Dr Chinmoy SarkarHealthy High Density Cities Lab (HHDC), HKUrbanLab

The University of Hong KongEmail: csarkar@hku.hk

Designing safe, smart, and sustainable built environments across diverse contexts to support

healthy longevity

Healthy Longevity: Global Grand ChallengeSocial Behavioural and Environmental Enablers of Healthy Longevity

US National Academy of Medicine6th - 8th November 2019, Washington DC.

09.00, 7th November 2019

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Health outcomes and the urban environment: connectionsThe Lancet Commissions. 2012. Shaping cities for health: complexity and the planning of urban environments in the 21st century. The Lancet; 379: 2079–108

Built environment Exposures Outcomes

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THE LANCET COMMISSION’S Report on HEALTH – URBAN ENVIRONMENT RELATIONSHIPS

Complexity: Urban health niche model of multi-level risk clustering, interactions and pathwaysSarkar & Webster, Current Opinion in Environmental Sustainability, 2017; 25:33-44.

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UK Biobank Urban Morphometric Platform (UKBUMP)

UKBUMP: A high resolution spatial database of 750 plus health-specific urban morphological metrics (morphometrics)

Highly characterized exposures: Measured within functional neighbourhood of participants’ geocoded dwelling

Niche methodology that can be automated and replicated: State-of-the-art spatial and network analyses algorithms and models on multiple national level UK databases

UKBUMP BE database linked to UK Biobank health database.

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UK BIOBANK URBAN MORPHOMETRIC PLATFORM (UKBUMP)

0.5 m resolution index of greenery (as captured by NDVI modelled from 0.5 m colour infrared imagery.

A street-level physical accessibility captured at multiple spatial scale

Terrain as mean and std. in slope within 0.5, 1 Km buffer

Density of 200+ health-influencing destinations within 0.5, 1, 1.5, 2.0 Km street buffer of a UKB participants’ address

Morphometrics

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Protective: Physical activity spaces, walkability, parks, greenness

Non-beneficial: Air pollution, neighbourhood deprivation

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• 419 562 adults of UK Biobank cohort, aged 37–73 yrs, 21 UK cities

• Housing unit density within 1 km street buffer vs adiposity and physical activity. Adjusted for retail, public transport, street-level movement and individual covariates

• Curvilinear dose-response curve (turning point at 1800 housing units/sq km)- Below 1800: obesogenic (+10% higher odds of obesity, 14% higher odds of reporting low PA): suburban sprawl effect

- above 1800: leptogenic (-9% lower odds of obesity, 5% lower odds of reporting low PA): physical activity – related mechanism

• Planning suburban densification -> Public health opportunity

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• Examined associations between green exposure, adiposity and travel behaviour

• Models controlled for individual-level covariates, SES and built environment exposures (retail density, street walkability, terrain, and PM10 and PM2.5)

• 3.2% lower odds of obesity and 9.3% higher odds of active mode of non-work travel per interquartile increment in mean NDVI greenness

• Beneficial effects of greenness more pronounced in high urbanicity and low SES subgroups

• Optimized green allocation, design ameliorate health externalities of obesogenic environment

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Sig. beneficial effects in elderly: lower BMI and risk of obesity

N=333,183 UK Biobank participants

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• N =94 879 participants of the UK Biobank cohort

• Models controlled for other environment metrics (street-level movement density, terrain, and fine particulate exposures)

• 4% lower odds of MDD per interquartile increment in NDVI greenness

• Optimized allocation and design of residential green enhances mental wellbeing and mental capital of cities

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Sig. beneficial effects in elderly: 5% lower odds of depression

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• N=429,334 participants of UK Biobank cohort

• Neighbourhood walkability had a protective effect upon hypertension outcomes (3% lower odds of hypertension), diastolic (β=-0.358 mmHg) and systolic pressures (β=-0.833 mmHg)

• Results consistent across spatial scales of 1, 1.5, 2 km street catchments

• Pronounced protective effects among those aged 50-60 years, female, in employment, residing in low SES, high residential density and greener areas

