Archives de catégorie : Santé/Health

Gendered inequalities, health and climate change

In climate change perspectives, three inequalities have been well-documented: inequalities between (1) and within countries (2), and inequalities between generations (3). However, the gendered inequalities are and will be exacerbated by climate change consequences (4). An open-access chapter presents the most important issues of this question (4). Authors add a health perspective combined with climate change gendered inequalities.

A set of key points:

  • Deaths related to natural disasters are higher among women. Their motor skills are generally lower than men (e.g., running, swimming, climbing). Also, they have a poor access to climate-related information.
  • Women may be more “biologically vulnerable” during heat waves. High temperatures also are associated with complications in pregnancy and poor neonatal outcomes.
  • Women are more exposed to indoor pollution (from fuel-wood stoves) and have higher burden to outdoor air pollution.
  • Women are the worst affected by food insecurity because they are (most of time) responsible for cooking, feeding caring…. and they eat less.
  • During dry seasons, women spend time and energy to collect water. It increases their risk of heat illness

You can find an interactive map displaying 130 studies that investigate how men and women are affected by climate change here .

You

  • 1. Guivarch C, Taconet N. Global inequalities and climate change. In: The Routledge Handbook of the Political Economy of the Environment. Routledge; 2021.
  • 2. United Nations Environment Programme. The emissions gap report 2020. 2020.
  • 3. Thiery W, Lange S, Rogelj J, Schleussner C-F, Gudmundsson L, Seneviratne SI, et al. Intergenerational inequities in exposure to climate extremes. Science [Internet]. 8 oct 2021 [cité 27 déc 2021]; Disponible sur: http://www.science.org/doi/abs/10.1126/science.abi7339
  • 4. Kommu V, Alexander D, Lingam L. Gendered vulnerabilities and health inequities. In: Climate Change and the Health Sector [Internet]. 1re éd. London: Routledge India; 2021. p. 90‑7.

Complex associations between air pollution, insomnia symptoms and physical activity

In a preprint co-authored with G. Chevance et al. (1), we examined the associations between climate change consequences and health behaviors. We identified a set of (bi)directional associations between natural hazards, rising sea level, greenhouse gas emission, temperature increase and the following behaviors : alcohol consumption, cigarette smoking, water consumption, preventive behaviors, sleep, food related behaviors and physical activity (PA) domains. We synthesized these associations with this figure.

This system map offers a “meta” and simplified perspective of previous studied associations. However, we did not include the potential associations between health behaviors. Indeed, these associations are not well identified and may be different in function of the time scale (i.e., daily associations vs long term association), study participant characteristics and assessment tools (see e.g., see the following reviews for PA sleep associations at short and long term (2,3)).
A recent cross-sectional study investigated the associations of long-term exposure to ambient air pollution with insomnia symptoms in a large Chinese sample. Furthermore, the authors examined whether PA domains had a potential “buffering effect”.
In the perspective of our review, it’s particularly relevant because we could improve the subsection about sleep, PA domains, and air pollution (4). Also, China is one of the most polluted countries in the world.

Strengths of this study:

  • -residents >3 years in their current residence
  • relative good measure of insomnia symptoms
  • good control of indoor air pollution and environmental factors (e.g., temperature)

I synthesized Xu et al. findings with the following slides (4). A buffering effect of physical activity was found for leisure PA and moderate PA “doses”. High levels of total and occupational PA accentuated the air pollution – insomnia association. In brief, the potential positive role of PA varied in term of domain, dose and air pollution measures.

 

 

This study is a good illustration of health behaviors associations complexity. In a climate change perspective (i.e., higher level of air pollution in cities around the world in next decades), physical activity promotion and insomnia prevention/treatment strategies should be revised.

  • 1. Chevance G, Fresán U, Hekler E, Edmondson D, Lloyd S j, Ballester J, et al. Thinking health-related behaviors in a climate change context: A narrative review [Internet]. OSF Preprints; 2021 [cited 2021 May 19]. Available from: https://osf.io/pb8vc/
  • 2. Kredlow MA, Capozzoli MC, Hearon BA, Calkins AW, Otto MW. The effects of physical activity on sleep: a meta-analytic review. J Behav Med. 2015 Jun;38(3):427–49.
  • 3. Atoui S, Chevance G, Romain A-J, Kingsbury C, Lachance J-P, Bernard P. Daily associations between sleep and physical activity: A systematic review and meta-analysis. Sleep Medicine Reviews. 2021 Jun;57:101426.
  • 4. Xu J, Zhou J, Luo P, Mao D, Xu W, Nima Q, et al. Associations of long-term exposure to ambient air pollution and physical activity with insomnia in Chinese adults. Science of The Total Environment. 2021 Oct;792:148197.

