Ethnic and socioeconomic inequalities in relation to air pollution exposure in the Netherlands

Abstract Background Air pollution (AP) contributes to a large disease burden and some populations are disproportionately exposed. It is unclear to what extent AP exposure differs across ethnic groups in the Netherlands and how this intersects with socioeconomic position (SEP). First, we identified differences in AP exposures between ethnic groups in the Netherlands. Second, we examined the interrelationships between ethnicity and SEP in relation to AP exposures. Methods We assessed AP exposures for residents of the Netherlands in 2019 (N = 17,251,511). Home address AP levels were estimated by dispersion models of the National Institute of Public Health and the Environment (RIVM). We linked exposure estimations of particulate matter <10 or < 2.5 μm (PM10, PM2.5), nitrogen dioxide (NO2), and elemental carbon (EC) to demographic data gathered by Statistics Netherlands. Absolute and relative differences in AP levels across ethnic groups were assessed. We conducted multivariable linear regression analyses and estimated marginal mean exposures to evaluate differences by ethnicity, SEP, age and sex within urban and rural areas. We tested for interactions and stratified accordingly. Results For the 40 largest minority ethnic groups (N > 18,314 per group), exposure to all pollutants was higher than for ethnic Dutch, with up to 1.5-fold differences for NO2. After stratification for urbanity and SEP, ethnic exposure inequalities persisted. For ethnic Dutch and some migrant groups, we found the lowest AP exposures in the middle SEP group (i.e. U-shaped trends), while we found linear patterns in other large migrant groups, with higher exposures at lower SEP. Conclusions Exposure to PM10, PM2.5, NO2, and EC was consistently higher in minority ethnic groups compared to ethnic Dutch. The association between SEP and AP levels showed different patterns between the majority ethnic Dutch and some of the largest minority ethnic groups. Further research is needed to define the equity and health implications. Key messages • Minority ethnic groups in the Netherlands are consistently exposed to higher levels of air pollution (PM10, PM2.5, NO2, and EC) than the ethnic Dutch population. • Depending on the ethnic group, the association between SEP and air pollution exposure was either linear (i.e. lower exposures at higher SEP) or U-shaped (i.e. lower exposures in the middle SEP group).


Background:
Italy was the first western country severely affected by the Covid-19 pandemic attesting more than 16 million cases since the outbreak began.Po Valley regions have been most afflicted, with Piedmont ranking sixth at 25,899 cases/100,000 inhabitants.Within this area, air dispersion is hampered making Po Valley a recognised air pollution hotspot.We aimed to explore the potential association between the environment and Covid-19 incidence.

Conclusions:
Results from ecological studies may support researchers' preliminary understanding of the interplay between environment and Public Health issues, including pandemics.A

Background:
Air pollution (AP) contributes to a large disease burden and some populations are disproportionately exposed.It is unclear to what extent AP exposure differs across ethnic groups in the Netherlands and how this intersects with socioeconomic position (SEP).First, we identified differences in AP exposures between ethnic groups in the Netherlands.Second, we examined the interrelationships between ethnicity and SEP in relation to AP exposures.

Methods:
We assessed AP exposures for residents of the Netherlands in 2019 (N = 17,251,511).Home address AP levels were estimated by dispersion models of the National Institute of Public Health and the Environment (RIVM).We linked exposure estimations of particulate matter <10 or < 2.5 mm (PM10, PM2.5), nitrogen dioxide (NO2), and elemental carbon (EC) to demographic data gathered by Statistics Netherlands.Absolute and relative differences in AP levels across ethnic groups were assessed.We conducted multivariable linear regression analyses and estimated marginal mean exposures to evaluate differences by ethnicity, SEP, age and sex within urban and rural areas.We tested for interactions and stratified accordingly.

Results:
For the 40 largest minority ethnic groups (N > 18,314 per group), exposure to all pollutants was higher than for ethnic Dutch, with up to 1.5-fold differences for NO2.After stratification for urbanity and SEP, ethnic exposure inequalities persisted.For ethnic Dutch and some migrant groups, we found the lowest AP exposures in the middle SEP group (i.e.U-shaped trends), while we found linear patterns in other large migrant groups, with higher exposures at lower SEP.

