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A growing empirical evidence base identifies environmental noise exposure as an important health problem. While the health effects depend for a great part on personal noise sensitivity and contextual factors, in environmental policy, generic noise standards and procedures based on objective sound levels are used. In this article, the relation between objective and subjective noise exposure variables is further explored by carrying out a residents’ survey in a highly noise polluted area along two highways south of the city centre of Ghent, Belgium. The survey results show only a weak correlation between objective and subjective exposure variables, with both variables demonstrating different associations with the respondents’ background characteristics. While lower-educated and lower-income people are generally higher exposed according to the models, they do not report a higher subjective exposure. People who have been living longer in the area are not necessarily higher exposed according to the models but do report a higher subjective exposure. Most strikingly, owners of a comfortable detached house report a higher subjective exposure than renters of an apartment or small house, while the latter group is significantly higher exposed according to the models. The results support a plea for the joint evaluation of both objective and subjective noise exposure variables in environmental policy and environmental assessments. In addition, the results argue for specific attention for noise exposure of socio-economically vulnerable people and the establishment of a shared knowledge base on noise exposure with both objective and subjective information.

While public health and urban planning were closely linked in the past, the relation has turned into a lock-in of two procedurally interrelated, but in fact disconnected domains of knowledge and action. In most cases, health intersects with spatial planning processes only through obligatory evaluations or restrictive environmental legislation. This institutionalization of health criteria in most western countries has difficulty in dealing with the rapidly changing spatial conditions of our complex society, the growing awareness of environmental impacts and the increasing empowerment and engagement of citizens. This dissertation aims to move beyond this lock-in and explores new approaches to deal with environmental health concerns in planning practice. Building on complexity theory, an environmental justice framework is proposed to localize environmentally unhealthy situations, and a matrix of planning strategies is presented to address these situations. To verify whether these theoretical insights could help to solve urban environmental health conflicts, an empirical research methodology was developed consisting of interviews, spatial data analysis, documentary analysis and a residents' survey. This research framework was applied to the city of Ghent (Belgium) in close collaboration with the city administrations and a local citizen initiative. By combining quantitative with qualitative results, case-specific and general policy recommendations were formulated that can lead to a more central place for health in urban planning.

Intraoperative thromboembolism is a well-documented complication associated with orthotopic liver transplantation (OLT) but its identification and intraoperative treatment are still an emerging topic in anesthesia. Intracardiac thrombus during OLT is associated with a high mortality rate. There are only a few reports describing the successful management of thromboembolism during OLT. We describe a case where routine intraoperative transesophageal echocardiography during a live donor liver transplantation enabled early detection of an intracardiac thrombus with subsequent successful heparin treatment. Our case suggests that if an intracardiac thrombus is identified early (before hemodynamic instability occurs), the use of IV heparin may be a safe therapeutic option.

Het doel om van de stad een gezonde en leefbare plek te maken, laat ook Gent niet onberoerd. Daarom zet de stad in op het voorzien van voldoende groen in de woonomgeving. In het kader van het Groenstructuurplan werd het huidige aanbod groene ruimte geanalyseerd. Hieruit blijkt dat het doel om in sommige wijken per inwoner 10 m² recreatief groen te voorzien nog lang niet is gerealiseerd. Vooral de binnenstad heeft nood aan bijkomend groen. De huidige beleidsdoelstellingen van de stad Gent worden hierop geënt. De vraag stelt zich echter of dit criterium niet verruimd moet worden en er ook andere factoren, naast de ruimtelijke verdeling, in rekening moeten worden gebracht bij het uitzetten van de beleidsprioriteiten. Hier wordt gekozen om te focussen op de sociale verdeling van groene ruimte over verschillende kansengroepen. Deze aanpak staat in relatie tot het begrip environmental justice dat de laatste jaren steeds meer weerklank vindt in stadsplanning. Om na te gaan of sociale ongelijkheid bestaat in de verdeling van groene ruimte zijn data noodzakelijk. Daarom wordt een GIS-analyse uitgevoerd naar de relatie tussen groene ruimte en sociaal-economische status in Gent. De relaties worden statistisch onderbouwd door middel van een correlatieanalyse. Hieruit blijkt dat er een verband bestaat tussen beide factoren en dat zwakkere sociaal-economische groepen gemiddeld minder groen in hun woonomgeving hebben. De resultaten worden echter met een kritisch oog bekeken. Het is niet vanzelfsprekend om dit concept van environmental justice te implementeren in het beleid, gezien dit belangrijke ethische en politieke keuzes vergt.

