly associated with tooth loss. Further research is needed ...
Environmental health : a global access science source, Jan 8, 2016
Climate change is a global threat to health and wellbeing. Here we provide findings of an interna... more Climate change is a global threat to health and wellbeing. Here we provide findings of an international research project investigating the health and wellbeing impacts of policies to reduce greenhouse gas emissions in urban environments. Five European and two Chinese city authorities and partner academic organisations formed the project consortium. The methodology involved modelling the impact of adopted urban climate-change mitigation transport, buildings and energy policy scenarios, usually for the year 2020 and comparing them with business as usual (BAU) scenarios (where policies had not been adopted). Carbon dioxide emissions, health impacting exposures (air pollution, noise and physical activity), health (cardiovascular, respiratory, cancer and leukaemia) and wellbeing (including noise related wellbeing, overall wellbeing, economic wellbeing and inequalities) were modelled. The scenarios were developed from corresponding known levels in 2010 and pre-existing exposure response f...
ABSTRACT The determinants of health and mortality inequalities in New Zealand and Australia have ... more ABSTRACT The determinants of health and mortality inequalities in New Zealand and Australia have been subjected to research, with the influence of a range of socio-economic and demographic influences (deprivation, social class, ethnicity) receiving notable attention. Both countries are considered privileged, positioned amongst the world leaders in rankings of mortality and life expectancy. This paper reports on observed rates of mortality and views how the countries have fared over time with respect to one another. This study derives comparable rates of mortality for both New Zealand and Australia, disaggregated by age and sex for the time period 1948-2008. The age-standardised rates are visualised using the Lexis mapping software program, showing the relative differences between the countries over time whilst simultaneously highlighting age, period and cohort effects. Relative to Australia, New Zealand had advantageous rates of mortality across almost all age groups between the years 1948 and 1980 (approximately). For both sexes, a reversal of fortunes in New Zealand has followed relative to Australia. For example, for younger males in New Zealand, the reversal is apparent. Over the period observed males aged 10-20 in New Zealand have moved from an advantageous position of having a mortality rate 20% lower than Australia to a relative position of 50% higher. The social and economic forces in both New Zealand and Australia which may have driven the divergence require further scrutiny. It could be argued, that one key element changing relative mortality fortunes are processes of selective migration and the large-scale population movements between the two countries as well as broader economic factors. These findings have important implications for policy formation and service planning, if the inequality in mortality is to be addressed.
In this longitudinal study, we compare the effects of different types of relocation and level of ... more In this longitudinal study, we compare the effects of different types of relocation and level of affectedness on the incidence and relapse of mood and anxiety symptom treatments identified by publicly funded care or treatment one year before and one and two years after the '2011 Christchurch earthquake' in New Zealand. Based on a subset of Christchurch residents from differently affected areas of the city identified by area-wide geotechnical land assessments (no to severe land damage) 'stayers', 'within-city movers', 'out-of-city movers' and 'returners' were identified to assess the interaction effect of different levels of affectedness and relocation on the incidence and relapse of mood and anxiety symptom treatments over time. Health and sample information were drawn from the New Zealand Ministry of…
ABSTRACT Monitoring of air quality alongside heavily-trafficked motorways has shown air pollutant... more ABSTRACT Monitoring of air quality alongside heavily-trafficked motorways has shown air pollutant levels are typically much higher than levels at background monitoring sites. In many large cities, a significant portion of the population resides on land immediately adjacent to motorways. For long-term residents, this has been associated with adverse health outcomes. However, generalizing the impact of major roads on nearby air quality is complicated by local influences such as wind climate, topography and vehicle fleet emission rates. This study aimed to quantify and explain differences in pollutant levels at two roadside and several associated setback sites in Auckland, New Zealand. Levels of nitrogen oxides (NOx) and carbon monoxide (CO) were monitored over the 2010 and 2011 autumn-winter transition (April - July), around two urban motorways roughly 5 km apart. Limited monitoring of ultrafine particles (UFP) was also conducted at two sites. Annual Average Daily Traffic (AADT) was 33% greater at the primary study site (122,098) than at the secondary site (81,075). Unmonitored ultrafine particle (UFP) concentrations were modeled from NOx data using linear regression (R2&gt;0.75). Missing CO data was predicted using nitric oxide (NO) concentrations (R2=0.93). Dispersion modeling was performed using The Air Pollution Model (TAPM) in order to assess the influence of meteorology on pollutant decay. Results show that, for both study sites, mean levels of NOx and UFPs were elevated by 41 - 52% at the roadside compared to setback sites as close as 134 m downwind. CO concentrations were elevated by 44 - 64%. Mean roadside UFP, NOx and CO at the busier study area was 25,672 pt/cm3, 128.6 µg/m3 and 1.1 ppm, respectively; higher than the lesser trafficked area by 43% (UFP, NOx) and 56% (CO). Overall results suggest that outdoor exposure along the roadside corridor is approximately 50% greater than for those living at setback distances. As New Zealand homes are particularly prone to infiltration of outdoor air, these results may have significant long-term exposure implications.
