Reducing the burden of pollution-related diseases in cities

Urban environments provide livelihoods, infrastructures, services, access to health, education, information, vibrant cultural exchanges, and more. However, these environments can also worsen health risks and provoke new shocks and stresses in the intersection with other sectors such as land use design and planning, water, energy, waste and resources, natural environment, logistics, infrastructure, or housing.

Extremely hot and cold episodes, urban heat island effects, lack of access to walking pathways and bike lanes, and green infrastructures unfairly distributed within urban space; in addition to the wide availability of tobacco, alcohol and unhealthy foods and beverages; drive the so-called Non-Communicable Diseases (NCD) epidemic.

In relation to this topic, we interviewed Dr. Paula Sol Ventura (PV), who is an expert in environmental medicine:

PV: Non-Communicable Diseases (NCDs) are chronic diseases that are not transmitted from one person to another. They tend to be long in duration; and result from a combination of genetic, physiological, environmental, and behavioural factors such as smoking, poor diet, lack of physical activity and exposure to toxic substances.

PV: NCDs and pollution are interlaced through several multidimensional factors. On the one hand, exposure to air pollutants such as fine particles (PM2.5), nitrogen oxide (NOx) and Volatile Organic Compounds (VOCs) may increase the risk of heart and respiratory diseases, as well as lung cancer. On the other hand, exposure to toxic chemicals in contaminated water or food has been linked to an increased risk of cancer, nervous system disorders, as well as hormonal disorders.

  _{^{Fig. 3: NCDs related to environmental risk factors. Source: PV.}}

PV: Environmental pollution damages the organism through various and complex anatomy-physiological mechanisms, which may vary depending on the pollutant, the affected organ, or the body system. Some of these mechanisms may be due to the activation of a chronic inflammatory response in tissues or organs to the effect of endocrine disruptors, which can mimic or block the action of natural hormones or damage genetic material. In addition, persistent and bio-accumulative pollutants can be deposited and stored in different organs and tissues over time, perpetuating and worsening the damage.

PV: Many chemicals (and Heavy-Metals are included in this category) are found naturally in the environment, but they can also be released in large quantities into the environment due to human activities such as mining, industry, or fossil fuels burning, polluting the air, water, and soil. There are metals that are necessary, in acceptable doses, for the proper functioning needs and requirements of our body. But in high doses, they can cause harm and increase the risk of chronic diseases, especially when we consider that some people are more susceptible than others. Some Heavy-Metals, regardless of whether they are necessary for our body or not, can have a toxic effect in low, moderate, or high doses, especially in vulnerable stages of life, such as intrauterine development or early life stages. Some examples are:

• Lead (Pb): affectation of cognitive development and the nervous system, anaemia, hypertension, renal dysfunction, immunotoxicity and reproductive organ toxicity.
• Cadmium (Cd): nausea, abdominal pain, diarrhoea, lung and kidney diseases.
• Cupper (Cu): nausea, abdominal pain, diarrhoea, and liver damage.
• Zinc (Zn): nausea, anaemia, affect the immune system, and HDL cholesterol decreasing.

PV: It is important to take steps to reduce exposure to environmental pollutants and Heavy-Metals, such as improving air, water, and food quality. Controlling industrial emissions and promoting safe practices in handling certain substances can reduce exposure to pollution, an essential step in preventing and controlling NCDs and promoting better overall health.

The Global Alliance for Chronic Diseases (GACD) advocates for interventions in cities to reduce the risk of NCDs, since lowering the burden of NCDs is crucial to building resilient and healthy societies. These interventions are proposed to be two-fold:

• Behavioural change interventions: Comprised of innovative approaches to helping citizens maintain good physical and mental health. These interventions might include programmes and policies targeting nutrition, sleep, physical activities, alcohol and tobacco use, and reducing exposure to environmental contaminants while addressing climate crisis-related matters.
• Built environment modification Interventions: Generally focused on improving the built environment to promote healthier settings. These interventions might include more pathways or bike lines in cities, less road traffic and noise; more green areas fairly distributed within the urban fabric; and care for flora, fauna, and biodiversity. Public water sources for kids, the elderly and pets also require consideration. Improved access to healthy foods, public water sources, safe housing and reduced access to tobacco and alcohol. And when needed, a specific focus on soil, air and water pollution reduction also. _{^{Fig. 4: Baia Mare. Source: AC}}

PV: On the one hand, the Global Alliance for Chronic Diseases (GACD) is an international coalition that addresses chronic NCDs, such as cardiovascular disease, diabetes, chronic respiratory disease, and cancer. On the other hand, the Global Action Plan on Physical Activity (GAPPA) is an initiative led by the WHO that seeks to promote physical activity in addition to providing a framework of policy actions to encourage physical activity at all levels as a strategy to prevent and control chronic diseases; and improve general health. Both initiatives share a common objective: to control and prevent chronic diseases by promoting healthy lifestyles.

