Search Results (1,221)

The COVID-19 pandemic exacerbated mental illness, accelerated cognitive decline, and deepened social inequalities. In low and middle-income countries (LMIC) such as Panama, it is unclear as to whether, and to what extent, the pandemic lockdowns affected cognitive, mental, and physical health of older adults. This study investigated changes in cognitive function, mental health, and physical health in a sample of Panamanian older adults assessed before and during the pandemic, and examined whether sociodemographic variables were associated with cognition and mental health. Participants completed in-person interviews between 2018 and early 2020 and a follow-up telephone interview between February and May 2021. Repeated measures analyses showed no significant changes in cognitive function or depression; however, participants reported fewer chronic illnesses. Linear regression analysis indicated that higher cognitive function during the pandemic was associated with younger age, higher education, and having sufficient income. An attrition analysis compared participants who completed both interviews to those who were lost to follow-up, revealing that participants who dropped out of the study had lower socioeconomic status and greater impairment at baseline. These findings highlight the need for targeted support for vulnerable older adults during public health crises. Full article

Background/Objectives: Dietary patterns have changed over time, characterising a process of nutritional transition that reflects socioeconomic and demographic inequalities among different populations. This study assessed changes in dietary consumption patterns and the associated social determinants, comparing two time periods in a sample of individuals from a state in the Northeast Region of Brazil. Methods: Data from the 2008–2009 and 2017–2018 Household Budget Survey for the state of Paraíba were analysed, totalling 951 and 1456 individuals, respectively. Foods were categorised according to the NOVA classification and compared based on sociodemographic and economic variables. To determine the factors that most strongly explain the contribution of each NOVA food group to the diet, beta regression analysis was conducted. Results: Differences were observed between the two periods regarding the dietary contribution of the NOVA food groups, with a decrease in consumption of unprocessed foods and an increase in ultra-processed foods. Living in urban areas, being an adolescent, and having an income above the minimum wage were associated with reduced intake of unprocessed foods in both periods. Additionally, being an adolescent and having more than eight years of schooling were associated with higher consumption of ultra-processed foods. Conclusions: The population under study showed changes in food consumption, reflecting a transition process that is occurring unevenly across socioeconomic and demographic groups, thereby reinforcing social inequalities. These findings can guide priorities in food and nutrition policies, highlighting the need for intervention studies to evaluate the effectiveness of such actions. Full article

Tuberculosis (TB) remains a leading cause of death in Bangladesh, disproportionately affecting low socio-economic status (SES) populations. This review, guided by the WHO Social Determinants of Health framework and Rockefeller-Lancet Planetary Health Report, examined how social, economic, and ecological factors link SES to TB burden. The first literature search identified 28 articles focused on SES-TB relationships in Bangladesh. A second search through snowballing and conceptual mapping yielded 55 more papers of diverse source types and disciplines. Low-SES groups face elevated TB risk due to smoking, biomass fuel use, malnutrition, limited education, stigma, financial barriers, and hazardous housing or workplaces. These factors delay care-seeking, worsen outcomes, and fuel transmission, especially among women. High-SES groups more often face comorbidities like diabetes, which increase TB risk. Broader contextual drivers include urbanisation, weak labour protections, cultural norms, and poor governance. Recommendations include housing and labour reform, gender parity in education, and integrating private providers into TB programmes. These align with the WHO End TB Strategy, UN SDGs and Planetary Health Quadruple Aims, which expand the traditional Triple Aim for health system design by integrating environmental sustainability alongside improved patient outcomes, population health, and cost efficiency. Future research should explore trust in frontline workers, reasons for consulting informal carers, links between makeshift housing and TB, and integrating ecological determinants into existing frameworks. Full article

