Health & Place

Urban mobility may provide insight into population health by capturing how residents connect to services, resources, and urban systems. This is relevant for communities facing higher disease burden and limited resources, where reduced connectivity may signal barriers to care, healthy environments, and participation. Mobility patterns are furthermore shaped by socioeconomic position, housing, environmental quality, facilities access, lifestyle patterns, and population composition. Mobility-health associations may therefore reflect underlying social and environmental disadvantage rather than mobility itself, risking misdirected public-health policy responses. This ecological cross-sectional study examined associations between aggregated mobile phone-based mobility and health outcomes in The Hague, Netherlands, from January-July 2019. Mobile phone mobility was measured as mean outgoing mobility distance across eight regions. Contextual and health indicators were available at neighbourhood-level and were aggregated or linked to regions where required. Health outcomes were operationalised as indicators of disease burden, including cardiometabolic medication prescriptions, polypharmacy, and a syndemic-based measure of interacting health conditions. Contextual domains were selected using spatial clustering and ordinary least squares models, after which residual mobility-health associations were assessed. Outgoing mobility varied across regions and was strongly patterned by contextual factors. Lifestyle, housing, physical environment, and income accounted for 73.2% of variance in outgoing mobility. After adjustment, residual mobility showed weak, non-significant associations with cardiometabolic medication prescription, polypharmacy, and the syndemic-based measure. Sensitivity analyses supported these findings. Aggregated mobility should not be interpreted as a straightforward independent determinant of health. Instead, it appears to function as an integrative marker of urban context, spatial structure, and population composition.

Summary Background: Spatial variation in heat-related mortality remains poorly understood, particularly at fine geographical scales. We conducted a nationwide small-area study to examine the association between spatial variation in heat-related mortality and environmental, demographic, health, and socio-economic factors. Methods: We obtained daily all-cause mortality data for people aged [≥] 65 years during the summers of 2011-2023 and linked them with municipality-level daily temperature estimates from the ERA5-Land reanalysis dataset. We applied a two-stage Bayesian hierarchical model to estimate small-area heat-related mortality and assess the contribution of community characteristics to spatial variability. Findings: Heat-related mortality showed marked geographical differences, with the highest rates in southern and southeastern Italy. Across municipalities, the relative risk at the 90th temperature percentile, relative to the minimum mortality temperature, ranged from 1.06 to 1.33. The heat-attributable fraction exceeded 6% in several southern municipalities, while excess mortality surpassed 8 deaths per 1,000 inhabitants in parts of the Po Valley, Tuscany, Apulia, and Sicily. National heat-attributable mortality peaked in 2022, with an estimated 17,828 deaths (95% credible intervals: 17,339, 18,285) among older adults. Municipalities with higher average temperatures, less green space, higher obesity prevalence, and more residents aged [≥] 85 years had higher heat-related mortality. Educational attainment and employment were among the strongest modifiers of spatial variation. Interpretation: Our findings highlight substantial small-area differences in heat-related mortality across Italy and identify socio-economic deprivation as a key determinant of vulnerability. Heat is likely to disproportionately affect disadvantaged communities, reinforcing the need for adaptation strategies addressing social inequality. Funding: Imperial College Research Fellowship; Italian Ministry of Health PNC (CUP J55I22004450001); NIHR Imperial Biomedical Research Center (BRC NIHR203323).

BackgroundDrowning remains a major global public health challenge. This study examined whether the timing and trajectories of urbanisation--beyond the current built environment--are associated with subnational drowning mortality. MethodsWe linked satellite-derived measures of built-environment change (GHSL), population crowding (WorldPop), surface water exposure (JRC Global Surface Water), and infrastructure proxies (VIIRS/DMSP nighttime lights) to GBD 2021 drowning mortality estimates across 203 ADM1 regions in 12 countries (2006-2021; 3,248 region-year observations). Temporal predictors captured recent expansion, development "newness" ([≤]10-year built share), acceleration/volatility, and a crowdingxgrowth interaction. We screened predictors using LASSO (10-fold cross-validation) and fitted mixed-effects models with region random intercepts. Distributed-lag models tested temporal precedence and development age, and income-stratified models assessed heterogeneity. ResultsAdding temporal predictors improved fit beyond contemporaneous built-environment measures ({Delta}AIC=177; {Delta}BIC=147). In adjusted models, crowdingxgrowth was strongly positively associated with drowning mortality, and a higher share of recent development was associated with higher mortality. Lag models showed a development age gradient: older built environment was most protective. Associations differed by income group, with several key coefficients reversing sign across strata. DiscussionDrowning mortality appears shaped by development histories as well as present-day conditions, with risk concentrated in rapidly changing, dense settings and the newest built environments. Cross-context heterogeneity suggests mechanisms and prevention priorities are unlikely to be uniform. ConclusionsDevelopment timing and trajectories help explain subnational drowning mortality beyond current built form alone. Prevention and planning should prioritise transition-period safety strategies in newly developing and rapidly densifying areas.

