Editorial
Martin Dohrn/Science Photo Library
Chikungunya—coming to America
See Correspondence page 514
First reported in the early 1950s in the Makonde Plateau, straddling the border of Tanzania and Mozambique, the chikungunya virus is similar to dengue, both in symptoms and transmission; the virus is spread by mosquitoes. The primary vector has been thought to be the Aedes aegypti mosquito, but a related species, A albopictus, has also emerged as a potent player in the spread of this disease. A letter in today’s Lancet highlights the frightening capacity of genetic mutation in the propagation of specific viral variants. In this context, independent evolutionary adaptations in the two species of Aedes mosquitoes might also contribute to the differential spread of distinct chikungunya viral genotypes, including the east, central, and South African lineage and several Asian strains. Once confined mainly to sub-Saharan Africa, southern Asia, and the Indian subcontinent, reported cases of autochthonous (locally originating) chikungunya have occurred in Europe—eg, Italy in 2007—Saint Martin in December, 2013, and, as of Jan 21, 2014, other French West Indies islands and the neighbouring British
Virgin Islands. Importantly, these most recent cases in the Caribbean are the first known appearance of autochthonous chikungunya in the Americas—a major possible public health threat in the making. Several factors amplify the potential for the spread of chikungunya. The Caribbean islands are a popular travel destination for Europeans and North Americans, which opens new channels for intercontinental transmission. The region currently lacks adequate surveillance and virological testing infrastructure, which could hinder efforts to contain the virus. Containment, however, will be a much larger issue since global warming patterns are changing the migration pattern of A aegypti (responsible for the present Caribbean outbreak). Warmer climates in North America will translate into more mosquitoes and more opportunity for autochthonous outbreaks. With no approved vaccine or antiviral treatment, millions are at risk. Chikungunya can no longer be considered an exotic disease from the tropics—it’s ready to be a household name. The Lancet
Richard Baker/In Pictures/Corbis
Building better urban health in England
For the RIBA report see http:// www.architecture.com/Files/ RIBAHoldings/PolicyAnd InternationalRelations/Policy/ PublicAffairs/RIBACity HealthCheck.pdf For the Lancet study on green spaces see Articles Lancet 2008; 372: 1655–60
488
What would encourage you to walk more? So asked the Royal Institute of British Architects (RIBA) in their new report—City Health Check—released last week. The report assesses health and the built environment in the nine most populated cities in England, including London, Manchester, and Bristol. It shows that the areas in these cities with the worst health indicators for physical activity, diabetes, and childhood obesity tend to have substantially less green space and a higher housing density. For example, areas with the highest prevalence of childhood obesity had twice the housing density and a third less green space compared with the healthiest areas. RIBA note that deprivation could play a part; areas with less green space are likely to be less affluent and home to more deprived families. However, they also draw attention to Michael Marmot’s report Fair Society, Healthy Lives, which states that “better health is related to green space regardless of socioeconomic status”. Indeed, a study in The Lancet in 2008 showed that health inequalities corrected for income deprivation were lower in populations living in the greenest areas.