Background: Cognitive decline is a growing public health concern in Latin America, driven by rapid aging, widespread micronutrient inadequacies, and socioeconomic disparities. Despite the recognized importance of nutrition, many older adults struggle to meet daily dietary micronutrients requirements, increasing the risk of mild cognitive impairment (MCI). This study aimed to establish expert consensus on the role of Multivitamin and Mineral supplements (MVMs) in promoting cognitive healthy aging among older adults in Latin America. Methods: A panel of nine experts in geriatrics, neurology, and nutrition applied a modified Delphi methodology to generate consensus statements. The panel reviewed the literature, engaged in expert discussions, and used structured voting to develop consensus statements. Results: Consensus was reached on 14 statements. Experts agreed that cognitive aging in Latin America is influenced by neurobiological, lifestyle, and socioeconomic factors, including widespread micronutrient inadequacies (vitamins B-complex, C, D, E, and minerals such as zinc, magnesium, chromium, copper, iron and selenium), which were identified as critical for global cognitive function and brain structures, yet commonly inadequate in the elderly. While a balanced diet remains essential, MVMs can be recommended as a complementary strategy to bridge nutritional gaps. Supporting evidence, including the COSMOS-Mind trials, demonstrate that MVM use improves memory and global cognition, and reduces cognitive aging by up to 2 years in older adults. Conclusions: MVMs offer a promising, accessible adjunct for cognitive healthy aging in Latin America’s elderly population, particularly where dietary challenges persist. Region-specific guidelines, public health initiatives, and targeted research are warranted to optimize outcomes and reduce health inequities. Full article

Urban health planning requires a multi-scalar understanding of the territory, capable of capturing socio-economic inequalities and health needs at the local level. In the case of Rome, current administrative subdivisions—Urban Zones (Zone Urbanistiche)—are too large and internally heterogeneous to serve as effective units for equitable health planning. This study presents a methodology for the territorial redefinition of Rome’s Municipality III, aimed at supporting healthcare planning through an integrated analysis of census sections. These were grouped using a combination of census-based socio-demographic indicators (educational attainment, employment status, single-person households) and real estate values (OMI data), alongside administrative and road network data. The resulting territorial units—21 newly defined Mesoareas—are smaller than Urban Zones but larger than individual census sections and correspond to socio-territorially homogeneous neighborhoods; this structure enables a more nuanced spatial understanding of health-related inequalities. The proposed model is replicable, adaptable to other urban contexts, and offers a solid analytical basis for more equitable and targeted health planning, as well as for broader urban policy interventions aimed at promoting spatial justice. Full article

The socio-economic geography of the Italian territory is framed by strong imbalances in the settlement development, with consequent inequalities in terms of accessibility to essential services. These challenges are most critical in the ‘inner areas’, which are remote from metropolitan and urban centers and affected by chronic demographic decline and depopulation. Both European and national policies have relied primarily on financial interventions, often implemented with limited integration into comprehensive urban and territorial planning frameworks. Using a case study methodology, this research examines the area-based strategies of the 72 pilot areas designated under the 2014–2020 program-ming cycle of the National Strategy for Inner Areas (SNAI). The main research question guiding this study is as follows: how does economic planning intersect with territorial governance in Italy’s inner areas, and what is the specific role of local autonomies and the management of core functions, particularly in relation to urban and regional planning? Through this lens, this study proposes a conceptual reframing of the inter-municipal ad-ministrative scale as a strategic framework for promoting more effective territorial policies. Full article

This study explores digital inequality as a socio-spatial phenomenon within the context of smart inclusion, focusing on the Regional Unit of Xanthi, Greece—a region marked by ethno-cultural diversity and pronounced urban–rural contrasts. Using a mixed-methods design, this research integrates secondary quantitative data with qualitative insights from semi-structured interviews, aiming to uncover how spatial, demographic, and cultural variables shape digital engagement. Geographic Information System (GIS) tools are employed to map disparities in internet access and ICT infrastructure, revealing significant gaps linked to geography, education, and economic status. The findings demonstrate that digital inequality is particularly acute in rural, minority, and economically marginalized communities, where limited infrastructure intersects with low digital literacy and socio-economic disadvantage. Interview data further illuminate how residents navigate exclusion, emphasizing generational divides, perceptions of technology, and place-based constraints. By bridging spatial analysis with lived experience, this study advances the conceptualization of digitally inclusive smart regions. It offers policy-relevant insights into how territorial inequality undermines the goals of smart development and proposes context-sensitive interventions to promote equitable digital participation. The case of Xanthi underscores the importance of integrating spatial justice into smart city and regional planning agendas. Full article