Drowning remains a major global public health challenge, yet how built environment characteristics shape population-level drowning risk remains poorly understood. This study linked satellite-derived built environment data to subnational drowning mortality estimates across 203 regions in 12 countries from 2006-2021. It found that built environment associations with drowning mortality are complex, non-linear, and shaped by development context. Urban extent was strongly protective, while built area near water showed protection overall but increased risk when combined with high population crowding. Almost all drowning mortality variance occurred between regions rather than within regions over time, indicating risk is predominantly determined by place-based characteristics. Income-stratified analyses revealed profound heterogeneity: crowding was protective in low-to middle-income settings but near-null in high-income regions, while waterfront development captured very different realities across contexts. These findings highlight the importance of tailoring drowning prevention strategies to local built environment configurations and development contexts.

Greenspace has been associated with a wide range of health outcomes and conditions related to functional limitation and disability. Yet less is known about how the spatial morphology of greenspace relates to disability prevalence across different stages of the life course. This study examines associations between greenspace morphology and disability prevalence among children, working-age adults, and older adults in urban census tracts across the contiguous United States. Using national land-cover data, we quantified morphological metrics at the census-tract level, including greenspace percentage, density, mean size, connectedness, shape complexity, inter-greenspace distance, and diversity. These indicators were linked with age-specific disability prevalence obtained from the American Community Survey. Spatial lag regression models were used to account for spatial dependence while adjusting for socio-demographic and contextual characteristics. Across age groups, higher greenspace percentage was consistently associated with lower disability prevalence (children: {beta} = -0.081, 95% CI: -0.096 to -0.066; adults: {beta} = -0.804, -0.858 to -0.750; older adults: {beta} = -1.132, -1.250 to -1.013). Among children, patch density ({beta} = -0.045, -0.061 to -0.029), mean patch area ({beta} = -0.029, -0.040 to -0.018), connectedness ({beta} = -0.051, -0.069 to -0.032), diversity ({beta} = -0.036, -0.051 to -0.020), and inter-greenspace distance ({beta} = 0.056, 0.039 to 0.073) were all associated with disability prevalence, whereas shape complexity was not ({beta} = 0.004, -0.010 to 0.018). Among working-age adults, associations were observed for mean area ({beta} = -0.023, -0.090 to -0.002), connectedness ({beta} = -0.127, -0.243 to -0.011), shape complexity ({beta} = -0.123, -0.174 to -0.072), diversity ({beta} = -0.146, -0.201 to -0.091), and inter-greenspace distance ({beta} = 0.151, 0.059 to 0.242), whereas patch density was not significantly associated with disability prevalence ({beta} = -0.013, -0.048 to 0.022). In older adults, all examined greenspace morphology metrics showed significant associations with disability prevalence, including patch density ({beta} = -0.445, -0.842 to -0.049), diversity ({beta} = -0.126, -0.188 to -0.065), and inter-greenspace distance ({beta} = 0.455, 0.409 to 0.501). Overall, the findings suggest that higher greenspace percentage, larger patch size, greater connectedness, greater diversity, and more spatially clustered greenspace distributions are associated with lower disability prevalence across the life course, although the strength and consistency of these associations varied across age groups. The study provides national-scale evidence for incorporating greenspace morphology into urban planning and public health strategies to support more inclusive and health-supportive urban environments.