The research starts from the observation that the disciplines of urban planning and public health are disconnected, partly due to an ongoing institutionalization of health criteria in formal laws and regulations. As such urban planning has difficulties to deal with the growing awareness of environmental impacts and the empowerment and engagement of citizens in health related issues. The research aims to move beyond this lock-in and explores a more context-dependent and adaptive urban planning perspective regarding environmental health. It builds on a matrix of planning management approaches, reflecting recent ideas of co-evolutionary and adaptive planning in a complex network society. To verify whether these academic and theoretical insights are useful in analyzing and solving urban environmental health conflicts, the matrix will be tested in several case studies in the city of Ghent. These are selected by means of an environmental justice approach, using a GIS analysis to compare the distribution of environmental impacts (air pollution and noise) with vulnerability (socio-economic characteristics) and responsibility (e.g. car ownership) indicators, allowing the detection of spatial inequalities. In the cases more detailed information about the context will be assembled, including bottom-up, subjective aspects, and the processes behind the inequalities. Consequently the justice of the situation can be assessed, and if deemed necessary, a redevelopment track can be devised making use of a combination of the four planning management approaches. Based on the case study results the research will formulate some recommendations how the use of the matrix could practically support a change in paradigm.

Although a growing societal awareness for the impact of the built environment on health and well-being urges spatial planners to take health aspirations into account, the issue is mostly addressed very late in the planning process.This results in a rather short term perspective of possible solutions and a mainly local focus on measures to mitigate environmental nuisance. The article starts from the existing gap between the requisite technical expertise concerning enviromnental nuisance and the daily spatial planning practice, preventing a substantial shift to incorporating public health concernsin spatial policy initiatives or interventions. Therefore opportunities to positively affect health and well-being through enhancing environmental liveabilty conditions are missed. The article focuses on environmental noise and air pollution in relation to human health in the Northern Fringe of Brussels. Useful data sources are explored and selected indicators are processed by GISanalysis to establish a comprehensible mapping method for evidence informed spatial policy,showing spatial varation of environmental health issues in the area.

The countryside, the rural area, the open space, … many definitions are used for rural Flanders. Everyone makes its own interpretation of the countryside, considering it as a place for living, working or recreating. The countryside is more than just a geographical area: it is an aggregate of physical, social, economic and cultural functions, strongly interrelated with each other. According to international and European definitions of rural areas there would be almost no rural area in Flanders. These international definitions are all developed to be used for analysis and policy within their specific context. They are not really applicable to Flanders because of the historical specificity of its spatial structure. Flanders is characterized by a giant urbanization pressure on its countryside while internationally rural depopulation is a point of interest. To date, for every single rural policy initiative – like the implementation of the European Rural Development Policy – Flanders used a specifically adapted definition, based on existing data or previously made delineations. To overcome this oversupply of definitions and delineations, the Flemish government funded a research project to obtain a clear and flexible definition of the Flemish countryside and a dynamic method to support Flemish rural policy aims. First, an analysis of the currently used definitions of the countryside, in Flanders and surrounding countries, was made. It is clear that, depending on the perspective or the policy context, another definition of the countryside comes into view. The comparative study showed that, according to the used criteria, the area percentage of Flanders that is rural, varies between 9 and 93 per cent. Second, dynamic sets of criteria were developed, facilitating a flexible definition of the countryside, according to the policy aims concerned. This research part was focused on 6 policy themes, like ‘construction, maintenance and management of local (transport) infrastructure’ and ‘offering of (minimal) services (education, culture, health care, …)’. For each theme a dynamic set of criteria or indicators was constructed. These indicators make it possible to show where a policy theme manifests itself and/or where policy interventions are possible or needed. In this way every set of criteria makes up a new definition of rural Flanders. This method is dynamic; new data or insights can easily be incorporated and new criteria sets can be developed if other policy aims come into view. The developed method can contribute to a more region-oriented and theme-specific rural policy and funding mechanism. Other possible sessions: - E. Finance and regional development - N. Regional strategies and policies - ZM. SS- Territorial Governance, rural areas and local agro food systems