Conclusions:
Exposure to PM10, PM2.5, NO2, and EC was consistently higher in minority ethnic groups compared to ethnic Dutch.The association between SEP and AP levels showed different patterns between the majority ethnic Dutch and some of the largest minority ethnic groups.Further research is needed to define the equity and health implications.

Key messages:
Minority ethnic groups in the Netherlands are consistently exposed to higher levels of air pollution (PM10, PM2.5, NO2, and EC) than the ethnic Dutch population.
Depending on the ethnic group, the association between SEP and air pollution exposure was either linear (i.e.lower exposures at higher SEP) or U-shaped (i.e.lower exposures in the middle SEP group).
Abstract citation ID: ckac129.564Policies out of sync -are healthy ageing agendas fit for the future?

Background:
In both scale and impact, population ageing has far reaching implications for our planet, not least as a major driver of population growth and the ever-increasing human demands on natural resources and ecosystems.This fundamentally impacts sustainable development efforts to eradicate poverty, achieve food security, build inclusive and resilient communities, and ensure sustainable consumption.The overarching connections between global ageing and sustainability are clear: a focus on sustainable healthy ageing is fundamental to a healthy planet.
Our responses to date have however largely been disconnected.
To progress this dual agenda, our work aims to i) assess whether current national/international strategies addressing healthy ageing include a strategic focus on sustainability; ii) present the evidence for such alignments; and iii) develop a framework of sustainable actions and aligned policy.

Methods:
A mixed-methods approach using content and applied thematic analysis was utilised to examine strategy documents, and develop an analytical framework derived from relevant theory to guide quantitative and qualitative analysis of the resultant data.Evidence themes were developed iteratively during analytical phases.Findings informed the development of the framework.

Results:
We identified and analysed 36 strategies published from 2000 to 2021 containing over 600 wide-ranging policies.No strategies and only a minority of policies included a strategic sustainability focus.A larger subset made reference to links between ageing and sustainability or environmental elements yet these were largely theoretical and not carried through in the key strategic approaches or resulting polices.

Conclusions:
This work provides valuable insights into strategic approaches to foster sustainable healthy ageing and identifies levers for greater alignment and sustainable action.The recently declared 2021-30 UN Decade of Healthy Ageing provides an ideal platform for action.

Key messages:
While the evidence for strong alignment is unequivocal, global healthy ageing and sustainability agendas are largely disconnected.
By strengthening the links between healthy ageing and sustainability agendas, stakeholders across sectors can reinforce and design approaches that meet human needs while protecting our planet.
Abstract citation ID: ckac129.565Identifying cross-sectoral cooperation for urban health Empirical evidence for collaborative health promotion practices is still limited.The Cross-Sectoral Cooperation Self-Assessment Tool (CroCo SA) presented here provides a tool for cities to assess their current commitment to promote urban health and well-being across sectors.The SA tool was validated by co-operating with 9 pilot cities and seven countries in the framework of the Healthy Boost project funded by Interreg Baltic Sea Region (2019Region ( -2022)).Addressing the current complexity, interdependence and emerging challenges of health promotion requires cross-sectoral cooperation and tools to assess cross-sectoral processes and make their impact visible.A digitized CroCo SA tool was developed and validated.An SA evaluation matrix was created, including 162 cells of options for reflective and guiding responses according to 6 scale x 27 items used in the SA tool.After submission of the electronic form, respondents can view anonymized results in a digital form on the Healthy Boost platform.The feedback report summarizes the results for respondents and provides, both numerical and descriptive, verbal feedback on the state of the assessed city's capacity for cross-sectoral cooperation, based on each assessment.The steps the respondents could take in their respective cities to improve cross-sectoral cooperation are outlined.Recommendations are based on the evidence found to be the prerequisites for effective cross-sectoral work for health promotion.SA can be conducted in many languages offered by the Google translation programme.Guiding feedback of CroCo SA defines areas for improvement in strategies and actions, allowing respondents also to do benchmarking and learn from other cities and countries.Self-assessment itself is a learning process.

Key messages:
The CroCo SA tool offers a method for gathering information about the state of cross-sectoral cooperation for urban health promotion.By identifying strengths and weaknesses in cooperation, the city can build capacity for cross-sectoral cooperation.

Abstract citation ID: ckac129.566
To what degree are health insurance enrollees aware of the restrictive conditions of their policies?