• City design -> optimizing walkability -> Hypertension prevention & control

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Color Infrared licensed by BlueSky; received and distributed by the Landmap Services of MIMAS, The University of Manchester. ©GeoPerspectives, Supplied by BlueSky

Single street trees around a dwelling catchment of LTDS resident

0.5 m res colour infrared image derived NDVI around a dwelling catchment of LTDS resident

Residential greenness promotes walkability HHDC |

• Cohort study of change in BMI on 3 occasions over 12 years (encompassing phases 3, 4 & 5)

• 684 men with complete covariate data• Change in BMI associated with:

• Land use mix • Density of retail, churches and recreation• Street-level movement• Slope variability

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Built environmentmorphometrics

Odds of psychological distress; N = 687

O.R. (95% Cr.I.) p-value

Dwelling type (terraced vs. Semi-detached) 0.48 (0.22, 0.99) p=0.03Land use mix (T2 vs. T1) 0.63 (0.33, 1.20) p = 0.07Land use mix (T3 vs. T1) 0.42 (0.17, 0.99) p = 0.03Density of bus stops 1.04 (0.98, 1.11) p = 0.07

Density of business & offices 1.02 (0.99, 1.04) p = 0.08

Street movement potential – 1200m 0.54 (0.28, 0.98) p < 0.03

Topography (standard deviation in slope) 1.38 (1.00, 2.01) p = 0.05

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© Sarkar et al.

• N=66,820 participants from Hong Kong Chinese Elderly Health Services cohort

• Daily concentrations of air pollution for each participant measured by applying inverse distance weighting based on cohort participants’ residential address

• Greenness measured from satellite-derived normalized difference vegetation index at two time points.

Evidence of significant interaction for risk of mortality from pneumonia between nitrogen dioxide, PM2.5, O3 and residential greenness.

Submitted; under peer review

Does residential greenness modify the short-term association between air pollution and respiratory mortality among older adults in Hong Kong?

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Prevention Early detection Chronic disease

management Ageing-in-place Sense of community and

social interaction and support Universal design for older

adults Activity-friendly living Self empowerment

New mantra for healthy longevity!

Health care – social care – urban planning –community collaboration: Holistic health care outside hospital walls!

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WHO (2007) Global age-friendly cities : a guide.

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Maintaining functional capacity over life-course

Functional capacity αPhysical activity, social interaction

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Walkability Active mobility (PT) Ageing-in-Place

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Legible configuration and information

Access to healthcare 5G in health Salutogenic/restorative env

Social networks community/family living intergenerational-spaces stake holders & decision makers

Climate change Safe streets & public spaces Dementia-friendly design

Social connectivity

Security & Resilience

Accessible healthcare and

wellbeing

Planning & design promoting

independence

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Housing• Social interactions • Quality of indoor micro-

environment and sensory stimulations

• Physical functioning• Ventilation, thermal

comfort

Street design• Street network configuration• Ease of access to neighbours(sense of community)• Walkability • Accessibility to services• Perception of safety

Urban green• Restorative potential • Improving air quality • Encouraging physical activity • Aesthetic values • Offsetting heat island effect

Neighbourhood density• High density, mixed land use • Compactness, pedestrian access • Exposure to natural light and ventilation • Livability • Visual and physical access to the outdoors

Perception of the environment

Potential city-level predictors of healthy longevity

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Conclusion: Smart city promoting healthy longevity• Smart mobility: door-to-door seamless transport across different modes,

collective mobility, and adapted-mobility• Adaptable age-friendly housing, buildings and infrastructure • Compact living with integrated infrastructures and supportive networks• Age-, disable-friendly design: familiar, legible, distinct, safe comfortable• Optimized design to enhance accessibility and segregate risks• Adaptable assistive-technologies in public space• Internalization and integration of healthy longevity on to the policy and

politics• Elderly as key stakeholders and decision makers

Thank you very much!

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