Green space, social inequalities and neonatal mortality in France

Abstract

BackgroundFew studies have considered using environmental amenities to explain social health inequalities.Nevertheless, Green spaces that promote good health may have an effect on socioeconomic health inequalities. In developed countries, there is considerable evidence that green spaces have a beneficial effect on the health of urban populations and recent studies suggest they can have a positive effect on pregnancy outcomes. To investigate the relationship between green spaces and the spatial distribution of infant mortality taking account neighborhood deprivation levels.MethodsThe study took place in Lyon metropolitan area, France. All infant deaths that occurred between 2000 and 2009 were geocoded at census block level. Each census block was assigned greenness and socioeconomic deprivation levels. The spatial–scan statistic was used to identify high risk cluster of infant mortality according to these neighborhood characteristics.ResultsThe spatial distribution of infant mortality was not random with a high risk cluster in the south east of the Lyon metropolitan area (p<0.003). This cluster disappeared (p=0.12) after adjustment for greenness level and socioeconomic deprivation, suggesting that these factors explain part of the spatial distribution of infant mortality. These results are discussed using a conceptual framework with 3 hypothetical pathways by which green spaces may have a beneficial effect on adverse pregnancy outcomes: (i) a psychological pathway, (ii) a physiological disruption process and (iii) an environmental pathway.ConclusionsThese results add some evidence to the hypothesis that there is a relationship between access to green spaces and pregnancy outcomes but further research is required to confirm this.

A Review of the Health Benefits of Greenness

“…Positive associations between greenness and birth weight were reported consistently across the majority of studies (31, 69-72). Other studies found that higher greenness exposure was linked to lower odds of a child being small for gestational age or preterm (31), larger head circumferences (68), and lower infant mortality risk (73), although these findings were not replicated across studies.…”

Green spaces and adverse pregnancy outcomes

“…This may be partly because groups with lower SES generally have a worse health status, less healthy behaviour, and live in areas with more environmental problems, and the combination of these factors may make them more likely to benefit from health promotion interventions compared to higher SES groups 28 29. Recently Kihal-Talantikite et al 8 discussed this in detail. The associations with measures of surrounding greenness among the lower ward-based SES groups may present a useful avenue for public health intervention through provision of green spaces in more deprived areas.…”

“…Recently Kihal-Talantikite et al 8 proposed a detailed model on the beneficial effects of greenness on pregnancy outcomes. These beneficial associations might be mediated through different pathways: promoting physical activity, affecting emotions (mainly by decreasing negative emotions and improving psychophysiological stress or through improving cognitive attention restoration), by increasing social contacts/cohesion, or by improving environmental conditions, such as decreasing noise and air pollution levels and moderating urban heat-island effect 8 10–13. To explore the underlying mechanism of reducing air pollution as a possible mediator for the association between surrounding greenness and pregnancy outcomes, we added the average PM10 exposure during the entire pregnancy as a covariate in the models, and no mediation effect was observed.…”

“…These effects might be mediated through (1) promoting physical activity, which has a well-established positive impact on health, (2) affecting emotions (mainly by decreasing negative emotions and improving psychophysiological stress, or through improving cognitive attention restoration), (3) increasing social contacts/cohesion or (4) improving environmental conditions, such as decreasing noise and air pollution levels and moderating urban heat island effects. Recently Kihal-Talantikite et al 8 proposed a detailed model on the beneficial effects of greenness on pregnancy outcomes.…”

An Ecological Study of the Association between Area-Level Green Space and Adult Mortality in Hong Kong

“…Green space not only enhances the beauty of the landscape but also has important significance for public health, and some studies have found evidence that green space improves people's health [3,4], with potential benefits including stress reduction [5], improving mental health [6], preventing overweightness and obesity [7], promoting a healthy duration of sleep [8], lowering neonatal [9] and stroke mortality [10], absorbing air pollution [11], and providing space for individuals to participate in the physical activities. Having more green spaces has been found to be associated with a higher likelihood of walking maintenance [12], which has been shown to have a positive influence on citizens' longevity in a densely populated city [13] and is associated with a lower odds of having any form of impaired glucose regulation [14].…”