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Similar a Green spaces and cardiovascular diseases in québec roland ngom
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Green spaces and cardiovascular diseases in québec roland ngom
- 2. 14 August 2014 Roland Ngom, Claudia Blais, Louis Rochette, Pierre Gosselin
- 3. GREEN SPACES FOR THE PRIMARY PREVENTION OF CARDIOVASCULAR DISEASES (CVD) CVD = High cost for public health budgets CVD and related public health budgets = Probably aggravated by climate change (extreme heat, pollution) GS can be used at best advantaged in a primary prevention process
- 4. GREEN SPACES (GS) FOR THE PRIMARY PREVENTION OF CARDIOVASCULAR DISEASES (CVD) Do GS significantly contribute to the reduction of the morbidity and mortality of CVD ? Complex question to answer given the variety of factors related with CVD and the multiple functions of GS
- 5. THE DEFINITION OF A GS ALMOST PHILOSOPHICAL What is a green space? Is it an open area with or without vegetation? Lawn or ligneous vegetation? Is a GS tailored for recreation? Is it a natural space? Is it a protected area? What minimal surface does a GS must have? Figure 1 : Various types of spaces qualified as « green spaces »
- 6. RELATIONSHIP BETWEEN GS AND CVD INVESTIGATED FOR THE CENSUS METROPOLITAN AREAS (CMA) OF MONTREAL AND QUEBEC Figure 2 : The Census Metropolitan Areas of Montreal (B) and Quebec City (A) with 6 digits postal codes
- 7. DATA AND ANALYSIS Multiples GS functions with the presence of vegetation Figure 3 : GS functions
- 8. DATA AND ANALYSIS Dependant variables Social Environmental Age Gender Deprivation index Population density Immigration Fitness centers Pollution Urban Heat Index Air conditionning Covariables Morbidity from types 1 and 2 diabetes and hypertension Morbidity and mortality of cerebrovascular illnesses, heart failure and ischemic heart diseases. Retrospective cohorts for three periods of exposition: P1 = 1996-2000; P2 = 2001-2005 and P3 = 2006-2011
- 9. Comparin g the first quartile of distances to GS (Individul s that are nearest to GS) to the last quartile of distance Modèle B Modèle A Modèle A Modèle B DATA AND ANALYSIS Regression models with stratified distances to GS
- 10. RESULTS AND DISCUSSION GS with specific functions exclusively showed a significant statistical relationship with CVD in the most recent period (2006- 2011): Mortality for all the CVD = 10% and mortality from heart failures = 13% higher for the most distant (compared to the less distant) to GS that contain biking/walking trails Morbidity from diabetes = 11% and morbidity from cerebrovascular illnesses = 13% higher for the most distant (compared to the less distant) to GS having sports facilities. GS that stimulate physical activities The surface area of GS was not a significant factor
- 11. RESULTS AND DISCUSSION Unlike the CMA of Montreal, the CMA of Québec showed greater equity in access to GS Figure 4: Significant reduction of distances between individuals and GS
- 12. RESULTS AND DISCUSSION Unlike the CMA of Montreal, the CMA of Québec showed greater equity in access to GS Figure 5: Margins from the Anova models of distances to green spaces, according to the categories of densities, material deprivation and by age groups
- 13. RESULTS AND DISCUSSION A probable gentrification phenomenon Figure 6: Regressions between individuals aged of 75 years and more and population densities according to material deprivation in the CMA of Quebec (A) and Montreal (B) for 2006- 2011
- 14. CONCLUSION There is an effective potential for primary prevention of CVD trough GS, however its effectiveness greatly depends on the spatial distribution of those GS and their function rather than the surface area of GS per individual. Social and economic processes such as gentrification in urban settings greatly affect the equity in access to GS, and therefore limit the effectiveness of positive effects of GS on population health. Urban sustainability: There is a big challenge mostly for big cities since they have to cope with multiple functions of GS (ecological and social) and with established urban structures that usually result from uncontrolled socioeconomic processes
- 15. Thanks for your attention Remerciements à Véronique Bouzaglou pour sa contribution dans la collecte des données, à Louis Rochette et Abdous Kacem pour leur disponibilité, à Danielle Saint-Laurent et à toute l’équipe de l’unité scientifique, Surveillance des maladies chroniques et de leurs déterminants à Institut national de santé publique du Québec pour leur assistance. For any correspondance please contact Dr. Roland Ngom roland_pierre.ngom@ete.inrs.ca
Notas del editor
- The spatial support of this study was composed of the CMA of Montreal and Quebec. A CMA is formed by one or more adjacent municipalities centered on a large urban area (known as the urban core). It must have a population of at least 100,000 inhabitants and the urban core must have a population of at least 50,000 inhabitants. To be included in the CMA, other adjacent municipalities must have a high degree of integration with the central urban area, as measured by commuting flows derived from census data on the workplace. The CMA of Montreal is the main catchment area in the province of Quebec and is the most important economic center. According to the latest available data from the Statistical Institute of Quebec (ISQ, December 2010 ), the Montreal’s CMA with its 3,824,221 people, represents 49% of the population of the province and 11% of the Canadian population. Its population density is about 898 inhabitants per square kilometer. The population of the Quebec city’s CMA is estimated to 765,706 people with 228 inhabitants per square kilometer. This is the second biggest CMA in the province after Montreal’s CMA.