Het platteland, het buitengebied, het ruraal gebied, … zowel ruimtelijke planners als het beleid worstelen met deze begrippen. Al te vaak wordt teruggegrepen naar een klassieke scheiding stad-platteland. In opdracht van de Vlaamse Landmaatschappij werd gezocht naar een heldere en dynamische omschrijving van het Vlaamse platteland, in functie van het plattelandsbeleid. Eerst werd een analyse gemaakt van bestaande plattelandsdefinities, in Vlaanderen en omliggende landen. Vervolgens werden dynamische criteriasets opgesteld die elk een eigen definitie van landelijk Vlaanderen construeren, gekoppeld aan specifieke beleidsthema’s. Deze flexibele afbakening van het platteland kan bijdragen tot een meer efficiënte realisatie van de plattelandsbeleidsdoelen, zonder de relatie met het verstedelijkte deel van Vlaanderen uit het oog te verliezen.

While urban planning and health were initially interlinked, in the twentieth century planning practice slowly moved away from its public health origins. In recent years however there is a growing interest in the health effects of our spatial organization. Although the direct impact of the physical environment on health has decreased – due to better standards of living, sanitary developments, improved housing – environmental quality still deserves our attention. First, the focus has shifted from life expectancy to health expectancy and quality of life. Public health impact no longer predominantly involves clear mortality risks, but rather comprises aspects of human well-being in a broad sense. Several direct impacts, like noise or air pollution, do not immediately kill people, but cause physical or mental disorders on the long term or severely reduce the quality of life of people. Second, the physical environment has many indirect effects on lifestyle and health, for example a reduced physical activity caused by a lack of walkable neighborhoods. A final important reason to justify this research is the aspect of environmental justice. The spatial characteristics responsible for direct and indirect health effects are spatially heterogeneously distributed, causing important differences in health status and healthy life expectancy between various residential neighborhoods. Today a lot of research exists on different health impacts caused by aspects of the physical environment. Most of this research focuses on one single impact (e.g. noise) or one spatial aspect (e.g. a road). An integrated approach, in which all the impacts and aspects are combined, seems to be lacking. However, there is a giant need for a better understanding of this issue, to inform community leaders and spatial planners about which community design and land-use choices are most effective in improving the physical, mental and social well-being of people. In this paper an attempt is made to give an overview of the main environmental characteristics with an effect on people’s health and well-being. The aim is to evaluate the evidence of the existing research output and to explore the relevance for spatial planning. Finally the results are discussed and recommendations for urban planning policy are formulated. Here the aspect of environmental justice comes into view, the right on a healthy living environment for every citizen regardless of social and economic status.

Meer dan 25 procent van de Vlaamse ruimte is bebouwd of verhard en prognoses geven aan dat Vlaanderen 30 tot 50 procent verhard zou worden tegen 2050 (Poelmans en Van Rompaey, 2009; Poelmans et al., 2010). De ruimte in Vlaanderen is echter niet oneindig beschikbaar. Willen we verstening een halt toeroepen, dan is een meer duurzame ruimtelijke ontwikkeling noodzakelijk met (her)gebruik van reeds ontwikkelde structuren en gebieden. Dit artikel stelt de resultaten voor van een onderzoek in opdracht van de Vlaamse Overheid waarin aangetoond wordt dat hergebruik een methode kan zijn om de toenemende druk op greenfields -en dus het aansnijden van nieuwe ruimte- te verminderen.

