Mental Health

Effects of the Illegal Consumption of Sea Turtles on Environmental Security and Human Health in Northwestern Mexico

 Authors: A. Alonso Aguirre1, Kathryn Jacobson2, Lila C. Fleming2, Alexander J. Robillard1, Cesar P. Ley- Quiñónez3, Alan A. Zavala-Norzagaray3
Author Affiliations: 1Environmental Science and Policy, George Mason University; 2Department of Global and Community Health, George Mason University; 3Instituto Politécnico Nacional, CIIDIR- Sinaloa, Mexico

Human consumption of endangered sea turtles remains prevalent throughout Mexico even though laws restricting trade in threatened and endangered species have been in place for several decades. Our prior research has found that the majority of sea turtle mortality in Baja California is due to human consumption. While demand for sea turtle meat has reportedly decreased in some regions, turtle trafficking and illegal harvesting continue to threaten environmental security in the region. Besides being a threat to animal and ecological health, poaching may be a threat to human health. People who consume turtle meat may be exposed to bacteria, parasites, and other pathogens as well as organochlorine compounds and heavy metals such as cadmium and mercury.

In 2017, we conducted a knowledge, attitudes, and practices (KAP) survey with a convenience sample of more than 200 residents of 14 fishing communities in northwestern Mexico. We asked participants about their nutritional and health status, dietary and risk behaviors, and perceptions of local ecological issues, and we collected hair samples that could be tested for heavy metals.

About one-quarter of the participants reported consuming sea turtle in the past month. Laboratory tests showed a high prevalence of elevated levels of arsenic, lead, and mercury. Preliminary analyses show that people who eat sea turtle meat are more likely than their neighbors to have high levels of mercury in their hair.

Conservation efforts may be more successful when they appeal to people’s self-interest rather than merely focusing on ecological benefits. Concerns about toxins in sharks, tuna, and other types of deep-sea fish have reduced human consumption of some species. Sea turtle conservation efforts may benefit from awareness campaigns that emphasize the adverse health outcomes associated with eating turtle meat while continuing to affirm the economic benefits of healthy ecosystems. Transdisciplinary research that draws on diverse fields such as ecology, epidemiology, toxicology, environmental law, and public policy provides a valuable foundation for solving planetary health issues. Creative reframing of biodiversity concerns in countries around the globe will be necessary for promoting environmental health and public health in a time of accelerating environmental change.

Quantifying the Social Costs of Health Impacts from Urban Housing Developments

Authors: Alistair Hunt1, Eleanor Eaton1, Dan Black2
Author Affiliations: 1University of Bath; 2DB+A

The link between the quality of urban environment and health has become better understood recently, but policy makers have lacked an effective method with which to assess the possible health impacts of a proposed development as part of an overall investment decision. Consequently, development design may be biased away from that which encourages healthy lifestyles. The study aim is to show how the social costs of these health impacts can be defined in monetary terms, using real-world commercial urban housing developments in the UK, and thereby demonstrating to decision-makers the hidden health costs to society of poor quality urban development. Evidence is gathered on health impacts associated with housing design, the natural environment, neighbourhood quality, green spaces, and transport, and the economic welfare costs calculated for subsequent incorporation in urban development investment appraisal.

The first methodological step is to undertake the quantification of associative relationships between quality of the urban/human environment and health effects. This analysis allows us to delineate bounds to the health incidence rates associated with different forms of urban development. This has been carried out using an informal meta-analytical approach to the relevant literature. The analysis identifies the nature and extent of possible spatial development–health linkages, and role and importance of potential confounding factors.

The second methodological step is to undertake the economic valuation of changes in health impact incidence associated with different urban developments. For each health effect identified, we estimate an economic cost per case. Three cost elements are estimated: health treatment costs; productivity costs; welfare costs (pain & suffering).

Total cost estimates for specific developments are then derived and subsequently disaggregated according to who bears them (state, health care providers, employers, police, individual victims).

Sixty individual health impacts are monetised, out of a total of 80 health impacts identified in the analysis of health incidence. We find that the most important features of the built environment – in terms of their influence of health costs – are neighbourhood design, crime, and the natural environment. Mental health care and premature death account for the largest health costs; social care and victims bear the highest share of costs.

Provisional findings suggest that greater resources can be justifiably targeted at these features of the built environment, and that there is evidence with which health and social care providers may be able to negotiate directly with developers and planners regarding the design of these features.

