HEALTH AND DEPRIVATION: Inequality and the north

Objectives. We analyzed differences in pediatric elevated blood lead level incidence before and after Flint, Michigan, introduced a more corrosive water source into an aging water system without adequate corrosion control. Methods. We reviewed blood lead levels for children younger than 5 years before (2013) and after (2015) water source change in Greater Flint, Michigan.We assessed the percentage of elevated blood lead levels in both time periods, and identified geographical locations through spatial analysis. Results. Incidence of elevated blood lead levels increased from 2.4% to 4.9% (P<.05) after water source change, and neighborhoods with the highest water lead levels experienced a 6.6% increase. No significant change was seen outside the city. Geospatial analysis identified disadvantaged neighborhoods as having the greatest elevated blood lead levelincreases andinformed response prioritization during the now-declared public health emergency. Conclusions. The percentage of children with elevated blood lead levels increased after water source change, particularly in socioeconomically disadvantaged neighborhoods. Water is a growing source of childhood lead exposure because of aging infrastructure. (Am J Public Health. 2016;106:283–290. doi:10.2105/AJPH.2015.303003)

https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2015.303003

Elevated Blood Lead Levels in Children Associated With the Flint Drinking Water Crisis: A Spatial Analysis of Risk and Public Health Response

Recent studies have characterized how host genetics, prenatal environment and delivery mode can shape the newborn microbiome at birth. Following this, postnatal factors, such as antibiotic treatment, diet or environmental exposure, further modulate the development of the infant's microbiome and immune system, and exposure to a variety of microbial organisms during early life has long been hypothesized to exert a protective effect in the newborn. Furthermore, epidemiological studies have shown that factors that alter bacterial communities in infants during childhood increase the risk for several diseases, highlighting the importance of understanding early-life microbiome composition. In this review, we describe how prenatal and postnatal factors shape the development of both the microbiome and the immune system. We also discuss the prospects of microbiome-mediated therapeutics and the need for more effective approaches that can reconfigure bacterial communities from pathogenic to homeostatic configurations.

The microbiome in early life: implications for health outcomes

Zakljucno, potrebno je i nadalje svakodnevno raditi na prevenciji demencije, osiguravati resurse i osmisljavati strategije borbe protiv demencije, jer ce broj osoba s demencijom i u Hrvatskoj u buducnosti biti veci. No, s obzirom da se u svijetu ulažu znatna sredstva u podrucju istraživanja demencije, za ocekivati je pozitivnih pomaka, kako na podrucju terapije, rane dijagnostike, tako i na podrucju rehabilitacije osoba s demencijom. Stoga - vrijeme je na nasoj strani!

/pdf/dementia-a-public-health-priority-4d8cnsux7q.pdf

Dementia: a public health priority

Exposure to traffic-related air pollution and risk of development of childhood asthma: A systematic review and meta-analysis

Administrative databases in the Canadian health sector do not contain socio-economic information. To facilitate the monitoring of social inequalities for health planning, this study proposes a material and social deprivation index for Canada. After explaining the concept of deprivation, we describe the methodological aspects of the index and apply it to the example of premature mortality (i.e. death before the age of 75). We illustrate variations in deprivation and the links between deprivation and mortality nationwide and in different geographic areas including the census metropolitan areas (CMAs) of Toronto, Montreal and Vancouver; other CMAs; average-size cities, referred to as census agglomerations (CAs); small towns and rural communities; and five regions of Canada, namely Atlantic, Quebec, Ontario, the Prairies and British Columbia. Material and social deprivation and their links to mortality vary considerably by geographic area. We comment on the results as well as the limitations of the index and its advantages for health planning.

A deprivation index for health planning in Canada.

OBJECTIVES: To overcome the absence of socio-economic information in administrative databases and to monitor social inequalities in health, a material and social deprivation index was developed for Quebec and Canada. METHODS: The index is based on the smallest area unit used in Canadian censuses, with 400 to 700 persons on average. It includes six socio-economic indicators grouped along two dimensions – material and social – produced from principal component analyses. The index exists for 1991, 1996, 2001 and 2006 and in different versions, from local areas to the whole of Canada. Numerous products related to the index are available online free of charge. RESULTS: The index has been used extensively in the field of health and social services, mainly in the province of Quebec but also elsewhere in Canada. It has had four main uses, all related to public health: describing geographic variations of deprivation, illustrating inequalities in population health status and in service use according to deprivation, supporting the development of health reports and policies, and guiding regional resource allocation. These applications are facilitated by a close partnership between the producers and users of the index. CONCLUSION: The deprivation index is a marker of social inequalities in health. It allows for monitoring of inequalities over time and space, and constitutes a useful tool for public health planning, intervention and service delivery.

/pdf/an-area-based-material-and-social-deprivation-index-for-c1jm3v20h4.pdf

An area-based material and social deprivation index for public health in Québec and Canada.

Background Area-based indicators are commonly used to measure and track health outcomes by socioeconomic group This is largely because of the absence of socio-economic information about individuals in health administrative databases The literature shows that the magnitude of differences in health outcomes varies depending on whether the socio-economic indicators are at the individual level or are area-based This study compares the two types of indicators Data and methods The data are from a fi le linking the results of the 1991 Census with deaths that occurred from 1991 to 2000―a 15% sample of the Canadian population aged 25 or older The socio-economic indicator used for comparison is a material and social deprivation index, in individual and areabased versions The health indicators are life expectancy and disability-free life expectancy, and risks of mortality and disability

A comparison of individual and area-based socio-economic data for monitoring social inequalities in health.

Health inequalities in urban and rural Canada: comparing inequalities in survival according to an individual and area-based deprivation index.

Background:Although it is well established that air pollutants can exacerbate asthma, the link with new asthma onset in children is less clear.Objective:We assessed the association between the onse...

Philippe Gamache

Papers

A deprivation index for health planning in Canada.

An area-based material and social deprivation index for public health in Québec and Canada.

A comparison of individual and area-based socio-economic data for monitoring social inequalities in health.

Health inequalities in urban and rural Canada: comparing inequalities in survival according to an individual and area-based deprivation index.

Childhood Exposure to Ambient Air Pollutants and the Onset of Asthma: An Administrative Cohort Study in Québec.