InSPIRE: Innovating UK clean air policies to prevent cognitive disorders across the lifespan, particularly for vulnerable urban populations

今天，公共卫生预防面临着一个严峻的挑战：新的研究表明，在我们生活的关键时刻，特别是在生命的早期，呼吸高水平的空气污染物可能会导致严重的认知障碍，包括痴呆症。然而，从公共卫生的角度来看，这种因果联系并不是主要的挑战。相反，挑战在于找出如何最好地防止它。一项新的研究初步表明，解释哪些人群最有可能患上基于空气污染的认知障碍的因素与他们的生活方式关系不大，更多的是与他们住在哪里有关，这是公共健康面临的真正挑战。换句话说，从预防的角度来看，某些人所生活的复杂的社会和环境系统似乎使空气污染成为他们的健康脆弱性。空气污染是认知健康不平等的一种形式。然而，有什么不清楚的是，这些复杂的系统是如何使空气污染成为认知健康脆弱性的？从交通管理和城市拥堵的政策到不公平地分享清洁空气战略带来的好处，我们并不完全了解空气污染的社会和环境决定因素导致认知障碍的途径。因此，反过来，我们并不完全知道如何有效地干预这些复杂的系统。换句话说，从初级预防的角度来看，尚不清楚哪种空气政策或干预措施最能缓解这些决定因素对认知健康的负面影响，特别是对英国主要城市中最脆弱的社会经济群体。因此，InSPIRE.OUR Complex APPROACHINSPIRE的目的是开发创新的初级预防策略来改善空气质量，这样一个人生活在英国的地方就不再是认知健康的脆弱性。INSPIRE(由来自9所大学的22名学者组成的合作网络)将参与一项雄心勃勃的研究计划，利用公共卫生系统科学方法的最新发展来做以下工作：1.开发一个名为PM2.5的尖端英国空气污染模型(1970-2020)。这些空气污染物是危险的，因为它们进入血液并进入大脑，导致认知障碍。2.与Dementias平台合作，将我们的空气污染模型与三个高度评价的英国队列的认知健康结果联系起来。3.与区域和国家合作伙伴合作，评估以前和当前的清洁空气战略(1970-2020)，以确定(对我们的队列而言)在减轻地方对认知健康的负面影响方面最成功的战略。4.创建这些政策战略的目录，并针对4个城市进一步评估它们：伦敦、伯明翰、泰恩韦尔和大曼彻斯特。5.利用这些结果产生高质量的政策信息和战略，向最终用户提供关于预防空气污染引起的认知障碍和健康不平等的信息。OUR工具包/模拟PLATFORMInSPIRE还将推出类似于英国多重剥夺指数和2050 DECC能量计算器的在线评估工具包和情景模拟平台。随着Impact站在我们与公众和利益相关者合作的前沿，我们的模拟平台和工具包将立即适合目标。此外，中央和本地终端用户将能够随着周围世界的变化而微调他们的平台。与国家或地方数据和区域服务相联系，它们还将有权确定哪些措施可行，哪些措施在短期和长期内具有成本效益。总之，INSPIRE将有助于减轻空气污染对认知健康的影响，为我们的人民打开通往这一认知障碍的前景和关闭道路。

THE PROBLEMPublic health prevention today faces a serious challenge: new research suggests that breathing high levels of air pollutants at critical points in our lives, particularly in early life, can lead to significant cognitive disorders, including dementia. This causal link, however, from a public health standpoint, is not the primary challenge. Instead, the challenge is in figuring out how best to prevent it. What new research tentatively suggests, and here is the real public health challenge, is that the factors that account for which populations are most likely to develop air-pollution-based cognitive disorders has less to do with 'how' they live and more to do with 'where' they live. In other words, it appears that, from a prevention standpoint, the complex social and environmental systems in which certain populations live makes air pollution a health vulnerability for them. Air pollution is a form of cognitive health inequality.What is not clear, however, is specifically 'how' these complex systems make air pollution a cognitive health vulnerability? From policies for traffic management and urban congestion to the un-equitable sharing of benefits derived from clean air strategies, we do not entirely understand the pathways by which the social and environmental determinants of air pollution lead to cognitive disorders. In turn, therefore, we do not entirely know how to effectively intervene into these complex systems. In other words, from a primary prevention standpoint it is not clear which air policies or interventions best mitigate against the negative impact these determinants have on cognitive health, particularly for the most socioeconomically vulnerable populations in the UK's major conurbations. Hence the purpose of InSPIRE.OUR COMPLEXITY APPROACHInSPIRE will develop innovative primary prevention strategies for improving air quality, so that where one lives in the UK is no longer a cognitive health vulnerability. InSPIRE (which is comprised of 22 academics working across 9 universities with a network of partnerships) will engage in a highly ambitious research programme using the latest developments in systems science methods for public health to do the following:1.Develop a cutting-edge UK air pollution model (1970-2020) of what is known as PM2.5. These air pollutants are hazardous because they enter the bloodstream and travel to the brain to cause cognitive impairment.2.Work with the Dementias Platform to link our air pollution model to the cognitive health outcomes of three different highly regard UK cohorts.3.Work with regional and national partners to evaluate previous and current clean air strategies (1970 - 2020) to identify the most successful (for our cohorts) at mitigating the negative impact place has on cognitive health.4.Create a catalogue of these policy strategies and evaluate them further for 4 conurbations: London, Birmingham, Tyne-Wear and greater Manchester. 5.Use these results to produce high quality policy information and strategies to inform end-users on preventing air-pollution-based cognitive disorders and health inequalities.OUR TOOLKIT/SIMULATION PLATFORMInSPIRE will also launch an online evaluation toolkit and scenario simulation platform similar to the UK Multiple Deprivation Index and 2050 DECC Energy Calculator. With impact at the forefront of our partnership with the public and stakeholders, our simulation platform and toolkit will be immediately fit for purpose. Additionally, central and local end-users will be able to fine tune their platform as the world changes around them. Linking with national or local data and regional services, they will also be empowered to determine what will work and what is cost effective in the short and long term. Together, InSPIRE will help mitigate the effect of air pollution on cognitive health, both opening prospects and closing pathways to this cognitive barrier for the good of our population.