Residential surrounding greenness is associated with slower cognitive decline in the ageing Whitehall II cohort: a longitudinal study

Authors: Carmen Keijzer1,2,3, Cathryn Tonne1,2,3, Xavier Basagaña1,2,3, Antònia Valentín1,2,3 , Archana Singh-Manoux4,5, Jordi Alonso2,3,6, Josep Maria Antó1,2,3, Mark J Nieuwenhuijsen1,2,3, Jordi Sunyer1,2,3, Payam Dadvand1,2,3
Author Affiliations: 1ISGlobal, Centre for Research in Environmental Epidemiology; 2Universitat Pompeu Fabra; 3CIBER Epidemiología y Salud Pública; 4INSERM Centre for Research in Epidemiology and Population Health, Université Paris-Saclay; 5Department of Epidemiology and Public Health, University College of London; 6Health Services Research Unit, IMIM-Institut Hospital del Mar d’Investigacions Mèdiques

Background – Cognitive functioning is one of the most important indicators of healthy ageing. The evidence on beneficial associations of green space with cognitive function in older adults is very scarce and mainly limited to cross-sectional studies. This study aimed to investigate the association between long-term residential surrounding greenness and cognitive decline.

Methods – This longitudinal study was based on three follow-ups of 6506 participants (45-68 years old) from the Whitehall II cohort from the United Kingdom, covering a 10-year period (1997-1999 to 2007-2009). The exposure assessment was based on the characterization of outdoor residential surrounding greenness at each follow-up. We obtained the greenness across buffers of 500 and 1000 meter around the participants’ residential address using satellite images on greenness (Normalized Difference Vegetation Index, NVDI) from a summer month in every follow-up period.
A battery of four cognitive tests was repeated three times over the study period, assessing reasoning, short-term memory, and verbal fluency. The cognitive scores were converted to z-scores and summarized in a “global cognition” z-score. To quantify the impact of greenness on the repeated measurements of cognition, we used linear mixed effect models that included an interaction between age and the indicator of greenness. The models were adjusted for time-varying covariates including individual and neighborhood indicators of socioeconomic status.

Findings – An interquartile range increase in NDVI was associated with a difference in the global cognition z-score of 0.020 (95% confidence interval (CI): 0.003 to 0.037, p=0.02) over 10 years. Comparing study participants of 55.7 years old, this difference was equivalent to a 4.6% slower decline over 10 years. Similar positive associations were also observed for reasoning (0.022, 95% CI: 0.007 to 0.038) and verbal fluency (0.021, 95% CI: 0.002 to 0.040). We observed some suggestions for stronger associations among women and participants with higher secondary education.

Interpretation – The findings suggest that higher residential surrounding greenness is associated with slower cognitive decline. Further research is needed to confirm our findings and provide information on the specific characteristics of green spaces that can maximize healthy cognitive ageing, especially for older adults residing in urban areas.

Prescriptions for antidepressant drugs increase after the recent major floods in England: controlled interrupted time series study

Authors: Ai Milojevic1, Ben Armstrong1, Paul Wilkinson1
Author Affiliations: 1London School of Hygiene & Tropical Medicine

Background: Floods are the most common type of natural disaster globally. Climate change and the pressures of development to accommodate emerging population could increase the number of people at risk of flooding. Although the immediate risk of death and injury from flooding is known to be small in high-income countries, emerging reports suggest flooding has prolonged adverse impacts on mental well-being. However, evidence remained limited as most previous studies are based on the survey or self-reports without robust pre-flood records. This methodological challenge applies to other natural and man-made disasters.

Methods: This study examines the mental health impacts of floods in England using routine prescriptions data which can provide data for both pre-flood and post-flood periods in flooded and non-flooded populations. We examined prescription records for drugs used in the management of common mental disorder among primary care practices located in the vicinity of recent large flood events in England, 2011-2014. A controlled interrupted time series analysis was conducted of the number of prescribing items for antidepressant drugs in the year before and after the flood onset. Pre-post changes were compared by distance of the practice from the inundated boundaries among 930 practices located within 10km of a flood. Impact of neighbourhood deprivation and population density on change in prescriptions over time and the number of prescriptions for non-antidepressant drugs were additionally controlled.

Findings: After control for deprivation and population density, there was an increase of 0.59% (95%CI 0.24 to 0.94) prescriptions in the post-flood year among practices located within 1km of a flood over and above the change observed in the furthest distance band. The results did not change after control for non-antidepressant drugs. The increase was greater in more deprived areas.

Interpretation: This study suggests an increase in prescribed antidepressant drugs in the year after flooding in primary care practices close to recent major floods in England. This small percent increase would if caused by flooding reflect a much larger increase in flooded households, which made up a very small part of the overall registered populations of these practices. Moreover, despite small increase in relative terms, high prevalence of mental disorders implied substantial mental health burdens after flooding, suggesting important implications for public health practices after disaster. More detailed linkage studies are required to detangle the contribution of actual individual flood exposure. We are currently extending this study with prescribing data of individual patient in primary care practices.



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