RIBA also surveyed more than 1300 residents in the nine cities about how design could encourage them to walk more in their local area. The top changes noted were safer design of pedestrian pathways and more attractive and safer designed public parks and green spaces. RIBA conclude that it is not only the quantity of green spaces in cities but also the quality that will encourage their residents to make healthier choices. The report is a welcome addition to the existing evidence from the medical community showing that the way cities and towns are designed, planned, and managed can have an important effect on health. One of the recommendations in the 2012 UCL/Lancet Commission on shaping cities for health called on urban planners to include health concerns in their decision making. RIBA’s report also calls for healthy design to be enshrined in planning, and urges developers to create beautiful, fitter, and safer cities. The Lancet supports these recommendations. Together the medical and architectural communities can, and should, lay strong foundations for better urban health in England. The Lancet www.thelancet.com Vol 383 February 8, 2014
Martin Dohrn/Science Photo Library
Chikungunya—coming to America
See Correspondence page 514
First reported in the early 1950s in the Makonde Plateau, straddling the border of Tanzania and Mozambique, the chikungunya virus is similar to dengue, both in symptoms and transmission; the virus is spread by mosquitoes. The primary vector has been thought to be the Aedes aegypti mosquito, but a related species, A albopictus, has also emerged as a potent player in the spread of this disease. A letter in today’s Lancet highlights the frightening capacity of genetic mutation in the propagation of specific viral variants. In this context, independent evolutionary adaptations in the two species of Aedes mosquitoes might also contribute to the differential spread of distinct chikungunya viral genotypes, including the east, central, and South African lineage and several Asian strains. Once confined mainly to sub-Saharan Africa, southern Asia, and the Indian subcontinent, reported cases of autochthonous (locally originating) chikungunya have occurred in Europe—eg, Italy in 2007—Saint Martin in December, 2013, and, as of Jan 21, 2014, other French West Indies islands and the neighbouring British
Virgin Islands. Importantly, these most recent cases in the Caribbean are the first known appearance of autochthonous chikungunya in the Americas—a major possible public health threat in the making. Several factors amplify the potential for the spread of chikungunya. The Caribbean islands are a popular travel destination for Europeans and North Americans, which opens new channels for intercontinental transmission. The region currently lacks adequate surveillance and virological testing infrastructure, which could hinder efforts to contain the virus. Containment, however, will be a much larger issue since global warming patterns are changing the migration pattern of A aegypti (responsible for the present Caribbean outbreak). Warmer climates in North America will translate into more mosquitoes and more opportunity for autochthonous outbreaks. With no approved vaccine or antiviral treatment, millions are at risk. Chikungunya can no longer be considered an exotic disease from the tropics—it’s ready to be a household name. The Lancet
Richard Baker/In Pictures/Corbis
Building better urban health in England
For the RIBA report see http:// www.architecture.com/Files/ RIBAHoldings/PolicyAnd InternationalRelations/Policy/ PublicAffairs/RIBACity HealthCheck.pdf For the Lancet study on green spaces see Articles Lancet 2008; 372: 1655–60
488
What would encourage you to walk more? So asked the Royal Institute of British Architects (RIBA) in their new report—City Health Check—released last week. The report assesses health and the built environment in the nine most populated cities in England, including London, Manchester, and Bristol. It shows that the areas in these cities with the worst health indicators for physical activity, diabetes, and childhood obesity tend to have substantially less green space and a higher housing density. For example, areas with the highest prevalence of childhood obesity had twice the housing density and a third less green space compared with the healthiest areas. RIBA note that deprivation could play a part; areas with less green space are likely to be less affluent and home to more deprived families. However, they also draw attention to Michael Marmot’s report Fair Society, Healthy Lives, which states that “better health is related to green space regardless of socioeconomic status”. Indeed, a study in The Lancet in 2008 showed that health inequalities corrected for income deprivation were lower in populations living in the greenest areas.
RIBA also surveyed more than 1300 residents in the nine cities about how design could encourage them to walk more in their local area. The top changes noted were safer design of pedestrian pathways and more attractive and safer designed public parks and green spaces. RIBA conclude that it is not only the quantity of green spaces in cities but also the quality that will encourage their residents to make healthier choices. The report is a welcome addition to the existing evidence from the medical community showing that the way cities and towns are designed, planned, and managed can have an important effect on health. One of the recommendations in the 2012 UCL/Lancet Commission on shaping cities for health called on urban planners to include health concerns in their decision making. RIBA’s report also calls for healthy design to be enshrined in planning, and urges developers to create beautiful, fitter, and safer cities. The Lancet supports these recommendations. Together the medical and architectural communities can, and should, lay strong foundations for better urban health in England. The Lancet www.thelancet.com Vol 383 February 8, 2014
