Environment, equity and health: microscope, telescope or panopticon

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Environment, equity and healthmicroscope,
telescope or panopticon?

• Mark McCarthy
• University College London
• UK

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Science and knowledge

• Science seeks causes
• experiments
• related observations

• Many papers available, few are chosen
• You cant create whats not there

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• Environmental health
• USA Environmental Protection Agency
• Risk assessment
• UK Health Protection Agency acute only

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Epidemiology

• income
• obesity
• culture

Mortality
Behaviours
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• Bradford-Hill criteria
• Strength of statistical association
• Temporality
• Replication
• Plausibility
• Specificity
• Dose-response

A
Co-variance
BUT .
Effect
Association is not always causal
B
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Respiratory problems in London are concentrated
in the poorest areas and correlate with high
traffic levels.
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The social inequalities within urban
environments are particularly marked, and this
has an effect on health outcomes. For example,
areas within London Borough of Camden there is
a life expectancy difference in the population
of up to 11 years

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Social determinants and health inequalities

• Social determinants
• of disease
• constitution?
• behaviours?
• life factors?

• Health inequalities
• social patterning?
• area distributions?
• area explanations?

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Built environment

• Housing
• And building regulations
• Nature
• most people like it
• Density
• Sprawl hate it or love it?
• Transport
• Both people and materials?

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PANOPTICON

• The Panopticon was proposed as a model prison by
  Jeremy Bentham (1748-1832), a Utilitarian
  philosopher and theorist of British legal reform.
  
• The major effect of the Panopticon to induce
  in the inmate a state of conscious and permanent
  visibility that assures the automatic functioning
  of power (Foucault)

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Health impact assessment

• Air
• Water
• Noise
• Chemicals
• Energy

Diseases and wellbeing Cancer Heart
disease Accidents Mental Diabetes Respiratory
Housing Density Nature Transport
Design

• Values
• Behaviours
• Mobility

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Health Impact Assessments

• Thames bridge
• Hospital planning
• Airport expansion

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Hazard exposure time disease risk
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Limitations include

• Attributable risks?
• Exposures?
• Pathways?
• Sub-groups?
• Unverifiable at individual level

Make a difference? By the private
sector? Costs? Become routine?
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Practice into science

• Complex environment studies