Poor environmental conditions, food and water insecurity, neighborhood perceptions, and self-reported physical and mental health in four disadvantaged urban communities in Salvador, Brazil: a cross-sectional study.

Emerging evidence suggests an association between environmental conditions and mental well-being. While the physical health impacts of environmental exposures such as contaminated drinking water or open sewers are well-documented with respect to the spread of infectious diseases, the mental health implications of these poor environmental conditions and exposures are less well understood, particularly in the context of urban impoverishment. Addressing the association between urban environmental conditions and mental health remains an important opportunity to reduce barriers to health, improve quality of life, and increase longevity. However, few studies have explored this relationship in the context of Brazil. The purpose of this study was to examine the associations between poor environmental health conditions, food and water insecurity, neighborhood perceptions and self-reported physical and mental health in four disadvantaged urban communities that were receiving a simplified sewage intervention in Salvador, Bahia Brazil. Using baseline surveys, we examined cross-sectional associations between water, sanitation, and hygiene conditions, food and water insecurity, and neighborhood perceptions with self-reported physical and mental health measured via the Short-Form 12 questionnaire. Poor environmental conditions, such as trash and open sewers near the home, were associated with lower mental health scores (ranging from -1.18 to -2.86 on average). Problems with sewer, sewer overflow, landslides and flooding were associated with worse physical health scores (-2.29 to -3.24 on average). Food insecurity was strongly associated with worse physical and mental health (-1.10 and -1.24 respectively for changes in food insecurity levels). Positive perceptions of neighbors including trust and willingness to help one another were associated with improved mental health scores (0.70-2.34 on average). The results suggest that improving environmental conditions and reducing food insecurity may have a positive impact on both mental health and physical health. Communities should be engaged in developing solutions to address these complex issues.