This research focuses on the ability of spatial decision-support tools (SDST) to transform urban ... more This research focuses on the ability of spatial decision-support tools (SDST) to transform urban regeneration processes through collaborative planning between authorities and communities. This article presents what was learned from the implementation of two SDST within planning authorities in Aotearoa, New Zealand. The first tool, Envision, enables the identification of suitable areas for urban regeneration; the second, ESP, focuses on the environmental and socio-economic assessment of regeneration scenarios at the neighbourhood scale. We use empirical observations from the implementation of these SDST in diverse planning authorities, to analyse the influence of local specificities and appropriate collaboration models for the development and adoption of the tools for decision-making and community engagement. We provide recommendations for future development and implementation of SDST to reinforce collaborative planning and local governance within urban regeneration processes.
Chronic Obstructive Pulmonary Disease is a progressive lung disease affecting the respiratory fun... more Chronic Obstructive Pulmonary Disease is a progressive lung disease affecting the respiratory function of every sixth New Zealander and over 300 million people worldwide. In this paper, we explored how the combination of social, demographical and environmental conditions (represented by increased winter air pollution) affected hospital admissions due to COPD in an urban area of Christchurch (NZ). We juxtaposed the hospitalisation data with dynamic air pollution data and census data to investigate the spatiotemporal patterns of hospital admissions. Spatial analysis identified high-risk health hot spots both overall and season specific, exhibiting higher rates in winter months not solely due to air pollution, but rather as a result of its combination with other factors that initiate deterioration of breathing, increasing impairments and lead to the hospitalisation of COPD patients. From this we found that socioeconomic deprivation and air pollution, followed by the age and ethnicity s...
Telephone triage is a health tool increasingly used to connect geographically distant populations... more Telephone triage is a health tool increasingly used to connect geographically distant populations. Such services are also utilised to address issues of Emergency Department (ED) overuse. New Zealand's tele-triage service, Healthline, has existed since 2001 but is yet to be the focus of analysis. This research sought to understand the role that travel time to ED had upon Healthline users' compliance with telephone advice. Additionally, the role of deprivation in Healthline (as a determinant of caller behaviour) was examined. Travel time to ED was found to influence the impact of Healthline advice upon callers but this was not confounded by deprivation. Those living closest to the ED were more likely to attend when advised to, and less likely to stay away if told to avoid the ED. Different time brackets showed stronger trends, suggesting that callers at varying distances from EDs may be more or less influenced by both travel time and Healthline advice.
This article explores the spatio-temporal variation of mood and anxiety treatments in the context... more This article explores the spatio-temporal variation of mood and anxiety treatments in the context of a severe earthquake sequence. The aim was to examine a possible earthquake exposure effect, identify populations at risk and areas with particularly large mood and anxiety treatment rate increases or decreases in the affected Christchurch urban area. A significantly stronger increase of mood and anxiety treatments among residents in Christchurch compared to others in New Zealand have been found, as well as children and elderly identified as especially vulnerable. Spatio-temporal cluster analysis and Bayesian spatio-temporal modelling revealed little changes in mood and anxiety treatment patterns for most parts of the city, whereas areas in the less affected north and northwest showed the strongest increases in risk. This effect may be linked to inner-city mobility activity as a consequence of the earthquakes, but also different levels of community cohesion after the disaster, which merit further research.
