Institute of Environmental Health (ISAMB), Faculty of Medicine of the University of Lisbon (FMUL), Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-028, Lisbon, Portugal.
Environmental Health Department, National Institute of Health, R. de Alexandre Herculano 321, 4000-055, Porto, Portugal.
BMC Public Health. 2020 Jun 3;20(1):853. doi: 10.1186/s12889-020-08905-0.
Population health is influenced by interactions between environmental determinants, which are captured by dimensions and indicators. This study aims to systematically review key environmental determinants and respective dimensions and indicators, relevant to evaluate population health in urban settings, and to understand their potential implications into policies.
A search of literature published between 2008 and 2018 was conducted in PubMed, Web of Science, Scopus and SciELO Portugal databases, on studies with evidence on association between an environmental determinant and a health outcome in urban contexts. Health determinants, dimensions and indicators researched in the selected studies were synthetized, and associations analyzed. An independent assessment of quality of the studies was performed. Key conclusions and policy recommendations were extracted to build a framework to analyze environment related population health and policies in urban settings.
Ninety four studies of varied methodological approaches and quality met the inclusion criteria. The review identified positive associations between all environmental determinants -socioeconomic, built environment, natural environment, healthcare, behaviors, and health outcomes - overall mortality and morbidity, in urban settings. Improvements in income, education, air quality, occupation status, mobility and smoking habits indicators have positive impact in overall mortality and chronic diseases morbidity indicators. Initiatives to improve population health in which policymakers can be more evidence-informed include socioeconomic, natural environment and built environment determinants.
There is scope and need to further explore which environmental determinants and dimensions most contribute to population health to create a series of robust evidence-based measures to better inform urban planning policies.
人口健康受环境决定因素的相互作用影响，这些决定因素可以通过维度和指标来捕捉。本研究旨在系统地回顾与评估城市环境中人口健康相关的关键环境决定因素及其相应的维度和指标，并了解它们对政策的潜在影响。
在 PubMed、Web of Science、Scopus 和 SciELO Portugal 数据库中，检索了 2008 年至 2018 年间发表的文献，研究了与城市环境中环境决定因素与健康结果之间存在关联的证据。综合了选定研究中研究的健康决定因素、维度和指标，并分析了它们之间的关联。对研究的质量进行了独立评估。提取了关键结论和政策建议，以构建一个框架，分析城市环境中与环境相关的人口健康和政策。
94 项具有不同方法学方法和质量的研究符合纳入标准。本综述确定了所有环境决定因素——社会经济、建筑环境、自然环境、医疗保健、行为和健康结果——在城市环境中与整体死亡率和发病率之间存在正相关关系。收入、教育、空气质量、职业状况、流动性和吸烟习惯指标的改善对整体死亡率和慢性病发病率指标有积极影响。改善人口健康的举措中，政策制定者可以更多地参考社会经济、自然环境和建筑环境的决定因素。
有进一步探索哪些环境决定因素和维度对人口健康贡献最大的空间和需要，以制定一系列基于强有力证据的措施，更好地为城市规划政策提供信息。
