Neighborhood-based subjective environmental vulnerability index for community health assessment: Development, validation and evaluation

Neighborhood-based environmental vulnerability is significantly associated with long-term community health impacts. Previous studies have quantified environmental vulnerability using objective environmental datasets. However, environmental cognition among a population may influence subjective feelings of environmental vulnerability, and this can be associated with community health risk. In this study, a mixed-methods approach was applied to estimate neighborhood-based environmental vulnerability based on objective environmental measures and subjective environmental understanding from a local population. The synergistic use of both qualitative and quantitative data resulted in a "subjective environmental vulnerability" index which can demonstrate environmental deprivation across Hong Kong. The resultant maps were compared with a mortality dataset between 2007 and 2014, based on a case-series analysis. The case-series analysis indicated that using a subjective environmental vulnerability index as an approach for neighborhood mapping is able to estimate the community health risk across Hong Kong. In particular, the following types of cause-specific mortality have significant association with the subjective environmental vulnerability index: 1) mortality associated with mental and behavioral disorders, 2) cardiovascular mortality, 3) respiratory mortality, and 4) mortality associated with diseases of the digestive system. In conclusion, the use of a subjective environmental vulnerability index can be implemented within a community health planning program, especially to reduce long-term adverse impacts on population with mental impairment.