Background Childhood overweight and obesity represent major public health challenges, shaped by socio-economic and environmental factors. This study investigates the mediating and moderating role of urban environmental exposures in socio-economic disparities in childhood excess weight. Methods Data was drawn from a population-based sample of children (2-9 years) and adolescents (10-17 years) living in Geneva, Switzerland. Parents reported household financial situation and children's height and weight, from which excess weight (i.e. overweight or obesity) was derived. Residential exposures to air pollution (PM2.5, NO2), noise (daytime, nighttime), and neighborhood greenness (green areas, canopy coverage) were estimated based on geocoded residential addresses. The association between household financial situation and excess weight was evaluated, as well as the mediating and moderating roles of urban environmental exposures. Results The analysis included 1006 children and 1154 adolescents. Among children, an average-to-poor household financial situation was associated with higher odds of excess weight in children (adjusted odds ratio [aOR]: 1.79, 95% confidence interval [CI]: 1.13; 2.84). Higher noise exposure was associated with excess weight (daytime: aOR: 1.40, 95% CI: 1.10; 1.77, nighttime: aOR: 1.37, 95% CI: 1.08; 1.74), while the association with PM2.5 appeared stronger among socio-economically disadvantaged children, though the interaction did not reach statistical significance (financial situation x PM2.5 interaction: aOR: 1.59, 95% CI: 0.98; 2.59). No significant associations were observed among adolescents. Conclusion These findings highlight the joint influence of social and environmental inequalities on childhood excess weight and stress the need to address these interconnected determinants to design equitable, targeted public health interventions.

Ambient temperature is emerging as an environmental factor that may influence cognitive performance in ageing populations. This is particularly relevant in Australia, where people live across diverse climatic regions spanning alpine to tropical conditions. We examined daily temperatures and cognitive performance in 1,873 midlife and older adults (1,297 women, mean age 61.0 years) who completed the Creyos online battery (formerly Cambridge Brain Sciences). Twelve tasks assessed memory, visuospatial processing, language, attention, and executive function. Task scores were linked to postcode-level contemporaneous weather data. The scores were analysed in relation to maximum and minimum air and wet-bulb temperatures and postcode- and month-relative temperature percentiles. Regression models adjusted for age, sex, education, socioeconomic status, and climate zone, with season included for air and wet-bulb measures. Higher minimum, but not maximum, temperature was associated with poorer performance on Paired Associates, a task assessing associative memory. This pattern was observed for air temperature, wet-bulb temperature, and temperature percentile, suggesting poorer memory performance after warmer nights, both in absolute terms and relative to local seasonal norms. Temperature was not significantly associated with performance on any other task, including measures of short-term/working memory, visuospatial processing, language, attention, or executive function. These findings suggest a task-specific association between higher overnight temperature and poorer associative memory performance, rather than a general reduction in cognition. Further studies incorporating personal exposure and sleep measures are needed to clarify whether night-time thermal conditions affect cognitive health in midlife and older populations.

Introduction: Socioeconomic deprivation is often associated with poorer health outcomes, but some studies suggest the opposite for Lyme disease. Here we test two hypotheses to explain this: differences in (i) local landcover of high risk habitats such as woodlands (landscape hypothesis) and (ii) outdoor recreation in such habitats (behaviour hypothesis). Methods: We analysed reported Lyme disease incidence data for 824 data zones in the city of Glasgow, UK, against deprivation rank (based on indicators relating to income, employment, health, education, crime and housing). We then tested how these relate to woodland cover and indices of urban greenspace usage (per capita and per ha of greenspace). Additionally, we measured Lyme disease hazard (density of infected ticks) in 32 greenspaces and tested relationships with deprivation, woodland and greenspace usage. Results: More advantaged data zones (data zones with low deprivation rank) had higher Lyme disease incidence. These areas had more woodland and woodland cover was positively correlated with both Lyme disease incidence and hazard. Deprivation did not correlate with greenspace usage, nor did greenspace usage correlate with Lyme disease incidence. Intensely used greenspaces had lower infected tick densities, consistent with a human disturbance effect on wildlife that carry ticks. Conclusions: Differences in woodland cover, but not outdoor recreation behaviour, can help explain our finding of higher Lyme disease incidence in more advantaged areas. However, to further test the behaviour hypothesis, we need more detailed data on outdoor recreation activity per capita both locally and in rural areas, as well data on mitigation behaviours.

