People who live in the country are less likely to survive cancer

Bad for your health, this. Image: Getty.

It is easy to romanticise about escaping to the country, with its clean air, green space, and idyllic views. But our latest research, a review of 39 studies from around the world, suggests the need for a bit of an adjustment: it turns out that people living in rural locations are less likely to survive cancer.

We previously found that people in the northeast of Scotland who live more than an hour away from a cancer treatment centre are more likely to die within the first year after their diagnosis. We were interested in whether studies from other parts of the world also found differences between urban and rural cancer survival. We also wanted to understand reasons why people living rurally might be disadvantaged.

We examined studies that observed people with cancer over time. The studies calculated the risk of a person dying from cancer depending on whether they lived in urban or rural locations. One of the things that can complicate research comparing urban and rural living is that pockets of poverty can exist geographically, and poverty negatively affects cancer survival. For this reason, we only included studies that accounted for deprivation levels.

The 39 relevant studies that we found were all from developed countries, mostly the US, Canada, the UK and Australia/New Zealand. They covered a large variety of different cancer types and involved more than 2m people. Thirty of these studies found a clear survival disadvantage for rural people compared to their urban counterparts.

We wanted to find out exactly how much of a disadvantage rural patients had and we were able to aggregate the results of 11 of the studies. This led us to conclude that rural people are 5 per cent less likely to survive cancer than those living in urban areas.

Understanding why

The authors of the original studies suggested reasons why people living rurally might do worse after a cancer diagnosis. It is possible that they behave differently to city dwellers. They might be more likely to smoke or consume more alcohol, for example. It is also possible that rural people are more stoical, and might put off seeking help for symptoms.

The transport situation. Image: Sam Burriss/creative commons.

Access to services is also likely to be important. Most developed countries centralise their specialist cancer services within major cities, and this could potentially lead to disadvantages for rural people.

Some studies suggest that patients who live far away from specialist centres might be treated differently – not receiving radiotherapy, for example. Travel burden, transport infrastructure, and the way that cancer services are organised are important considerations. It might be, for example, that people in rural areas are more likely to avoid long journeys to city hospitals for treatments that will only make small improvements to their life expectancy.


Whatever the case, more research is needed to determine exactly which factors are at play, and which are the most important. Equally, it raises questions about survival rates for other illnesses in people living in the countryside.

There are many advantages to living in rural areas, and we are certainly not suggesting that everyone should move to the city. The big question is what we could do to improve cancer outcomes in people who live far away from cancer centres. Recognising that there is a problem is a good starting point, and research to build a deeper understanding of the problem could be coupled with innovative strategies to reduce rural cancer inequality.

One area of promise is digital/communications technology, such as getting people to communicate with clinicians via the internet. Possibilities would include everything from more automated appointment reminders to apps that help people to examine themselves online. On the whole, however, we need to better understand the problem better before we start proposing solutions. Having established that there is a definite disadvantage to living in the countryside if you have cancer, we now need to get to the bottom of it.

The Conversation

Rosalind Adam, Clinical Lecturer, University of Aberdeen; Peter Murchie, Professor of Primary Care, University of Aberdeen, and Romi Carriere, Doctoral Researcher, Epidemiology, University of Aberdeen.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

 
 
 
 

Green roofs improve cities – so why don’t all buildings have them?

The green roof at the Kennedy Centre, Washington DC. Image: Getty.

Rooftops covered with grass, vegetable gardens and lush foliage are now a common sight in many cities around the world. More and more private companies and city authorities are investing in green roofs, drawn to their wide-ranging benefits which include savings on energy costs, mitigating the risk from floods, creating habitats for urban wildlife, tackling air pollution and urban heat and even producing food.

A recent report in the UK suggested that the green roof market there is expanding at a rate of 17 per cent each year. The world’s largest rooftop farm will open in Paris in 2020, superseding similar schemes in New York City and Chicago. Stuttgart, in Germany, is thought of as “the green roof capital of Europe”, while Singapore is even installing green roofs on buses.

These increasingly radical urban designs can help cities adapt to the monumental challenges they face, such as access to resources and a lack of green space due to development. But buy-in from city authorities, businesses and other institutions is crucial to ensuring their success – as is research investigating different options to suit the variety of rooftop spaces found in cities.

A growing trend

The UK is relatively new to developing green roofs, and governments and institutions are playing a major role in spreading the practice. London is home to much of the UK’s green roof market, mainly due to forward-thinking policies such as the 2008 London Plan, which paved the way to more than double the area of green roofs in the capital.

Although London has led the way, there are now “living labs” at the Universities of Sheffield and Salford which are helping to establish the precedent elsewhere. The IGNITION project – led by the Greater Manchester Combined Authority – involves the development of a living lab at the University of Salford, with the aim of uncovering ways to convince developers and investors to adopt green roofs.

Ongoing research is showcasing how green roofs can integrate with living walls and sustainable drainage systems on the ground, such as street trees, to better manage water and make the built environment more sustainable.

Research is also demonstrating the social value of green roofs. Doctors are increasingly prescribing time spent gardening outdoors for patients dealiong with anxiety and depression. And research has found that access to even the most basic green spaces can provide a better quality of life for dementia sufferers and help prevent obesity.

An edible roof at Fenway Park, stadium of the Boston Red Sox. Image: Michael Hardman/author provided.

In North America, green roofs have become mainstream, with a wide array of expansive, accessible and food-producing roofs installed in buildings. Again, city leaders and authorities have helped push the movement forward – only recently, San Francisco created a policy requiring new buildings to have green roofs. Toronto has policies dating from the 1990s, encouraging the development of urban farms on rooftops.

These countries also benefit from having newer buildings, which make it easier to install green roofs. Being able to store and distribute water right across the rooftop is crucial to maintaining the plants on any green roof – especially on “edible roofs” which farm fruit and vegetables. And it’s much easier to create this capacity in newer buildings, which can typically hold greater weight, than retro-fit old ones. Having a stronger roof also makes it easier to grow a greater variety of plants, since the soil can be deeper.


The new normal?

For green roofs to become the norm for new developments, there needs to be buy-in from public authorities and private actors. Those responsible for maintaining buildings may have to acquire new skills, such as landscaping, and in some cases volunteers may be needed to help out. Other considerations include installing drainage paths, meeting health and safety requirements and perhaps allowing access for the public, as well as planning restrictions and disruption from regular ativities in and around the buildings during installation.

To convince investors and developers that installing green roofs is worthwhile, economic arguments are still the most important. The term “natural capital” has been developed to explain the economic value of nature; for example, measuring the money saved by installing natural solutions to protect against flood damage, adapt to climate change or help people lead healthier and happier lives.

As the expertise about green roofs grows, official standards have been developed to ensure that they are designed, built and maintained properly, and function well. Improvements in the science and technology underpinning green roof development have also led to new variations on the concept.

For example, “blue roofs” increase the capacity of buildings to hold water over longer periods of time, rather than drain away quickly – crucial in times of heavier rainfall. There are also combinations of green roofs with solar panels, and “brown roofs” which are wilder in nature and maximise biodiversity.

If the trend continues, it could create new jobs and a more vibrant and sustainable local food economy – alongside many other benefits. There are still barriers to overcome, but the evidence so far indicates that green roofs have the potential to transform cities and help them function sustainably long into the future. The success stories need to be studied and replicated elsewhere, to make green, blue, brown and food-producing roofs the norm in cities around the world.

Michael Hardman, Senior Lecturer in Urban Geography, University of Salford and Nick Davies, Research Fellow, University of Salford.

This article is republished from The Conversation under a Creative Commons license. Read the original article.