Urban Public Health in the context of Geography - Understanding the link between human health and the urban socio-ecological environment
Final Report Abstract
Human-made and natural disasters happen with regularity around the globe and are increasing with the growing influence of environmental climate change putting an increasing number of communities at risk for experiencing the mental health consequences of disasters, such as depression and posttraumatic stress disorder (PTSD). Urban populations are particularly concerned because of high population densities with larger numbers of communities potentially exposed to disaster as compared to rural populations. In addition, growing urbanization leads to more and more people being exposed to factors from the urban social (e.g. poverty, lack of social support) or physical environment (e.g. pollution, traffic noise) being negatively associated with psychological resilience and urban population health. With this project I sought to assess the interactions between socio-ecological factors and health risk across geographic space. Using a spatial epidemiological approach, my team was among the first to provide evidence for geographic variation in post disaster mental health risk based on both, survey data, and on social media data from Twitter. The project results provide evidence that local social and physical conditions affect post disaster mental health risk and that individual- and community-level resources and exposure shape post disaster resilience. For example, individuals who experienced individual stressors (e.g. multiple losses) and who lived in more disaster-damaged communities were more likely to report poor mental health or need for services than were other persons after a disaster. The findings suggest the need for on-going support to economically disadvantaged communities in which residents have endured disaster-related stressors. Independently of disaster, adverse socio-ecological environments such as in slums were also linked to poor health outcomes (e.g. mental well-being, mortality). These results suggest that large variations of poverty even within urban areas are important factors to consider when interpreting rural-urban differences in health providing key insights for priority setting and targeting of disease prevention programmes. The here applied spatial epidemiological approach is transferable to other regions around the globe and, in the light of a changing climate and increasing urbanization, could be used to strengthen neighborhood resources of demographic groups at greatest risk of adverse outcomes. This may improve community-level resilience especially in those areas and populations at risk of disaster. In the aftermath of a disaster, the approach can be used to identify survivors at greatest risk of mental health problems and to plan for targeted interventions to reach them. Moreover, in countries with limited formal surveillance infrastructure, a spatial epidemiological approach using social media may have potential for the identification of mass trauma and guidance of emergency care into those areas mostly afflicted.
Publications
- Place of Residence Moderates the Risk of Infant Death in Kenya: Evidence from the Most Recent Census 2009. Stoute JA, editor. PLoS ONE. 2015;10:e0139545–5
Gruebner O., Lautenbach S., Khan M.M.H., Kipruto S., Epprecht M., Galea S.
(See online at https://doi.org/10.1371/journal.pone.0139545) - The geography of post-disaster mental health: spatial patterning of psychological vulnerability and resilience factors in New York City after Hurricane Sandy. International Journal of Health Geographics. 2015;14:16
Gruebner O., Lowe S.R, Sampson L., Galea S.
(See online at https://doi.org/10.1186/s12942-015-0008-6) - Mapping concentrations of posttraumatic stress and depression trajectories following Hurricane Ike. Scientific Reports. 2016;6:32242
Gruebner O., Lowe S.R., Tracy M., Joshi S., Cerdá M., Norris F.H., et al.
(See online at https://doi.org/10.1038/srep32242) - Mental health surveillance after the terrorist attacks in Paris. The Lancet. Elsevier; 2016;387:2195–6
Gruebner O., Sykora M., Lowe S.R., Shankardass K., Trinquart L., Jackson T., et al.
(See online at https://doi.org/10.1016/S0140-6736(16)30602-X) - The Geography of Mental Health and General Wellness in Galveston Bay After Hurricane Ike: A Spatial Epidemiologic Study With Longitudinal Data. Disaster Med Public Health Prep. 2016;10:261– 73
Gruebner O., Lowe S.R., Tracy M., Cerdá M., Joshi S., Norris F.H., et al.
(See online at https://doi.org/10.1017/dmp.2015.172)