BackgroundYoung sexual and gender minorities of color face compound health risks shaped by interlocking systems of racism, cisgenderism, and class inequality. Spatial health research documents that place shapes health, but existing methods cannot specify the mechanisms through which spatial configurations produce different health outcomes for differently positioned people. This gap prevents targeted intervention. ObjectiveTo develop and pilot test the Spatial Intersectionality Health Framework (SIHF), which specifies three mechanisms through which space produces intersectional health inequities: Layered (multiple oppressive systems activating simultaneously), Positional (the same space producing different health pathways by intersectional position), and Conditional (nominally protective spaces carrying hidden costs for specific positions). We also introduce and validate Intersectional Geographically-Explicit Ecological Momentary Assessment (IGEMA) as the methodology operationalizing SIHF across three data levels. MethodsThe GeoSense study enrolled 32 young sexual and gender minorities of color (ages 18-29) in New York City. IGEMA was implemented across three integrated levels: (1) GPS mobility tracking via participants personal smartphones, linked to census tract structural exposure indices across n=19 participants; (2) ecological momentary assessment of intersectional discrimination with multilevel modeling of mood, stress, and sleep outcomes; and (3) map-guided qualitative interviews with SIHF mechanism coding and intercoder reliability assessment across 92 coded records from 18 participants. This study was conducted as the pilot for NIH R01HL169503. ResultsAll three SIHF mechanisms were empirically detectable. A compound structural gendered racism index outperformed every single-axis alternative in predicting daily mood (b=-0.048, p=.001) and stress (b=0.121, p<.001). The Positional mechanism accounted for 71% of coded harm experiences. Intercoder reliability for mechanism assignment reached kappa=0.824 at Stage 2 reconciliation. Daily intersectional discrimination predicted greater sleep disturbance (b=1.308, p=.004). ConclusionsSIHF and IGEMA together provide an empirically testable framework for specifying how space produces intersectional health inequities. Mechanism specification, not spatial location alone, is the condition for designing research and intervention that reaches the source of harm for multiply marginalized populations.

Climate change draws attention to the planetary health perspective in sport and exercise sciences, that is, to physical activity that supports both human wellbeing and environmental sustainability. Active commuting is a sustainable form of physical activity with well-established somatic health benefits. However, more knowledge is needed on its relationship with mental health. We examined dose-response associations between active commuting, anxiety symptoms, and mental wellbeing among Finnish adults, and whether green commuting environment moderates these relationships. We used data from the cross-sectional Environment and Health Survey collected in June-September 2023 in the ten largest cities in Finland. Employed participants with data on anxiety symptoms (Generalized Anxiety Disorder-7, GAD-7), mental wellbeing (World Health Organization-Five Well-Being Index, WHO-5), commuting profile over a year (mode, frequency, distance, and perceived greenness along the commute route), and sociodemographic and lifestyle factors were included (n=1,672; mean age 45.3 years; 53.8% women). Active commuting was defined as travelling the entire commute by walking or cycling (including e-biking) that was converted into approximated annual km/week and MET-h/week. We used linear and logistic regression with restricted cubic splines to evaluate dose-response associations, adjusted for key covariates. The role of perceived greenness was tested using an active commuting x commute greenness interaction term. We found no dose-response relationships between active commuting and anxiety symptoms or mental wellbeing in any of the models. No effect modification by commute greenness was observed. More research on how active commuting may support planetary health from a mental health perspective is needed.

Residential greenness has been associated with reduced heat-related illness, yet the specific role of greenspace morphology at the neighborhood scale remains insufficiently understood. This study quantified the relationship between heat-related illness and multiple dimensions of greenspace morphology using an eight year (2016-2023) unbalanced panel dataset comprising 19,021 block group year observations across 2,427 census block groups in Arizona, USA. One meter high resolution National Agricultural Imagery Program aerial imagery was classified to calculate greenspace percentage, number of greenspaces, average size, shape complexity, connectedness, and distantness, at the block group level. We applied conditional spatial autoregressive models with a negative binomial distribution to estimate associations between each morphology metric and yearly heat-related illness counts, adjusting for sociodemographic and geographic covariates. We found higher greenspace percentage, aggregation, shape complexity, connectedness, and density were consistently associated with lower heat-related illness risk. A one standard deviation increases in shape complexity corresponded to a 12.4% decrease in expected heat-related illness counts (IRR=0.876, 95% CI: 0.834-0.921). Similarly, increases in greenspace percentage (14.6% decrease; IRR=0.855, 95% CI: 0.827-0.885), number of greenspace patches (3.7% decrease; IRR=0.963, 95% CI: 0.937-0.990), average size (4.5% decrease; IRR=0.955, 95% CI: 0.923-0.989), and connectedness (5.5% decrease; IRR=0.945, 95% CI: 0.918-0.972) were all protective. In contrast, larger inter greenspace distances were associated with increased heat-related illness risk (6.1% increase; IRR=1.061, 95% CI: 1.033-1.091). Our findings highlight the critical importance of multiple dimensions of greenspace morphology in mitigating heat-related health risks. These results suggest that heat reduction planning with greening initiatives should consider not only the amount of greenspace but also its spatial configuration to maximize cooling and result in health benefits.