 

Impacts of wildfires on physical activity

I write this blog article during an important forest fire in British Columbia (Canada), occurring during an extreme heat wave in the same geographical area. The last Lancet report on health and climate change called it : the ‘converging crises’ (1). Climate projections indicate wildfires will increase in frequency and intensity in the U.S, Canada, Australia, Russia… What are the effects of wildfires on physical activity patterns ?

Cruz et al examined the effects of bushfires on accelerometer measured physical activity among exposed and control children (245 vs 344, 8-10 years, Australia) (2). Additionally, they modelized the association between Air Quality Index (AQI) and moderate to vigorous physical activity (MVPA) in exposed children (with sub analyses for sex and socioeconomic status). Authors collected PA data for their multi-center interventional study, and the bushfires occurred between the end of intervention and first follow-up measures. Children were classified as affected by bushfires if they were exposed to AQI >100 for 3 consecutive days, and their school received targeted advice to avoid outdoor Pas. Their statistical analyses were well-adapted and sophisticated.

Children’s physical activity was not strongly influenced by the presence of smoke during bushfires. Findings were similar for MVPA, VPA, MPA during or outside school hours or after the inclusion of temperature as covariable. During the school time, an AQI of 1 standard deviation increase was associated with a decrease of 2 and 0.6 daily minutes for MPA and VPA, respectively. The curvilinear models suggested that AQI >737 (AQI > 200 = ‘hazardous’) was associated with a drastic MVPA reduction among exposed children. This ‘tipping point’ was not different for children with living in family with low or high socioeconomic background.

Authors suggested that the relative stable PA level during the wildfire episode may be explained by a possible PA indoor practices or family/teachers might not follow the Australian Education Department recommendation about outdoor PA restrictions. Consequently, the children might have been exposed to high level of air pollution.

A US study examined the association between four AQI classes (ranged from moderate to hazardous air quality) and daily number of steps (measured with fitbit) among adults living in California during 2017-2018 wildfire seasons (N > 1000) (3). A significant 18% reduction in daily step count was found when the AQI exceeded 200 compared with AQIs < 100. Similar results were observed after multivariable adjustment, but sex was missing among the covariables.

Finally, another PA characteristic has been examined: active travel in urban context. Doubleday et al. (4) used the bicycle and pedestrian counters data in Seattle (Washington state) to examine the effects of wildfire smoke events. They compared daily bicycle and pedestrian counts across 3 periods, 20 days before wildfires, during wildfire (>3 consecutive days with PM2.5 >15), and 20 days after.

A significant decrease of active travel frequency was observed during the second and larger of two wildfire smoke events (2018, see figure). Findings also showed a slow return to pre-wildfire smoke event physical activity levels in some areas.

This significant PA decrease could be observed only for 2018 because wildfire smoke events were more intense, but also by an improvement of risk reduction messages dissemination by local authorities.

 

 

  • 1. Watts N, Amann M, Arnell N, Ayeb-Karlsson S, Beagley J, Belesova K, et al. The 2020 report of The Lancet Countdown on health and climate change: responding to converging crises. The Lancet. 2021 Jan;397(10269):129–70.
  • 2. del Pozo Cruz B, Hartwig TB, Sanders T, Noetel M, Parker P, Antczak D, et al. The effects of the Australian bushfires on physical activity in children. Environment International. 2021 Jan 1;146:106214.
  • 3. Rosenthal DG, Vittinghoff E, Tison GH, Pletcher MJ, Olgin JE, Grandis DJ, et al. Assessment of Accelerometer-Based Physical Activity During the 2017-2018 California Wildfire Seasons. JAMA Network Open. 2020 Sep 30;3(9):e2018116.
  • 4. Doubleday A, Choe Y, Busch Isaksen TM, Errett NA. Urban bike and pedestrian activity impacts from wildfire smoke events in Seattle, WA. Journal of Transport & Health. 2021 Jun;21:101033.

Comment ne pas rater sa revue de littérature systématique ?

