Paula Santana

• PhD
• Professor (Full) at University of Coimbra

Monitoring slum health through ecological deprivation indices is a valuable strategy for understanding and reducing health inequalities within a city. In this study, a Socioenvironmental Deprivation Index (SeDI) was developed for small areas of the Municipality of São Paulo. The index was derived through Principal Component Analysis and can be deco...

Asthma is a chronic inflammatory disease of the airways presenting high global prevalence. Geoclimatic characteristics, especially relative air humidity, play an important role in its epidemiological profile, despite being still understudied. This study aims to evaluate the influence of individual and environmental geoclimatic factors on the preval...

Road network connectivity determines the accessibility of urban activities for pedestrians, while streetscape characteristics have an impact on route attractiveness. Methods used to measure the influence of connectivity and streetscape characteristics on walking behavior differ substantially, while trip purpose is a key factor. This paper explores...

Aging is rapidly accelerating worldwide; by 2050, the number of people aged 65 and older will have more than doubled to reach 1.5 billion and represent 16% of the global population. In this chapter, we offer an overview of this demographic trend at the global scale. Beyond the global figures, demographic aging is characterized by many spatial varia...

The development of sustainable and equitable cities is on most international and national agendas – and the promotion of a walkable environment is crucial for sustainable development. Although it seems plausible to assume that walkable environments are not always equally distributed among socio-economic groups in dense metropolitan areas, we lack e...

Obesity has been characterized as an ongoing pandemic. This swift and continuous weight increase cannot be explained solely by individual factors. High availability of Ultra Processed Food (UPF) and reduced supply or absence of unprocessed/minimally processed foods in food environments can influence food choices and promote a syndemic process invol...

Promoting health equity is a place-based issue that goes way beyond the health sector alone. Urban planning plays a key role in addressing inequities in the social, economic, built, and physical determinants of health. The WHO and EU have been stressing the need of placing health equity at the core of urban policies to ensure that everyone has fair...

O direito à proteção da saúde suscita um debate sobre a evolução dos direitos sociais e das políticas públicas consubstanciadas pelos Estados como instrumentos provisores desses direitos. Paralelamente, para além de um crescente envolvimento e responsabilização dos sujeitos pela gestão da sua própria saúde, assistimos à instalação de um conjunto de...

As a cross-sectoral issue, the promotion of health needs to be addressed across all policies. In Portugal, as more competencies are being transferred to local governments, the integration of health considerations into municipal plans remains a challenge and guidance on how to develop an integrated municipal health strategy is absent. The aim of thi...

Ultra-processed drinks (UPDs) consumption is increasing, and this intake has been associated with the risk of illness and death. Data on individuals (n = 430) and food stores (n = 231) were collected in an economically vulnerable area in Recife-Brazil, and multilevel regression models were applied to assess the association between UPDs consumption...

The COVID-19 pandemic has severely hit urban areas around the world, where approximately 55% of the world’s population lives. It has tested the ability of their authorities and residents to respond to multiple challenges and not fail in terms of public health, social, economic and political aspects. This chapter questions the role of urban environm...

Promoting participation and combining evidence with expert knowledge in constructing composite indices that can be meaningfully interpreted are key open challenges identified in performance measurement literature. To address them, this article proposes a sociotechnical decision-aid process, under a collaborative value-modelling framework, rooted in...

Background Both CMV and Rubella virus infections are associated with the risk of vertical transmission, fetal death or congenital malformations. In Angola, there are no reports of CMV and Rubella studies. Therefore, our objectives were to study the seroprevalence of anti-CMV and anti-Rubella antibodies in pregnant women of Luanda (Angola), identify...

Scientific evidence shows that each place/environment generates specific conditions with associated impacts on the mental health and well-being of the population. A holistic, multilevel and integrated environmental approach to mental health enhances the understanding of this phenomena, supporting the local decision-making processes to improve spati...

Evidência científica indica que a obesidade é responsável por diversas doenças crónicas, como são exemplo a hipertensão e a diabetes mellitus tipo 2. Recentemente, a literatura tem vindo a chamar a atenção para o facto de indivíduos com obesidade apresentarem risco mais elevado de desenvolver sintomas graves da Covid-19. Ser ativo é visto como medi...

O objetivo deste estudo foi avaliar o contributo do ambiente construído, entre outros fatores, no excesso de peso, em Portugal, utilizando como amostra a Rede Portuguesa de Municípios Saudáveis (RPMS). Foi aplicado um estudo transversal com inquérito de base populacional, realizado entre maio/2020-abril/2021, com uma amostra de 10.047 indivíduos ad...