Background Increasingly accessible satellite imagery provides scalable measures of the built and natural environment relevant to population health. However, whether such imagery can capture subnational variation in mortality and life expectancy remains unclear. We therefore assessed its predictive value for regional mortality and life expectancy across OECD regions. Methods We conducted an ecological, cross-sectional prediction study using 2023 data from OECD Territorial Level 3 (TL3) regions. Annual cloud-masked composites from the Harmonized Landsat and Sentinel-2 collection were processed in the Google Earth Engine, tiled at 224 x 224 pixels, and encoded with the pretrained Prithvi foundation model to derive region-level satellite embeddings. For each outcome, we trained LightGBM regressors for a country-only baseline, a satellite-only model, a combined model (country + satellite), and a final contextual model that additionally included prespecified socioeconomic and environmental covariates. Performance was evaluated using 10-fold outer cross-validation with held-out test folds; R2 was the primary metric. Results The analytic sample comprised 2,414 OECD TL3 regions across 38 countries, for which 939,959 satellite image tiles were processed. In paired bootstrap comparisons, adding satellite features to country indicators improved predictive performance for all outcomes, with incremental R2 ranging from 0.097 to 0.233. The final contextual model achieved R2 values of 0.78 (95% CI, 0.74-0.81) for crude mortality, 0.87 (0.84-0.89) for age-adjusted mortality, 0.86 (0.82-0.88) for infant mortality, and 0.76 (0.69-0.84) for life expectancy. In SHAP analyses, the aggregated satellite image effect consistently ranked among the top predictors across outcomes. Conclusion Satellite imagery captures subnational environmental heterogeneity relevant to regional mortality and life expectancy beyond country identity alone. Earth observation may therefore provide a scalable, complementary data source for characterizing geographic disparities in population health.

Background: Urban environmental and lifestyle factors during early life may influence pubertal timing, but the combined effects of multiple environmental exposures within an exposome analytical framework remain poorly understood. Objective: To examine the association between early-life urban environmental exposures and pubertal timing, and to explore whether these exposures interact with early-life nutritional factors, namely breastfeeding duration and childhood diet quality. Methods: Data from two European population-based birth cohorts were analysed: Generation XXI (G21, Portugal; n=5263; 51.5% girls) and INfancia y Medio Ambiente (INMA, Spain; n=1019; 50.1% girls). Urban environmental exposures including indicators of air pollution, traffic, built environment, and natural spaces were estimated at 4 early-life stages at both cohorts: pregnancy (INMA only), birth, 1 year, and 4-5 years of age. Pubertal development timing was assessed using Tanner staging and/or the Pubertal Development Scale (PDS), and age at menarche was self-reported. Exposome-Wide Association Study (ExWAS) models and unsupervised clustering followed by ordinal logistic regression models were used to examine single- and multi-exposure associations, respectively. Regression models were fitted adjusting for relevant child characteristics, maternal factors, and household socioeconomic conditions, and corrected for multiple testing. Results: Individuals living in more unfavourable urban environments characterised by higher building density, air pollution, and lower access to natural spaces showed earlier pubertal timing according to multiple outcomes, across multiple early-life exposure periods, and in both cohorts. In the G21 cohort, these environmental profiles were associated with earlier age at menarche, particularly for exposures at 1-1.5 and 4-5 years (e.g., 1-1.5y: {beta}=-0.172, FDR-adjusted p-value=0.041), while in the INMA cohort, boys exposed to more unfavourable environmental profiles showed more advanced pubertal development, also particularly for exposures at 1-1.5 and 4-5 years of age (e.g., 1-1.5y; {beta}=0.572, FDR-adjusted p-value=0.008). Among environmental domains, air pollution and traffic were the factors most consistently associated with pubertal timing. Regarding early-life nutritional factors, longer duration of exclusive breastfeeding was associated with a lower Tanner stage among girls in G21. No significant interactions between breastfeeding duration and environmental exposure clusters were observed. Conclusion: Early-life urban environmental exposures, particularly air pollution and traffic, may influence pubertal timing. Exclusive breastfeeding may have a protective role against earlier pubertal development. These findings highlight the importance of improving urban environmental conditions and promoting breastfeeding to support healthy developmental trajectories.