- Data from the Desktop Managing technologies Inc. (DMTI) were used as source to build all the GS variables
- We used the Quebec integrated chronic disease surveillance system (QICDSS) of the Institut national de santé publique du Québec, the linkage of five health administrative data. For P1 there was a total of 960,000 individuals, 1,013,000 for P2 and 1,300.000 for P3.
- Pour éviter la colinéarité entre variables prédictives, des analyses de corrélations intégrant toutes les variables prédictives ont été conduites au préalable Mesures d’association • Risque relatif (Risk ratio ou Relative risk) – Risque chez les exposés/Risque chez les non-exposés • Rapport de cotes (Odds ratio) – odds chez les exposés/odds chez les non-exposés • Rapport de taux d’incidence (Incidence rate ratio) – Taux d’incidence chez les ex posés/Taux d’incidence chez les non-exposés • Rapport de risque instantané (Hazards ratio) – Risque instantané chez les exposés/Risque instantané chez les non-exposés
- En vue de comparer les variations extremes
- Quebec City, the urban core of the CMA Quebec showed more equity in access to GS. One can argue that given its moderate size, the level of social disparities is lower than in big cities. However, it is also true that the distribution of GS is less centralized than in Montreal where big parks such as the Mount Royal and the Agrignon are of crucial importance, given their size and the spatial configuration of the island. In Québec CMA, specific green spaces features such as the linear park of Saint Charles river with a 32 km walking/cycling track along the river have been developed and they allow a more equitable access to GS than in Montreal CMA.
- Quebec City, the urban core of the CMA Quebec showed more equity in access to GS. One can argue that given its moderate size, the level of social disparities is lower than in big cities. However, it is also true that the distribution of GS is less centralized than in Montreal where big parks such as the Mount Royal and the Agrignon are of crucial importance, given their size and the spatial configuration of the island. In Québec CMA, specific green spaces features such as the linear park of Saint Charles river with a 32 km walking/cycling track along the river have been developed and they allow a more equitable access to GS than in Montreal CMA.
- The results of the present paper show a significant improvement of the access to GS. This effort appears to be insufficient in view of the variability of access between different social groups. These relate to all age groups and are more alarming in the densest areas of the island of Montreal. Everything happens as if we are witnessing a process of gentrification with a significant impact on access to GS. Gentrification is an urban phenomenon where wealthier newcomers appropriate space initially occupied by less privileged users. This transforms the economic and social profile of the neighborhood for the exclusive benefit of a higher social stratum (Ruth Glass, 1964). It translates, among other high pressure of new people on authorities to improve their neighbourhood, particularly in terms of public spaces including GS. The poor who lived in the neighborhood before gentrification cannot be followed for rent and must look elsewhere, for example in cheaper neighborhoods that offer fewer benefits (remote areas). However, if it is difficult (for lack of offers elsewhere, for example), they will respond, too, to be able to stay, and will call for social housing. It was actually witnessed in recent years a transformation of the real estate market especially in the area of the island of Montreal. Gentrification benefit developers and can benefit cities’ coffers, as higher property values lead to more tax revenue. In many local newspapers there is a warming on the steady decline in the availability of rental housing as more and more triplexes are being turned into condominiums.
- The results of the present paper show a significant improvement of the access to GS. This effort appears to be insufficient in view of the variability of access between different social groups. These relate to all age groups and are more alarming in the densest areas of the island of Montreal. Everything happens as if we are witnessing a process of gentrification with a significant impact on access to GS. Gentrification is an urban phenomenon where wealthier newcomers appropriate space initially occupied by less privileged users. This transforms the economic and social profile of the neighborhood for the exclusive benefit of a higher social stratum (Ruth Glass, 1964). It translates, among other high pressure of new people on authorities to improve their neighbourhood, particularly in terms of public spaces including GS. The poor who lived in the neighborhood before gentrification cannot be followed for rent and must look elsewhere, for example in cheaper neighborhoods that offer fewer benefits (remote areas). However, if it is difficult (for lack of offers elsewhere, for example), they will respond, too, to be able to stay, and will call for social housing. It was actually witnessed in recent years a transformation of the real estate market especially in the area of the island of Montreal. Gentrification benefit developers and can benefit cities’ coffers, as higher property values lead to more tax revenue. In many local newspapers there is a warming on the steady decline in the availability of rental housing as more and more triplexes are being turned into condominiums.