Il y a quelques années, j’avais réalisé une présentation sur les enjeux méthodologiques des revues systématiques de la littérature. J’ai toujours des difficultés à retrouver les diapo et les documents associés dans mon ordinateur, alors j’en fais un article. Le contenu est toujours juste et les diapo résument les directives mais sont aussi émaillées de quelques conseils issus de ma participation à plusieurs projets de revues systématiques (1–4). J’avais utilisé le document de l’INESS très bien fait : Les normes de production des revues systématiques. Les exemples sont majoritairement issus des Sciences de l’activité physique et de mes travaux. Plus récemment, j’ai découvert le document réalisé par le Pr Madhukar Pai qui résume très bien les enjeux et étapes d’une revue systématique de qualité.

 

  • 1. Baillot A, Saunders S, Brunet J, Romain AJ, Trottier A, Bernard P. A systematic review and meta-analysis of the effect of exercise on psychosocial outcomes in adults with obesity: A call for more research. Mental Health and Physical Activity. 2018 Mar 1;14:1–10.
  • 2. Bernard P, Romain A-J, Caudroit J, Chevance G, Carayol M, Gourlan M, et al. Cognitive behavior therapy combined with exercise for adults with chronic diseases: Systematic review and meta-analysis. Health Psychol. 2018;37(5):433–50.
  • 3. Bernard P, Savard J, Steindorf K, Sweegers MG, Courneya KS, Newton RU, et al. Effects and moderators of exercise on sleep in adults with cancer: Individual patient data and aggregated meta-analyses. Journal of Psychosomatic Research. 2019 Sep;124:109746.
  • 4. Romain AJ, Bortolon C, Gourlan M, Carayol M, Decker E, Lareyre O, et al. Matched or nonmatched interventions based on the transtheoretical model to promote physical activity. A meta-analysis of randomized controlled trials. Journal of Sport and Health Science. 2018 Jan 1;7(1):50–7.

Changement climatique et santé: la convergence des risques (3)

Nous poursuivons l’analyse de rapport 2020 du Lancet sur la santé et le changement climatique.  (précédents article ici et là)

Adaptation et planification pour la santé

Sur la base d’une étude de l’organisation mondiale de la santé, environ la moitié des 100 pays étudiés avait un plan d’adaptation pour la santé mais moins de 10 % d’entre eux avaient le budget nécessaire pour le mettre en place. Parmi les 35 pays en voie de développement ayant répondu, seulement la moitié rapportaient avoir accès aux fonds internationaux pour mettre en place un plan national d’adaptation pour la santé face au changement climatique. Cette étude rapporte aussi que ces plans d’adaptation sont rarement coordonnés avec d’autres secteurs comme celui de l’agriculture, de l’énergie ou encore des services sociaux.

Évaluation des risques liés au changement climatique au sein des villes

77 % des 689 grandes métropoles interrogées ont ou sont en train d’évaluer les risques associés au changement climatique. Plus de 60 % d’entre elles concluent que le changement climatique va sérieusement altérer les services de santé ainsi que la santé de ses habitants.

Niveau de préparation des pays face a des urgences de santé publique

Une méthode a été développée afin d’évaluer le niveau de planification, de gestion et de ressources allouées à un plan national qui anticipe les enjeux de santé publique liée à des catastrophes naturelles (sécheresses, inondations, tempêtes). Parmi 166 pays, plus de 60 % ont mis en place un plan de préparation. Cependant, il y a une disparité géographique importante à l’échelle mondiale.

La balance bénéfices – risques de l’utilisation de l’air conditionné

En 2018, l’utilisation de l’air conditionné représentait 8,5 % de la consommation globale d’électricité. Son utilisation peut être associée à des émissions de gaz à effet de serre, à l’augmentation de la concentration de particules fines ainsi que la formation d’ozone (due au gaz hydrofluocarbone). De plus, durant les pics de chaleur, la chaleur rejetée par les appareils accentue le phénomène d’îlot de chaleur en ville. Les auteurs du rapport soulignent que la balance bénéfice risque de son utilisation doit encore être examinée (même si l’utilisation de l’air conditionné limite les risques de mortalité durant les vagues de chaleur).

Les espaces verts urbains

Le rapport souligne les bénéfices nombreux d’un accès un espace vert en milieu urbain. Les auteurs insistent aussi sur l’importance de la question de l’équité dans l’accès à ces espaces. Seulement 9 % des centres urbains majeurs mondiaux sont classés comme exceptionnels au niveau de la densité de leur espace vert. On retrouve parmi les cinq premières villes : Colombo, Washington, Dhaka, San Salvador et Havane.

1. Watts N, Amann M, Arnell N, Ayeb-Karlsson S, Beagley J, Belesova K, et al. The 2020 report of The Lancet Countdown on health and climate change: responding to converging crises. The Lancet. 2021 Jan;397(10269):129–70.