Background: With rising concerns about health impacts from climate change and environmental exposures, planetary health approaches are increasingly prominent, considering connections between human health and that of the natural environment. Naturopathy is an holistic traditional medicine system characterised by philosophies and practices rooted in nature that theoretically align with planetary health. However, it is unknown to what extent these philosophies translate into consideration of relevant factors during patient care. This study describes the perceptions and clinical behaviours of the global naturopathic workforce in addressing the health impacts of climate change and environmental pollutants. Methods: A cross-sectional online survey was administered to an international sample of naturopathic practitioners, recruited through communications from World Naturopathic Federation member organisations. The survey utilised the Climate Change Perceptions Scale, and asked participants about their perceptions of the health impacts of climate change and environmental pollutants. The survey also examined participant considerations of factors relating to climate change and environmental pollutants during clinical case assessment and prescribing of treatments. Data were descriptively analysed. Results: Of n=363 naturopathic practitioners who completed the survey, 88.7% agreed climate change is real, of whom the majority were concerned about impacts of climate change on their patients' health (89.1%). Almost all participants agreed that environmental pollutants harm human health (99.7%) and were concerned about impacts on their patients (99.5%). Climate-related health factors such as water intake (74.2%) and food security (72.9%) were frequently considered during patient assessment, while impacts of severe weather events (41.4%) were less commonly considered. Consideration of factors relating to environmental pollutants was more commonly reported, particularly for food quality (83.8%) and domestic/indoor sources of pollutants (73%). When formulating prescriptions, participants reported highly frequent consideration of all climate-related factors (73%-86.8%) and varied consideration of environmental pollutant exposures (54.4%-83.4%). Conclusions: The global naturopathic workforce demonstrates a high level of awareness and engagement with factors relating to health impacts of climate change and environmental pollutants, suggesting alignment with planetary health. While this engagement is evident in clinical behaviour, some gaps between awareness and application suggest a need for greater support to strengthen the naturopathic application of planetary and environmental health.

Background Physical inactivity and sedentary behaviour are major contributors to non-communicable diseases (NCDs) and are unevenly distributed across populations, disproportionately affecting migrants and ethnic minority groups. Somali communities in the UK experience multiple structural and socio-economic disadvantages; however, evidence on physical activity and associated inequities remains limited. This study examined physical activity, sedentary behaviour, and related barriers and facilitators among Somali residents in Sheffield, United Kingdom. Methods A cross-sectional mixed-methods study was conducted among Somali adults (n = 238). Quantitative data were collected using the International Physical Activity Questionnaire Short Form (IPAQ-SF) and analysed using descriptive statistics and ordinal logistic regression. Qualitative data were obtained from two focus group discussions (n = 14) and analysed using inductive thematic analysis to explore socio-cultural, environmental, and structural determinants of physical activity. Results No statistically significant predictors of physical activity were identified in the adjusted analysis; however, consistent trends indicated lower activity levels among older adults and those in employment. Qualitative findings revealed multiple, intersecting barriers rooted in structural inequities, including migration-related lifestyle changes, reduced incidental activity, sedentary occupations, limited health literacy, language barriers, financial constraints, and gendered responsibilities. Cultural norms and environmental conditions further shaped behaviour. Facilitators included community-based, culturally tailored interventions, peer support, gender-sensitive programmes, and adaptation of traditional practices. Conclusion Somali residents in Sheffield face overlapping structural and socio-cultural barriers to physical activity that are not fully captured by quantitative measures alone. Equity-oriented, culturally competent, and community-led interventions addressing both systemic and behavioural determinants are essential to improve access to physical activity and reduce health inequalities and NCD risk.