Australian and New Zealand journal of public health, Jan 15, 2016
Since 2012, all community care recipients in New Zealand have undergone a standardised needs asse... more Since 2012, all community care recipients in New Zealand have undergone a standardised needs assessment using the Home Care International Residential Assessment Instrument (interRAI-HC). This study describes the national interRAI-HC population, assesses its data quality and evaluates its ability to be matched. The interRAI-HC instrument elicits information on 236 questions over 20 domains; conducted by 1,800+ trained health professionals. Assessments between 1 July 2012 and 30 June 2014 are reported here. Stratified by age, demographic characteristics were compared to 2013 Census estimates and selected health profiles described. Deterministic matching to the Ministry of Health's mortality database was undertaken. Overall, 51,232 interRAI-HC assessments were conducted, with 47,714 (93.1%) research consent from 47,236 unique individuals; including 2,675 Māori and 1,609 Pacific people. Apart from height and weight, data validity and reliability were high. A 99.8% match to mortality...
ABSTRACT Background: As urbanization escalates globally, urban neighbourhood features which impro... more ABSTRACT Background: As urbanization escalates globally, urban neighbourhood features which improve physical and, more recently, mental health are of growing importance. One area of exploration is the role of visibility of green/blue space. Objective: To quantify visual exposure to green/blue space using novel spatial methodologies and to investigate whether visibility was associated with psychological stress (K-10) in a national adult sample. Methods: Novel visibility measurements were created for blue/green space to account for the distance, slope, aspect and relative elevation of visible areas from each population-weighted neighbourhood viewpoint. We fitted separate cluster robust linear regression models for K-10 scores and visibility measures, adjusted for age, sex, personal income, and neighbourhood population density, crime and deprivation. Results: We did not detect a significant association between total green space visibility and K-10 scores. By distance bands, we found that green space visibility only at distances 3-6km and 6-15km were associated with decreased psychological stress (β = -21, p = 0.01 and β = -0.15, p = 0.06). For blue space, we found increased visibility was associated with decreased psychological stress (β = -0.32, p &lt;0.001). Personal income (in all models), neighbourhood deprivation and population density (in several models) also exhibited significant independent effects on K-10 scores. Conclusion: These results suggest that increased visibility of blue space generally and of distant green space have a salutogenic effect and may play a role in psychological stress reduction.
As urbanisation escalates globally, urban neighbourhood features which may improve physical and m... more As urbanisation escalates globally, urban neighbourhood features which may improve physical and mental health are of growing importance. Using a cross-sectional survey of adults and the application of novel geospatial techniques, this study investigated whether increased visibility of nature (green and blue space) was associated with lower psychological distress (K10 scores), in the capital city of Wellington, New Zealand. To validate, we also tested whether visibility of blue space was associated missing teeth in the same sample. Cluster robust, linear regression models were fitted to test the association between visibility of nature and K10 scores, adjusted for age, sex, personal income, neighbourhood population density, housing quality, crime and deprivation. Higher levels of blue space visibility were associated with lower psychological distress (β=-0.28, p<0.001). Importantly, blue space visibility was not significantly associated with tooth loss. Further research is needed ...
Environmental health : a global access science source, Jan 8, 2016
Climate change is a global threat to health and wellbeing. Here we provide findings of an interna... more Climate change is a global threat to health and wellbeing. Here we provide findings of an international research project investigating the health and wellbeing impacts of policies to reduce greenhouse gas emissions in urban environments. Five European and two Chinese city authorities and partner academic organisations formed the project consortium. The methodology involved modelling the impact of adopted urban climate-change mitigation transport, buildings and energy policy scenarios, usually for the year 2020 and comparing them with business as usual (BAU) scenarios (where policies had not been adopted). Carbon dioxide emissions, health impacting exposures (air pollution, noise and physical activity), health (cardiovascular, respiratory, cancer and leukaemia) and wellbeing (including noise related wellbeing, overall wellbeing, economic wellbeing and inequalities) were modelled. The scenarios were developed from corresponding known levels in 2010 and pre-existing exposure response f...