COVID-19 hit the world in a sudden and uneven way. Scientific community has provided strong evidence about socioeconomic characteristics of the territory associated with the geographical pattern of COVID-19 incidence. Still, the role played by these factors differs between study areas. Geographically Weighted Regression (GWR) models were applied to...

Background HIV and HBV infections remain responsible for high rate of morbidity and mortality in many African Countries, affecting women and newborns. This study aims to analyze the spatial pattern of HIV and HBV infections in pregnant women in Luanda, Angola, and the statistical association between HIV and HBV and socio-economic characteristics, h...

The study of premature deaths from causes that are generally preventable given the current availability of healthcare – called amenable deaths due to healthcare – provides information on the quality of services. However, they are not only impacted by healthcare characteristics: other factors are also likely to influence. Therefore, identifying the...

Significance From 1990 to 2018, the Black–White American life expectancy gap fell 48.9% and mortality inequality decreased, although progress stalled after 2012 as life expectancy plateaued. Had improvements continued at the 1990 to 2012 rate, the racial gap in life expectancy would have closed by 2036. Despite decreasing mortality inequality, inco...

Background Non-communicable diseases are a leading cause of health loss worldwide, in part due to unhealthy lifestyles. Metabolic-based diseases are rising with an unhealthy body-mass index (BMI) in rural areas as the main risk factor in adults, which may be amplified by wider determinants of health. Changes in rural environments reflect the need o...

Objective: To analyse the trends in chronic liver diseases and cirrhosis mortality, and the associated socioeconomic inequalities, in nine European cities and urban areas before and after the onset of the 2008 financial crisis. Methods: This is an ecological study of trends in three periods of time: two before (2000-2003 and 2004-2008), and one...

While the government responses to the COVID-19 pandemic have varied across the globe, there has been a unifying cry from academia and public health professionals warning of the detrimental effects of attaching our understanding of this new threat to our already ageist attitudes. What is inescapable is that COVID-19 has an age-related risk component...

Trata-se de um livro de homenagem a uma geógrafa de elevado mérito académico, científico e pedagógico que recentemente atingiu o momento da sua jubilação na Universidade de Coimbra, onde trabalhou durante mais de quarenta anos. As suas áreas de interesse científico vão da Geografia Humana (Geografia da População; Geografia Cultural e, nomeadamente,...

Epidemiological studies on the impact of determining environmental factors on human health have proved that temperature extremes and variability constitute mortality risk factors. However, few studies focus specifically on susceptible individuals living in Portuguese urban areas. This study aimed to estimate and assess the health burden of temperat...

COVID-19 was identified in December 2019 in Wuhan, ChinaChina, and has spread worldwide at an unprecedented speed. On January 31, 2020, the first case was identified in Spain and on March 2 in Portugal, on the following months, transmissionTransmission increased rapidly. This work aims to identify different spatiotemporal patterns in the evolution...

The present work evaluated the surveillance of the drinking water quality information system database and correlated the findings of the microbiological analysis with the distribution of intestinal protozoa from the metropolitan region of Rio de Janeiro. From the database, we obtained 1,654 georeferenced monitoring stations that were used in the an...

The purpose of this paper is to analyse how socio‐economic inequalities in mortality (total and avoidable) evolved in Portugal from the 1990s onwards by looking at differences by gender, age group, poverty and cause of death. Results show that mortality in younger age groups is decreasing faster in the most deprived municipalities. Yet, avoidable d...

In 2006, a policy reform restructured the maternal and perinatal healthcare system, including closing smaller maternity units, to further improve care in Portugal. This study aimed to investigate the effects of the 2006 National Program of Maternal and Neonatal Health policy on spatial inequalities in access to care and consequently avoidable infan...

Background: The main objective was to study the seroprevalence of anti-CMV and anti-Rubella antibodies in pregnant women of Luanda (Angola), identify the primary maternal infection during gestation and to evaluate the socio-demographic risk factors associated with CMV and Rubella virus infections. Methods: A prospective cross-sectional study was co...

Vast differences in environmental exposures exist between socioeconomic groups at the global, regional, and local level. The associated adverse health outcomes are largely avoidable by policy decisions and therefore unfair and unjust. The definitions of environmental inequality and environmental justice are not clear-cut and depend on the local con...

Although there is a large gap between Black and White American life expectancies, the gap fell 48.9%between 1990 and 2018, mainly due to mortality declines among Black Americans. We examine age-specific mortality trends and racial gaps in life expectancy in high- and low-income US areas and with reference to six European countries. Inequalities in...

Background The effect of inequalities aggravated by economic recessions in the mortality rates of certain diseases has been previously described. In this study, we analyzed the relationship between socio-economic deprivation and cancer mortality. We focused on lung, colon, prostate, and breast cancers in nine European urban areas over three periods...