Background: Climate change is an escalating global health threat, with sub-Saharan Africa disproportionately affected due to entrenched spatial inequalities, high exposure to environmental hazards, and limited adaptive capacity. Increasingly frequent extreme weather events (EWEs), including floods and cyclones, are reshaping the material and social conditions of place, with implications for mental health and wellbeing. However, evidence remains limited, particularly multi-country qualitative research that examines how mental health impacts are produced through lived experiences of place in contexts of recurring environmental disruption and structural vulnerability. This study explored the mental health and wellbeing impacts of EWEs among individuals with lived experience of such events in Mozambique, Burkina Faso, South Africa, and Kenya, using participatory methods that centred community narratives and place-based accounts of everyday life. Methods: This qualitative study employed digital storytelling as a participatory visual method to examine how EWEs are experienced and narrated across diverse socio-spatial contexts. A total of 37 participants (8 to 10 per country) were recruited from rural, peri-urban, and informal urban settlements with recent exposure to flooding or cyclone events. Participants produced digital stories during facilitated five-day workshops. These narratives were analysed using inductive and deductive thematic analysis informed by Braun and Clarke's framework, with attention to the spatial and relational production of distress and coping. Results: Across Mozambique, Burkina Faso, South Africa, and Kenya, findings show that the mental health impacts of EWEs are deeply embedded in place-based conditions and are cyclical, cumulative, and relational rather than confined to discrete disaster events. Participants described how repeated environmental disruptions reconfigured everyday life in place, generating ongoing uncertainty, anticipatory anxiety during rainfall periods, and acute fear during floods and cyclones. Loss of housing, livelihoods, infrastructure, and social anchors of place contributed to enduring psychological distress, which was frequently reactivated by subsequent environmental cues such as heavy rain, wind, and deteriorating physical environments. Persistent anxiety, hypervigilance, sleep disturbance, and emotional distress were reported across all sites. While social and community networks constituted critical infrastructures of care within place, these were often simultaneously overwhelmed as entire communities experienced shared disruption. Limited and delayed institutional responses further compounded spatial and social precarity. Conclusions: This study provides a comparative participatory account of how EWEs shape mental health through their embeddedness in place across diverse sub-Saharan African contexts. The findings demonstrate that psychological distress is produced through the interaction of repeated environmental exposure, structural inequality, and disrupted place-based infrastructures of daily life, rather than emerging solely as a post-disaster outcome. These results underscore the need for climate-responsive mental health and psychosocial support that is integrated into place-based disaster risk governance, alongside strengthened social protection and community infrastructure that can sustain wellbeing in contexts of recurring environmental instability.

Introduction: Child health and well-being in Kalaallit Nunaat (Greenland) remain a major public health concern, yet systematic, population-level research is limited. Previous studies have focused on isolated indicators such as vaccination coverage and infant mortality, without capturing the broader structural and social determinants shaping childrens lives. The Meeqqat Peqqissut project addresses this gap by developing a cross-sectoral, register-based approach to identify both risk and health promoting factors influencing child health and well-being for alle children in Kalaallit Nunaat. Grounded in the Indigenist Ecological Systems Model (IESM) and complemented by the Peqqissuserput framework, the project adopts a strengths-based perspective that emphasizes resilience and culturally embedded determinants of well-being. Methods: Meeqqat Peqqissut is a collaboration between the Centre for Public Health in Greenland and Statistics Greenland. The study integrates longitudinal register data linked via personal identification numbers, combining healthcare records (COSMIC), socio-economic data from Statistics Greenland, municipal case management systems (Get Organized), and police records. Additional sources include education and social services. Data will be combined and analysed on Statistics Greenlands secure platform using advanced methods such as latent class and trajectory analyses. A participatory approach ensures continuous dialogue with practitioners to validate data quality and contextual relevance. Results: The project supports evidence-based strategies for improving child health and well-being in Kalaallit Nunaat and contributes to the national public health strategy Inuuneritta III. It aligns with the Kalaallit Nunaat governments research strategy for 2022-2030, as it aims to support sustainable societal development by contributing to improved public health and reducing social health inequalities. Ethical approval has been obtained from the Scientific Ethics Committee in Kalaallit Nunaat (VEK 2025-12). Conclusion: The Meeqqat Peqqissut project will provide a robust, cross-sectoral evidence base to strengthen efforts to improve child health and reduce social health inequalities in Kalaallit Nunaat. By integrating administrative data and applying an Indigenous, strengths?based framework, the study advances understanding of structural and social determinants of well?being. The project establishes a sustainable approach to equity?oriented child health monitoring and will inform policy, practice, and long?term public health action.