Door verstedelijking is de Vlaamse open ruimte niet langer een monofunctioneel productielandbouwgebied, maar kent ze een complexe gefragmenteerde structuur met verschillende dichtheden en functies. Deze paper, in het kader van het Steunpunt Ruimte en Wonen, wil hierin inzicht bieden door te focussen op vier onderschatte niet-agrarische landgebruiken: wonen, bedrijvigheid, privaat gebruik (o.a. privéweiden, moestuinen) en recreatief medegebruik. De paper analyseert de relatie tussen deze ‘nieuwe’ functies en maakt een inschatting van hun ruimtelijke impact aan de hand van negen casestudy’s. Deze inzichten kunnen bijdragen aan een beleid dat beter afgestemd is op de huidige ontwikkelingen in de Vlaamse open ruimte.

De Vlaamse ruimte is sterk bebouwd en versnipperd. Dit geeft aanleiding tot het stereotiepe beeld van Vlaanderen als één homogeen verstedelijkt veld. Analyses van de bebouwing en versnippering tonen echter aan dat er binnen de Vlaamse ruimte belangrijke verschillen zijn. Deze analyses leveren niet enkel meer gedetailleerde inzichten in de ruimtelijke realiteit van Vlaanderen, maar stellen ook de gangbare manier van denken over verstedelijkte ruimte in vraag. Zeker wat betreft de open ruimte worden bebouwing en versnippering vaak als een eenduidige verstoring gezien, die het gebied eensklaps minder waardevol maken. Deze conservatieve houding gaat voorbij aan de unieke eigenschappen en potenties van dergelijke gebieden. Gebieden met veel verspreide bebouwing vergen immers een andere ontwerpaanpak dan verlinte of verkavelde gebieden, en ook kleinere openruimtefragmenten kunnen een belangrijke socioculturele en zelfs ecologisch rol spelen. Het exploreren van deze potenties komt niet enkel de waarde van deze versnipperde ruimten ten goede, maar kan ook een interessant uitgangspunt vormen voor het nadenken over toekomstige verstedelijkingsprocessen.

De paper bespreekt het ruimtelijk patroon van de verspreide bebouwing in Vlaanderen. Door middel van GIS wordt een beeld opgebouwd van de huidige nederzettingsstructuur in de Vlaamse open ruimte. Dit beeld is genuanceerder dan de nederzettingsstructuur anno 1994 die wel de basis vormde voor het buitengebied- versus stedelijkgebiedbeleid uit het Ruimtelijk Structuurplan Vlaanderen. De paper wil ook een opstap vormen naar verdiepend en beleidsrelevant onderzoek dat verschillende clichés over lintbebouwing in Vlaanderen moet objectiveren: is lintbebouwing werkelijk belastend voor publieke dienstverlening, belemmert ze inderdaad het zicht op het achterliggende landschap en zijn er toch mensen die lintbebouwing als woonomgeving wensen?

The boundary between the Flemish urban and rural areas has faded in recent years and a fragmented spatial structure has emerged. The ‘open space’ is evolving from an agricultural production area to a semi-urbanized consumption area. On the one hand the public use of open space seems to be growing, particularly because of the success of recreational networks. On the other hand the open space also seems to be increasingly used in a private way, as a consequence of residential development, setting up gardens and hobby farming. An empirical case study showed that these evolutions are actual phenomena and that some determining conditions can be defined. Both evolutions tend to change the open space profoundly. Planning policy should be aiming to guide these evolutions in the best way possible, considering the limited carrying-capacity of open space. Maybe the control of accessibility of the countryside is part of the solution.