PV: One Health concept is based on recognising the interrelationship between humans, animals, and environmental health. Alliances and Initiatives such as GACD, GAPPA or One Health, share a common goal provoking synergies and complementing each other from a multidisciplinary and multisectoral lens. They address the challenges of chronic diseases by promoting healthy lifestyles and a healthy environment while strengthening the capacities of cities to cope with the stress and challenges and make them more resilient.

PV: By promoting human health in harmony with planetary health, these initiatives seek to contribute to a resilient and sustainable future for all.

PV: Urban resilience refers to the ability of cities to resist, adapt and recover from challenges and shocks such as natural disasters, climate change and health crises. Urban resilience can contribute to health promotion and chronic disease prevention in several ways: healthy urban planning, risk reduction actions, resilient infrastructure measures and multi-sector collaboration, to name a few.

PV: Many strategies can be implemented to reduce the burden of pollution-related diseases in cities, but they require a comprehensive approach. It needs a combination of individual, community, and government actions, including improving air quality, promoting sustainable mobility, creating green spaces, fostering energy efficiency, raising awareness, building capacity, and changing behaviour among citizens.

In the city of Baia Mare, the past extractions at the Sasar mine have caused environmental pollution on the surface and underground water, air and soil. Compared to the Romanian population's average life expectancy, the city's life expectancy is 2.2 years less. In addition, the overall mortality index is 10-15% higher; D2 deficiency is 65-95% higher, and the frequency of metabolic diseases caused by lead pollution is 40-60% higher.

The smart SPIRE iGIS gathers site ground analytical data from the 5 pilot sites. The system locates the sites and provides information about soil analysis and the heavy-metal concentration values. These concentration values in every region can be compared with the allowed limits set by WHO for Heavy-Metals. The project already counts on the heavy-metal concentrations at the beginning of the project per site:
Pilot site 1: Romplumb

Pilot site 2: Ferneziu

Pilot site 3: Colonia Topitorilor

Pilot site 4: Urbis

Pilot site 5: Craica

SPIRE evidence-based interventions focus on modifying the pilot sites and actions hankering after a behavioural change from Baia Mare citizens concerning environmental and health awareness, climate change commitments, and public open spaces enjoyment. The Immaterial Local Environmental Utility (iLEU)  represents a reward system for environmentally friendly activities based on blockchain technologies. It is provoking a systemic change by working in the interdependencies between the local community, locally owned businesses, innovation and new technologies, training and educational programs and participatory processes

_{^{Fig. 6: iLEU. Source: https://appadvice.com/app/ileu-baia-mare/1578679670}}

The SPIRE strategic multi-stakeholder framework aims to transform the current urban social dynamics into a new model based on three primary actions:

• Citizen engagement as a high priority for the SPIRE project and partners since the focus of the participatory approach is on the project's spirit.
• Real co-creation processes as the tool to ensure consistency between citizens and future ecological (and experimental) public spaces.
• Active participation of the local community as a critical milestone to ensure the success of the re-naturalization of the five selected pilot sites through Plantathlons activities; and the use of the innovative iLEU digital reward system.

Cities need to understand the features and processes that render them fragile to environmental and climate crisis and their health-related impacts. The International Agenda(s) support this understanding, proposing concrete actions and goals to overcome the health crisis in urban settings: The Sendai Framework for Disaster Risk Reduction 2015–2030, the Sustainable Development Goals (SDG), particularly SDG 3 and 11, the Paris Agreement (from climate change mitigation and adaptation lens), and the New Urban Agenda that advocates specifically for healthy, resilient, and sustainable cities.

_{^{Fig. 7. International Agendas. Source: UN}}

Environmental, social and economic policies influence health and well-being in cities. Strategic decisions activate synergies and achieve co-benefits that underpin the health and well-being of urban inhabitants. Public health authorities, health care practitioners, academia, researchers, local stakeholders, and communities have the duty to understand how to intervene within the built environment for health. Individual and/or structural-level interventions contribute to delivering better urban public health.