The need for analysis and action across the interrelated domains of human behaviors and lifestyles, environmental sustainability, health and inequality is increasingly apparent. Currently, these areas are often not considered in conjunction when developing policies or interventions, introducing the potential for suboptimal or conflicting outcomes. The INHERIT model has been developed within the EU-funded project INHERIT as a tool to guide thinking and intersectoral action towards changing the behaviors and lifestyles that play such an important role in today’s multidisciplinary challenges. The model integrates ecological public health and behavioral change models, emphasizing inequalities and those parts of the causal process that are influenced by human behaviors and lifestyles. The model was developed through web-based and live discussions with experts and policy stakeholders. To test the model’s usability, the model was applied to aspects of food consumption. This paper shows that the INHERIT model can serve as a tool to identify opportunities for change in important −food-related behaviors and lifestyles and to examine how they impact on health, health inequalities, and the environment in Europe and beyond. The INHERIT model helps clarify these interrelated domains, creating new opportunities to improve environmental health and health inequality, while taking our planetary boundaries into consideration.
The world’s challenges of climate change, damage to ecosystems, and social and health inequalities require changes in human behaviours at every level of organisation, among governments, business, communities, and individuals. An important question is how behaviour change can be enabled and supported at the scale and speed required. The research reported in this paper describes important lessons for good practice in changing contexts to modify behaviours for a triple win for health, equity and environmental sustainability. Authors synthesised learning from qualitative, quantitative and cost benefit evaluations of 15 case studies conducted in 12 countries in Europe. The case studies address ways of living (green spaces and energy efficient housing), moving (active transport) and consuming (healthy and sustainable diets) that support the triple win. Ten lessons for good practice were identified. These include bringing a triple win mindset to policy and practice in planning interventions, with potential to improve environmental sustainability, health and equity at the same time. The lessons for good practice are intended to support governmental and non-governmental actors, practitioners and researchers planning to work across sectors to achieve mutual benefits for health and environmental sustainability and in particular to benefit poorer and more socio-economically disadvantaged groups.
This study describes the implementation, in North Macedonia, of a “tool”, initially devised in Scotland, to generate community and stakeholder discussion about the places in which they live and notably a place’s capacity to generate health wellbeing and greater equity among citizens. In this study, the “place standard tool” (PST) is viewed from the perspective of creating places which can deliver a triple win of health and wellbeing, equity, and environmental sustainability. Skopje, North Macedonia’s capital, inevitably differs economically, culturally, and politically from Scotland, thus providing an opportunity to augment existing knowledge on adaptability of the tool in shaping agendas for policy and action. Тhe PST was tested through seminars with selected focus groups and an online questionnaire. Over 350 respondents were included. Information on priorities enabled the distillation of suggestions for improvement and was shared with the Mayor and municipal administration. Skopje citizens valued an approach which solicited their views in a meaningful way. Specific concerns were expressed relating to heavy traffic and related air and noise pollution, and care and maintenance of places and care services. Responses varied by geographic location. Application of the PST increased knowledge and confidence levels among citizens and enthusiasm for active involvement in decision making. Effective implementation relies heavily on: good governance and top-level support; excellent organization and good timing; careful training of interviewers and focus group moderators; and on prior knowledge of the participants/respondents.
The aim of this study was to identify noise exposure indicators during day and night in the city of Skopje and to see if there is an association between these noise exposure indicators and annoyance. We have performed noise measurements and interviewed 510 adult subjects, using a questionnaire, prepared according to the ISO/TS-15666 standard. Average noise level over the day (L day ) was (62±6.45) dB(A) and over night (L night ) (56±6.52) dB(A). Thirteen percent of subjects reported a high level, and 33.5 % moderate level of annoyance. The most annoying noise sources were construction activities (34 % of the subjects), road traffi c (24 %), and leisure/entertainment activities (18 %). We found a signifi cant association between exposure to L day in the range 61 dB(A) to 65 dB(A) and annoyance in the exposed population (chi-square = 86.14; p<0.001; Spearman's R=0.45; p<0.05). During the night time annoyance was reported with exposure to L night above 46 dB(A). Levels of annoyance in Macedonia are similar to levels in developed European countries. Differences are in the source of noise. This study has shown that environmental noise is a signifi cant hazard in urban environments, and assessment of annoyance may prove a useful tool for town planners and public health policy makers.
Aim. To evaluate sleep disturbance caused by environmental noise in residents of Skopje urban centre and to quantify the probability for sleep disturbance related to night-time noise exposure. Methods.Cross sectional study with noise measurements for determination of noise exposure indicator L night . A randomised sample was selected from adult population and directly interviewed with questionnaire for assessment of sleep disturbance.Results. 510 questionnaires were collected and the response rate was 72%, 8% of the population sample reported a high level of sleep disturbance and 18% reported a moderate level of sleep disturbance. The most frequent sources of noise were neighbourhood and road traffic. The most disturbed age group were individuals 51-65 years old, who were significantly more disturbed (p=0.010) than the age group of 41-50 years old. Differences in sleep disturbance were significant only for the group exposed to L night ≥ 56 dBA (Wald = 4.31; p = 0.04). Exposure to L night above 56 dBA had OR = 2.2 (95% CI 1.1 -4.7) or double significant increase probability for sleep disturbance, compared with control group of subjects exposed to L night ≤ 45 dBA. Conclusion.Night time noise exposure above the established limit values significantly increased the risk for sleep disturbance. These findings induce necessity for reducing noise exposure, especially during night-time and for taking preventive measures.
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