ABSTRACT The determinants of health and mortality inequalities in New Zealand and Australia have ... more ABSTRACT The determinants of health and mortality inequalities in New Zealand and Australia have been subjected to research, with the influence of a range of socio-economic and demographic influences (deprivation, social class, ethnicity) receiving notable attention. Both countries are considered privileged, positioned amongst the world leaders in rankings of mortality and life expectancy. This paper reports on observed rates of mortality and views how the countries have fared over time with respect to one another. This study derives comparable rates of mortality for both New Zealand and Australia, disaggregated by age and sex for the time period 1948-2008. The age-standardised rates are visualised using the Lexis mapping software program, showing the relative differences between the countries over time whilst simultaneously highlighting age, period and cohort effects. Relative to Australia, New Zealand had advantageous rates of mortality across almost all age groups between the years 1948 and 1980 (approximately). For both sexes, a reversal of fortunes in New Zealand has followed relative to Australia. For example, for younger males in New Zealand, the reversal is apparent. Over the period observed males aged 10-20 in New Zealand have moved from an advantageous position of having a mortality rate 20% lower than Australia to a relative position of 50% higher. The social and economic forces in both New Zealand and Australia which may have driven the divergence require further scrutiny. It could be argued, that one key element changing relative mortality fortunes are processes of selective migration and the large-scale population movements between the two countries as well as broader economic factors. These findings have important implications for policy formation and service planning, if the inequality in mortality is to be addressed.
In this longitudinal study, we compare the effects of different types of relocation and level of ... more In this longitudinal study, we compare the effects of different types of relocation and level of affectedness on the incidence and relapse of mood and anxiety symptom treatments identified by publicly funded care or treatment one year before and one and two years after the '2011 Christchurch earthquake' in New Zealand. Based on a subset of Christchurch residents from differently affected areas of the city identified by area-wide geotechnical land assessments (no to severe land damage) 'stayers', 'within-city movers', 'out-of-city movers' and 'returners' were identified to assess the interaction effect of different levels of affectedness and relocation on the incidence and relapse of mood and anxiety symptom treatments over time. Health and sample information were drawn from the New Zealand Ministry of…
ABSTRACT Monitoring of air quality alongside heavily-trafficked motorways has shown air pollutant... more ABSTRACT Monitoring of air quality alongside heavily-trafficked motorways has shown air pollutant levels are typically much higher than levels at background monitoring sites. In many large cities, a significant portion of the population resides on land immediately adjacent to motorways. For long-term residents, this has been associated with adverse health outcomes. However, generalizing the impact of major roads on nearby air quality is complicated by local influences such as wind climate, topography and vehicle fleet emission rates. This study aimed to quantify and explain differences in pollutant levels at two roadside and several associated setback sites in Auckland, New Zealand. Levels of nitrogen oxides (NOx) and carbon monoxide (CO) were monitored over the 2010 and 2011 autumn-winter transition (April - July), around two urban motorways roughly 5 km apart. Limited monitoring of ultrafine particles (UFP) was also conducted at two sites. Annual Average Daily Traffic (AADT) was 33% greater at the primary study site (122,098) than at the secondary site (81,075). Unmonitored ultrafine particle (UFP) concentrations were modeled from NOx data using linear regression (R2&gt;0.75). Missing CO data was predicted using nitric oxide (NO) concentrations (R2=0.93). Dispersion modeling was performed using The Air Pollution Model (TAPM) in order to assess the influence of meteorology on pollutant decay. Results show that, for both study sites, mean levels of NOx and UFPs were elevated by 41 - 52% at the roadside compared to setback sites as close as 134 m downwind. CO concentrations were elevated by 44 - 64%. Mean roadside UFP, NOx and CO at the busier study area was 25,672 pt/cm3, 128.6 µg/m3 and 1.1 ppm, respectively; higher than the lesser trafficked area by 43% (UFP, NOx) and 56% (CO). Overall results suggest that outdoor exposure along the roadside corridor is approximately 50% greater than for those living at setback distances. As New Zealand homes are particularly prone to infiltration of outdoor air, these results may have significant long-term exposure implications.
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