There is considerable evidence pointing to the existence of a socioeconomic gradient in mortality, which tends to be steeper in urban areas. Similar to other European cities, Lisbon is far from homogeneous since considerable geographical inequalities exist between the more advantaged and the more deprived neighborhoods. The main goals of this study...

We report a study on toxoplasmosis in pregnant women in Luanda, Angola, determining the seroprevalence, geospatial distribution and its association with socio-economic features, dietary habits and hygiene and health conditions. Anti-Toxoplasma gondii IgG and IgM were quantified in serum samples of women attended at the Lucrecia Paim Maternity Hospi...

Different authors have identified geographic variations in the rates of suicide. This study aims to discuss the limitations of the officially recorded suicide data and to evaluate the statistical relationship between a biometeorological index, Apparent Temperature (AT), and suicide in Madrid and Lisbon. We performed a time-series study. The associa...

Background: Non-communicable diseases (NCDs) are a leading cause of health loss worldwide, in part due to unhealthy lifestyles. Metabolic-based diseases are rising with an unhealthy body-mass index (BMI) in rural areas as the main risk factor in adults. Health loss risks in rural areas may be amplified by wider determinants such as socio-demography...

Geographical accessibility to health care services is widely accepted as relevant to improve population health. However, measuring it is very complex, mainly when applied at administrative levels that go beyond the small-area level. This is the case in Portugal, where the municipality is the administrative level that is most appropriate for impleme...

Urban health inequities often reflect and follow the geographic patterns of inequality in the social, economic and environmental conditions within a city—the so-called determinants of health. Evidence of patterns within these conditions can support decision-making by identifying where action is urgent and which policies and interventions are needed...

Previous studies have consistently analyzed the impact that extreme temperatures will have on human health. However, there are very few data on temperature-related mortality burden considering future demographic changes in a context of climate change in Portugal. This study aims to quantify the impact of climate change on heat-, cold-, and net chan...

Introduction Type 2 diabetes is one of the non-communicable diseases with higher increasing incidence across the world. Portugal is one of the most affected countries with this increase. Most risk factors for diabetes are modifiable and can be changed by a supportive built environment. The walkability index has been wildly used as concept to descri...

The natural environment has been considered an important determinant of cardiovascular morbidity. This work seeks to assess the impact of the winter thermal environment on hospital admissions from diseases of the circulatory system by using three biometeorological indices in five regions of the Iberian Peninsula. A theoretical index based on a the...

During the last decades, important efforts have been taken to tackle cardiovascular diseases, which resulted in important mortality and disability decreases. Despite this, cardiovascular diseases are still one of the major causes of death in Portugal. Thus, the aim of this study is to analyse the evolution of the spatial pattern of deaths by cardio...

Social, economic, and environmental differences across the European Union significantly affect opportunities to move forward in achieving greater equity in health. Cohesion Policy (CP) funds can contribute positively through investments in the main determinants of health. The aim of this study is to analyze to what extent the planned investments fo...

Background: Population health measurements are recognised as appropriate tools to support public health monitoring. Yet, there is still a lack of tools that offer a basis for policy appraisal and for foreseeing impacts on health equity. In the context of persistent regional inequalities, it is critical to ascertain which regions are performing bes...

Several studies emphasize that temperature-related mortality can be expected to have differential effects on different subpopulations, particularly in the context of climate change. This study aims to evaluate and quantify the future temperature-attributable mortality due to circulatory system diseases by age groups (under 65 and 65+ years), in Lis...

Objective: To analyse socioeconomic inequalities in all-cause mortality among men and women in nine European urban areas during the recent economic crisis, and to compare the results to those from two periods before the crisis. Method: This is an ecological study of trends based on three time periods (2000-2003, 2004-2008 and 2009-2014). The uni...

Climate change is now widely recognised as the greatest global threat over the coming decades. This study aimed to quantify and project the effects of climate change on future temperature-attributable mortality due to circulatory system diseases (CSD) in Lisbon metropolitan area (LMA) and in Porto metropolitan area (PMA). The future time slices of...

Background The availability of reliable and comparable data at the regional level is extremely important to measure regional health inequalities. The aim of this research is to assess the data availability of the indicators included in EURO-HEALTHY’s Population Health Index (PHI), a multidimensional tool developed to measure population health acros...

The aim of this study is to estimate the mortality burden attributable to low temperature in Athens, Lisbon and London from 2002 to 2011 and to discuss related inequalities in socioeconomic conditions. We address a lack of quantitative estimates of cold-related mortality, particularly for the cities of Lisbon and Athens. To estimate the mortality b...