Background: The effect of extreme temperatures on miscarriage is not well understood. Even less understood is the gestational period most vulnerable to extreme temperature exposure, as early miscarriages are often missed in incident datasets. We employ a birth-rate based approach to infer the risk of miscarriage in response to extreme temperature exposure by gestational week. Methods: We conducted a population-based ecological study using birth registry data from the 7,948 municipalities of Italy between 2013 and 2024 (4.5 million births). The analyses were stratified by five climatically coherent macro-regions (Ecoregions). To infer unreported pregnancy losses, we regressed birth rates dated from the last menstrual period against weekly temperatures across gestational weeks 3-21, accounting for temporal seasonality and spatial heterogeneities. Findings: Exposure to heat (mean weekly temperature of 30.4 degree/C) during gestational weeks 3-4 was associated with a reduction of birth rates of 1.62 (0.71 - 2.51)%, and of 1.91 (0.92 - 2.88)% to mean weekly temperature of 1.6 degree/C. Whilst heat was found to be harmful during gestational weeks 3-4 and 18-21, cold spells were found to be consistently harmful from the 3th up to the 12th week, depending on the Ecoregion. Interpretation: Pregnancies are vulnerable to extreme temperatures during the post-conceptual period and the second trimester. The findings underscore the need for a pre-conceptual cohort to clarify the mechanisms of loss, and urge public health action to protect pregnancies from the beginning of gestation.

Socioeconomic inequalities in health and well-being are a major public health concern, particularly in ageing populations. Education is a key determinant shaping multiple aspects of health outcomes. We used cross-sectional data from wave 9 of the German sample (n=4,148) of the Survey of Health, Ageing and Retirement in Europe (SHARE) to test whether formal education is associated with well-being in later adulthood, with health literacy, self-rated health, and preventive health behaviours as possible mediators. Our results showed that education was positively associated with greater well-being, but only via indirect pathways. Specifically, self-rated health, health literacy, and fruit and vegetable consumption mediated the relationship between education and well-being accounting for 54.7, 24.7, and 12.6 percent of the total effect, respectively. In addition, there were significant positive correlations between education and health literacy, as well as high-intensity physical activity, daily fruit and vegetable consumption, more preventive health check-ups, and less smoking. In contrast, alcohol consumption was more common among those with higher levels of education. All health behaviours and health literacy were correlated directly or indirectly (i.e., mediated by health) with well-being. These findings highlight the importance of examining indirect pathways linking education to well-being in later life. Interventions aimed at improving health literacy and promoting healthy behaviours may help reduce educational inequalities in quality of life among older adults. About the SHARE Working Paper SeriesThe SHARE Working Paper Series started in 2011 and collects pre-publication versions of papers or book chapters, technical and methodological reports as well as policy papers based on SHARE data. The working papers are not reviewed by the publisher (SHARE-ERIC), layout and editing are not standardized. The publisher takes no responsibility for the scientific content of the paper. Working Papers can be updated - a version number is indicated on the front page. Previous versions are available upon request.

Socioeconomic, demographic, and health system structures may have shaped COVID-19 pandemic impact across populations, but past analyses typically examined few factors. We systematically examined correlates of COVID-era excess mortality, considering 2,745 county-level variables of demography, race/ethnicity, income, insurance, education, employment, housing, and health system. Pearson correlation coefficients (CCs) were obtained for the most recent available pre-pandemic value against age-standardized county excess-death for each year during 2020-2024. Counties were population-weighted. Variables were grouped by meaning into 11 semantic super-clusters. Overall, 17.3% of variables reached at least a moderate correlation level (|CC| > 0.30) and 2.8% reached strong correlations (|CC| > 0.45). Strongest correlations were seen for college attainment (CC -0.54), uninsurance among adults 40-64 (+0.53), and high income (-0.53). At least moderate correlations were seen for 9.1% of variables in 2020 and 8.5% in 2021, but only 1.8%, 0%, and 1.3% in 2022, 2023, and 2024, respectively. Similar patterns of concentration of moderate correlations in the first two pandemic years appeared in both elderly and non-elderly populations. Of 472 variables with |CC| > 0.30, 362/395 moderate-band and 77/77 strong-band variables belonged to demography and socioeconomic super-clusters. Only 7% of health system variables reached |CC| > 0.30, versus 31% of socioeconomic and demographic variables. Using the most recent available value until 2023 or 2015, different population weighting, and Spearman correlations yielded similar results. Overall, these ecological analyses suggest strong relationships of socioeconomic structure and demographics rather than health-care resources/supply with excess mortality across US counties especially during 2020-2021.