title: Tool for assessing health and equity impacts of interventions modifying air quality in urban environments.
abstract: BACKGROUND
  Urban outdoor air pollution (AP) is a major public health concern but the mechanisms by which interventions impact health and social inequities are rarely assessed. Health and equity impacts of policies and interventions are questioned, but managers and policy agents in various institutional contexts have very few practical tools to help them better orient interventions in sectors other than the health sector. Our objective was to create such a tool to facilitate the assessment of health impacts of urban outdoor AP interventions by non-public health experts.
  
  
  METHODS
  An iterative process of reviewing the academic literature, brainstorming, and consultation with experts was used to identify the chain of effects of urban outdoor AP and the major modifying factors. To test its applicability, the tool was applied to two interventions, the London Low Emission Zone and the Montréal BIXI public bicycle-sharing program.
  
  
  RESULTS
  We identify the chain of effects, six categories of modifying factors: those controlling the source of emissions, the quantity of emissions, concentrations of emitted pollutants, their spatial distribution, personal exposure, and individual vulnerability. Modifiable and non-modifiable factors are also identified. Results are presented in the text but also graphically, as we wanted it to be a practical tool, from pollution sources to emission, exposure, and finally, health effects.
  
  
  CONCLUSIONS
  The tool represents a practical first step to assessing AP-related interventions for health and equity impacts. Understanding how different factors affect health and equity through air pollution can provide insight to city policymakers pursuing Health in All Policies.
authors.affiliation: Ecole des Hautes Etudes en Santé Publique (Sorbonne Paris Cité), Rennes, France.; Canada Research Chair in Evaluation and Health System Improvement, Canada.
authors.forename: Yuri
authors.initials: Y
authors.lastname: Cartier
authors.affiliation: Ecole des Hautes Etudes en Santé Publique (Sorbonne Paris Cité), Rennes, France.; Canada Research Chair in Evaluation and Health System Improvement, Canada; Département de santé communautaire, Université de Montréal, Montréal, Québec, Canada.
authors.forename: Tarik
authors.initials: T
authors.lastname: Benmarhnia
authors.affiliation: Canada Research Chair in Evaluation and Health System Improvement, Canada; Département des sciences de la santé communautaire, Centre de Recherche de l'Hôpital Charles-LeMoyne, Université de Sherbrooke, Longueuil, Québec, Canada. Electronic address: astrid.brousselle@usherbrooke.ca.
authors.forename: Astrid
authors.initials: A
authors.lastname: Brousselle
mesh_terms: D000397:Air Pollution / Q000009:adverse effects*; D002170:Canada; D004784:Environmental Monitoring / Q000331:legislation & jurisprudence / Q000592:standards*; D004787:Environmental Pollution / Q000009:adverse effects; D005260:Female; D005602:France; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008452:Maximum Allowable Concentration; D020380:Needs Assessment; D011050:Policy Making; D011634:Public Health / Q000592:standards* / Q000639:trends; D014505:Urban Population; D001335:Vehicle Emissions / Q000032:analysis*
chemical_list: D001335:Vehicle Emissions
keywords: Air pollution; Assessment; Equity; Evaluation; Health; Policy