Background: Few studies have assessed the impact of the financial crisis on inequalities in suicide mortality in European urban areas. The objective of the study was to analyse the trend in area socioeconomic inequalities in suicide mortality in nine European urban areas before and after the beginning of the financial crisis. Methods: This ecolo...

Background: The ability to measure regional health inequalities across Europe and to build adequate population health indices depends significantly on the availability of reliable and comparable data at the regional level. Within the scope of the EU-funded project EURO-HEALTHY, a Population Health Index (PHI) was built. This model aggregates 39 in...

As transformações no clima urbano das cidades, a excessiva poluição atmosférica e o aumento das desigualdades sociais tornaram-se fatores determinantes do alto risco de internações por doenças respiratórias. Dessa forma, o objetivo deste trabalho foi compreender como os atributos meteorológicos (temperatura do ar, umidade relativa do ar e precipita...

Mental health is an intrinsic dimension of health influenced by individual and contextual factors. This cross-sectional study analyzes the association between the individual, neighborhood characteristics, and one’s self-assessed mental health status in the Lisbon region after an economic crisis. Via the application of multilevel regression models,...

Background: Health inequalities have been consistently reported across and within European countries and continue to pose major challenges to policy-making. The development of scenarios regarding what could affect population health (PH) inequalities across Europe in the future is considered critical. Scenarios can help policy-makers prepare and be...

The article analyses the spatial-temporal distribution of dengue in the epidemic year of 2012 and the post-epidemic year of 2013, in the city of Fortaleza-Ceará. For this, were used Kernel maps and geostatistical procedures (Pearson correlation, Cronbach's alpha coefficient, global and local Moran index). Climatologic, epidemiologic and socioeconom...

This article investigates the health outcomes and determinants between two different European populations, Portuguese and Czech, on two hierarchical levels: country and metropolitan area. At first, the decomposition method of age and cause of death were compared on the country level, and then health was examined based on a factor analysis at the mu...

Background There has been increasing interest in assessing the impacts of extreme temperatures on mortality due to diseases of the circulatory system. This is further relevant for future climate scenarios where marked changes in climate are expected. This paper presents a solid method do identify the relationship between extreme temperatures and mo...

Although winter mortality and morbidity are phenomena common to most European countries, their magnitude varies significantly from country to country. The geographical disparities among regions with similar climates are the result of several social, economic, demographic, and biological conditions that influence an individual’s vulnerability to win...

The different geographical contexts seen in European metropolitan areas are reflected in the uneven distribution of health risk factors for the population. Accumulating evidence on multiple health determinants point to the importance of individual, social, economic, physical and built environment features, which can be shaped by the local authoriti...

A limited number of studies have addressed environmental inequality, using various study designs and methodologies and often reaching contradictory results. Following a standardized multi-city data collection process within the European project EURO-HEALTHY, we conducted an ecological study to investigate the spatial association between nitrogen di...

Cerebrovascular diseases are the leading cause of mortality in Portugal, especially when related with extreme temperatures. This study highlights the impacts of the exposure-response relationship or lagged effect of low and high temperatures on cerebrovascular mortality, which can be important to reduce the health burden from cerebrovascular diseas...

Objectives Large socioeconomic inequalities in health are still present in the Central Europe. The aim was to explore socioeconomic inequalities in mortality in Visegrad countries—the Czech Republic, Hungary, Poland and Slovakia (V4), by three different socioeconomic indicators (unemployment, risk of poverty/social exclusion, education). The study...

Urban areas in Europe are facing a range of environmental public health challenges, such as air pollution, traffic noise and road injuries. The identification and quantification of the public health risks associated with exposure to environmental conditions is important for prioritising policies and interventions that aim to diminish the risks and...

The socio-economic status (SES) is the main shaper of individual life results. The surrounding built environment (BE) and SES characteristics have an impact in social connections and life achievements. The built environment plays a crucial role in emphasizing the social inequality gap between different social groups. Moreover, the lower inequality...

The first author was missing

Background: Metropolitan areas (MAs) in Europe face diverse risk factors affecting population health. Within the scope of EUROHEALTHY project, a multidimensional measure - Population Health Index (PHI) - was built to reflect population health in an integrated approach, considering two main components - health outcomes and determinants -, both disag...

Background: Individuals with mental disorders are often susceptible to the effects of extreme ambient temperatures. The aim of this study is to assess the short-term impacts of daily mean temperature on hospitalizations for mental disorders in the Lisbon Metropolitan Area, Portugal. Methods: To assess the short-term impacts of daily mean tempera...

Background: In accordance the WHO framework of health system functions and by using the indicators collected within the EURO-HEALTHY project, this work aims to contribute to the discussion on the classification of EU health systems. Methods: Three methods were used in this article: factor analysis, cluster analysis and descriptive analysis; data...