China’s rapid urbanization has driven tremendous socioeconomic development while posing new forms of social–spatial inequalities that challenge environmental sustainability and spatial justice. This study investigates urban park-accessibility patterns across 10 s-tier provincial capital cities in China, examining how these patterns relate to housing-price dynamics to reveal diverse manifestations of social–spatial (in)justice. Using comprehensive spatial analysis grounded in distributive justice principles, we measure park accessibility through multiple metrics: distance to the nearest park, park size, and the number of parks within a 15 min walk from residential communities. Our findings reveal significant variation in park accessibility across these cities, with distinctive patterns emerging in the relationship between housing prices and park access that reflect different forms of social–spatial exclusion and inclusion. While most cities demonstrate an unbalanced spatial distribution of parks, they exhibit different forms of this disparity. Some cities show consistent park access across housing-price categories, while others display correlations between high housing prices and superior park accessibility. We argue that these divergent patterns reflect each city’s unique combination of economic development trajectory, politically strategic positioning within national urban hierarchies, and geographical constraints. Through this comparative analysis of second-tier cities, this study contributes to broader understandings of social–spatial (in)justice and urban environmental inequalities within China’s urbanization process, highlighting the need for place-specific approaches to achieving equitable access to urban amenities. Full article

Objective: To explore the relationship between type of grocery store used (chain vs. independent), transportation access, food insecurity, and fruit and vegetable intake in Detroit, Michigan, USA, during the COVID-19 pandemic. Design: A cross-sectional online survey was conducted from December 2021 to May 2022. Setting: Detroit, Michigan. Participants: 656 Detroit residents aged 18 and older. Results: Bivariate analyses showed that chain grocery store shoppers reported significantly greater fruit and vegetable intake (2.42 vs. 2.14 times/day for independent grocery store shoppers, p < 0.001) and lower rates of food insecurity compared to independent store shoppers (45.9% vs. 65.3% for independent grocery store shoppers, p < 0.001). Fewer independent store shoppers used their own vehicle (52.9% vs. 76.2% for chain store shoppers, p < 0.001). After adjusting for socioeconomic and demographic variables transportation access was strongly associated with increased odds of shopping at chain stores (OR = 1.89, 95% CI [1.21,2.95], p = 0.005) but food insecurity was no longer associated with grocery store type. Shopping at chain grocery stores was associated with higher fruit and vegetable intake after adjusting for covariates (1.18 times more per day, p = 0.042). Qualitative responses highlighted systemic barriers, including poor food quality, high costs, and limited transportation options, exacerbating food access inequities. Conclusions: These disparities underscore the need for targeted interventions to improve transportation options and support food security in vulnerable populations, particularly in urban areas like Detroit. Addressing these structural challenges is essential for reducing food insecurity and promoting equitable access to nutritious foods. Full article

West Africa faces persistent food and nutrition insecurity despite agricultural efforts, exacerbated by population growth, climate change, and socio-economic vulnerabilities. This study argues that integrating food processing principles with nutrition-sensitive agriculture (NSA) and nutrition-smart agriculture (NSmartAg) offers a transformative solution for human health. Therefore, we delineate these interconnected concepts and highlight their synergistic potential for a nutrition-focused food system. Likewise, critical analysis of key regional challenges, including infrastructural weaknesses, policy gaps, and gender inequities, was made prior to identifying significant opportunities for leveraging food processing as a strategic entry point to accelerate the implementation of NSA and NSmartAg. Based on these insights, six strategic pathways are proposed to achieve this objective: (i) integrating food processing into policies; (ii) investing in interdisciplinary R&D that puts nutrition and health benefits at the forefront of desired outcomes along with others; (iii) strengthening farmer and food processor capacities; (iv) improving agri-food infrastructure; (v) fostering multi-sectoral collaboration; and (vi) prioritizing youth engagement and market development. By adopting these integrated strategies, West African countries can build more resilient, equitable, and nutrition-centered food systems, ultimately improving public health outcomes and fostering sustainable regional development. Full article

In an era marked by accelerating ecological degradation and widening global inequalities, prevailing patterns of resource extraction and consumption are proving increasingly unsustainable. Driven by hyper-consumption and entrenched linear production models, the global economy continues to exert immense pressure on planetary systems. This communication article calls for a fundamental paradigm shift from the long-standing assumption of resource abundance to a framework of responsible scarcity. Drawing from recent data on material throughput, on the transgression of planetary boundaries, and on the structural and geopolitical disparities underlying global resource use, this article highlights the urgent need to realign natural resource governance with ecological limits and social justice. A conceptual framework is proposed to support this transition, grounded in principles of ecological constraint, functional sufficiency, equity, and long-term resilience. The article concludes by outlining a forward-thinking research and policy agenda aimed at fostering sustainable and just modes of resource utilization in the face of growing environmental and socio-economic challenges. Full article

