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

问题今天的公共卫生预防面临着一个严峻的挑战：新的研究表明，在我们生命的关键时刻，特别是在生命的早期，呼吸高浓度的空气污染物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，这种因果关系并不是主要挑战。相反，挑战在于如何最好地预防它。新的研究初步表明，导致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，而与他们的“生活地点”关系更大，这是真正的公共卫生挑战。换句话说，从预防的角度来看，某些人群生活的复杂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，目前尚不清楚的是，这些复杂的系统具体“如何”使空气污染成为认知健康的弱点？从交通管理和城市拥堵政策，到清洁空气战略带来的利益的不公平分享，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，目前尚不清楚哪些空气政策或干预措施能最好地减轻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社会经济上最脆弱的人群。这就是InSPIRE的目的。我们的复杂性方法启发将制定创新的初级预防战略，以改善空气质量，使人们在英国的生活不再是认知健康的弱点。InSPIRE（由9所大学的22名学者组成，拥有合作伙伴关系网络）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，开展以下工作：开发一个先进的英国空气污染模型（1970-2020），即PM2.5。这些空气污染物是有害的，因为它们会进入血液并进入大脑，导致认知障碍。与痴呆症平台合作，将我们的空气污染模型与三个不同的高度重视的英国队列的认知健康结果联系起来。3 .与区域和国家伙伴合作，评估过去和目前的清洁空气战略（1970 - 2020年），以确定（对我们的研究对象而言）在减轻空气对认知健康的负面影响方面最成功的战略。为伦敦、伯明翰、泰恩-威尔和大曼彻斯特4个城市创建这些政策策略的目录，并进一步评估它们。利用这些结果编制高质量的政策信息和战略，向最终用户通报如何预防基于空气污染的认知障碍和健康不平等。我们的工具包/模拟平台minspire还将推出一个在线评估工具包和场景模拟平台，类似于英国多重剥夺指数和2050年DECC能源计算器。随着我们与公众和利益相关者合作伙伴关系的最前沿影响，我们的模拟平台和工具包将立即适合目的。此外，中央和本地终端用户将能够随着周围世界的变化而调整他们的平台。他们还将与国家或地方数据和区域服务联系起来，有权决定在短期和长期内什么是有效的，什么是具有成本效益的。InSPIRE将共同帮助减轻空气污染对认知健康的影响，为我们的人民的利益开辟前景和关闭这一认知障碍的途径。

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.