Property crime is a pressing issue in maintaining social order and urban sustainability, particularly in regions marked by pronounced socioeconomic disparity. While the link between socioeconomic stress and crime is well established, regional variations in Thailand have not been fully examined. Therefore, the purpose of this research was to examine spatial patterns of property crime and identify the potential associations between property crime and socioeconomic environment across Thailand. Using nationally compiled property-crime data from official sources across all provinces of Thailand, we employed geographic information system (GIS) tools to conduct a spatial cluster analysis at the sub-national level across 76 provinces. Both global and local statistical techniques were applied to identify spatial associations between property-crime rates and neighborhood-level socioeconomic conditions. The results revealed that property-crime clusters are primarily concentrated in the south, while low-crime areas dominate parts of the north and northeast regions. To analyze the spatial dynamics of property crime, we used geospatial statistical models to investigate the influence of socioeconomic variables across provinces. We found that property-crime rates were significantly associated with monthly income, areas experiencing high levels of household debt, migrant populations, working-age populations, an uneducated labor force, and population density. Identifying associated factors and mapping geographic regions with significant spatial clusters is an effective approach for determining where issues concentrate and for deepening understanding of the underlying patterns and drivers of property crime. This study offers actionable insights for enhancing safety, resilience, and urban sustainability in Thailand’s diverse regional contexts by highlighting geographies of vulnerability. Full article

Inclusion in play, physical education, outdoor life, organized sports, and other movement-based activities can promote resilience and support physical, emotional, and social well-being. These arenas are particularly important for reducing health disparities and preventing social marginalization across the lifespan. Yet, children and adolescents from vulnerable or disadvantaged backgrounds encounter persistent barriers to participation, rooted in broader inequalities related to their socioeconomic position, disability, gender, ethnicity, and access to supportive environments. This perspective outlines how inclusive movement contexts, when informed by developmental systems theory and resilience frameworks, can interrupt trajectories of marginalization and promote long-term equity in health, education, and work inclusion. We emphasize the need for interdisciplinary approaches, combining longitudinal and qualitative methods, to uncover how vulnerability and participation interact dynamically over time. By integrating insights from developmental science, education, public health, and spatial ecology, we identify strategic pathways for research and action. Addressing these challenges requires coordinated efforts across sectors and stakeholders to co-create inclusive, context-sensitive interventions. Full article

This article investigates the political cost of poverty in democracies marked by deep social divisions. We develop a probabilistic voting model that incorporates clientelism as a strategic tool employed by elite political parties to secure electoral support from non-elite voters. Unlike models based on ideological proximity, our framework conceptualizes party competition as structured by the socioeconomic composition of their constituencies. We demonstrate that in contexts of high inequality and widespread poverty, elite parties face structural incentives to deploy clientelistic strategies rather than universalistic policy agendas. Our model predicts that clientelistic expenditures by elite parties increase proportionally with both inequality (GINI index) and poverty levels, rendering clientelism a rational and cost-effective mechanism of political control. Empirical evidence from a cross-national panel (2013–2019) confirms the theoretical predictions: an increase of the 1 percent in the GINI index increase a 1.3 percent in the clientelism, even after accounting for endogeneity and dynamic effects. These findings suggest that in divided democracies, poverty is not merely a condition to be alleviated, but a political resource that elites strategically exploit. Consequently, clientelism persists not as a cultural residue or institutional failure, but as a rational response to inequality-driven constraints within democratic competition. Full article

This study examines the political and elite motives behind Colombo’s ‘world-class city’ initiative and its impact on public housing in underserved communities. Informed by interviews with high-ranking government officials, including urban planning experts and military officers, this study examines how President Rajapaksa’s elite-driven postwar Sri Lankan government leveraged military capacities within the neoliberal developmental framework to transform Colombo’s urban space for political and economic goals, often at the expense of marginalized communities. Applying a contextual discourse analysis model, which views discourse as a constellation of arguments within a specific context, we critically analyzed interview discussions to clarify the rationale behind the militarized approach to public housing while highlighting its contradictions, including the displacement of underserved communities and the ethical concerns associated with compulsory relocation. The findings suggest that Colombo’s postwar public housing program was utilized to consolidate authoritarian control and promote speculative urban transformation, treating public housing as a secondary aspect of broader political and economic agendas. Anchored in militarized urban governance, these elite-driven strategies failed to achieve their anticipated economic objectives and deepened socio-spatial inequalities, raising serious concerns about exclusionary and undemocratic planning practices. The paper recommends that future urban planning strike a balance between economic objectives and principles of spatial justice, inclusion, and participatory governance, promoting democratic and socially equitable urban development. Full article