School of Population Health

Impact driven: changing the environment to save lives

Xiao Feng

With a focus on promoting more liveable, healthier and equitable communities, leading epidemiologist Xiaoqi Feng is Associate Professor in Urban Health and Environment at UNSW School of Population Health, co-chair of the School’s Non-Communicable Diseases Research Stream, and Cultural Diversity Champion for UNSW Faculty of Medicine and Health.

A/Professor Feng is Founding Director of the Rapid Urbanisation and Population Health (RUPH) research network, established in 2020  and recently affiliated with the UNSW Institute for Global Development (IGD), bringing together UNSW researchers working across cities, health and wellbeing. 

Internationally, Xiao leads a National Health and Medical Research Council/UK Research and Innovation-funded research collaboration and is an elected council member and education committee chair for the International Society for Environment Epidemiology Asia-Western Pacific Chapter. She is also a member of the Editorial Board for the journal, Environment International.

Xiao’s many accolades include being a finalist in the 2021 Women’s Agenda Leadership Awards in the category of Emerging Leader in Climate Action and the winner of Park and Leisure Australia’s national research award in 2019. Her research has directly informed the City of Sydney’s $377M strategy to plant 700 new trees annually for 10 years and reach 40% green cover by 2050; and has resulted in all patients admitted to emergency departments of two hospitals in Western Sydney now routinely tested for type 2 diabetes, a leading cause of death globally that often goes undetected. 

Xiao shares with us what has inspired her impact-driven journey in population health and narrowing health inequalities, reflections on COVID-19, what’s next, and more. 

What inspired you professionally and academically to focus on population health research? 

My academic background is in the social sciences, public health and health services research, a mix that has made social determinants of health, and especially environmental and macroeconomic policies for improving population health and reducing health inequities, very compelling to research. 

My experiences of living in many cities across a range of countries with social, economic, topographic and cultural differences while sharing similar problems (e.g. chronic disease, loneliness, discrimination, homelessness, pollution, urban sprawl, inequity) was a catalyst for me to become an academic. My corporate experience in marketing and finance has given me opportunities to develop managerial skills that have been hugely valuable in my academic career. 

What brought you to UNSW School of Population Health? 

I joined the School in September 2019 after five wonderful years at the University of Wollongong, where I began my tenured academic career, co-founded a thriving research lab, and did research that had impact in the health and urban planning sectors. I felt the time was right to develop new collaborations beyond population health, in data science, social policy, built environment and urban planning which are central to my research; and the opportunity to help shape the next chapter of the School of Population Health at UNSW was the perfect fit. 

What does your work focus on? 

My work involves developing high-quality learning experiences, fulfilling governance responsibilities, and building innovative research projects and partnerships that empower people. I’m focused on ‘how’, ‘why’, and ‘what’ we can do about the impacts of urbanisation on the health and wellbeing of people in cities in Australia and around the world. This includes my work with RUPH and the Non-Communicable Diseases Research Stream at the School. I also teach two postgraduate courses:  Environmental Health and Applied Research Methods in Public Health

I design my research to generate new scientific evidence that can be useful for decision making that impacts thousands, potentially millions of people. 

Why are you passionate about population health and this focus? 

One of the great epidemiologists and public health researchers, Geoffrey Rose, once said: “The primary determinants of disease are mainly economic and social, and therefore its remedies must also be economic and social. Medicine and politics cannot and should not be kept apart.”  

There is no clearer example of this than the impact of the environment on our health. Simply telling every person to live a healthier life by not smoking, by keeping active, by eating the ‘right’ foods, by getting the ‘right’ amount of sleep and by taking time to relax or meditate isn’t enough. If the environments in which people live continue to discourage healthy behaviors, cause stress and other harms (e.g. heart and lung diseases caused by breathing polluted air), public health education and healthcare-based approaches can be like feathers in a hurricane - by improving our environments, we can improve population health and reduce health inequities.

What are the top highlights from your career? 

A big highlight has been doing work that has mattered for other people and seeing the results manifest in the form of new policies and practice-level changes, such as my research directly informing the Urban Greening Strategy of Wollongong City and the Greening Strategy of the City of Sydney (under development), and resulting in people in Western Sydney having greater access to diabetes tests

Other highlights include the opportunities to have worked in many different countries, co-founding a thriving research lab, building long-term collaborations with colleagues whom I feel I can depend on, and nurturing generations of new scholars to achieve their academic and career goals. For example, some of my PhD students have gone on to develop careers at the University of Alberta, Queen’s University Belfast, Swinburne University, Bhutan Ministry of Health, and NSW Department of Planning Industry and the Environment.

Reflecting on COVID-19, are there any insights you’d like to share and are you doing any specific work in this area? 

In general, there is a little more awareness and concern about the links between population health and environment now than before the COVID-19 pandemic. For example, we saw countless stories of how people flocked to their local parks and how air pollution levels dropped significantly when flights stopped and how all of this could help improve health. In this way, the COVID-19 pandemic has helped others to understand a little more about the research I and many others do. The next few years of recovery are crucial to see whether we go back to what was before, or if we go bold and try to prioritise policies that create a more sustainable, equitable and healthier place for everyone to live.  

I am currently collaborating on a series of COVID-19 related studies with colleagues in the University of Wollongong. So far, we have shown that people who had the flexibility of working from home during the pandemic not only visited green spaces more often, but also had much greater felt benefits as a result, such as more mental restoration and more frequent exercise. We have also found that people in Melbourne, who were in lockdown, visited green spaces more often and benefited more from them in comparison to their counterparts in Sydney, who were not in lockdown. This may be partly because of better access to green space in Melbourne, but also because the lockdown was a stressful antecedent condition that likely motivated people to seek out nature and connect with neighbours.

In your opinion, what is a key priority to address inequities with real, lasting impact on global health and communities? 

Environmental injustice continues to be an under-addressed global health priority. This is when vulnerable populations are disproportionately exposed to environments that cause harm, such as air pollution and fast food and are absent of the things that are essential for our health and wellbeing, such as high-quality green space. 

High-quality evidence is needed not only to reveal these environmental injustices, but also to test the effectiveness, cost-effectiveness, sustainability and acceptability of proposed solutions. Needed solutions are multi-faceted and not easy to implement for economic and political reasons, for example, because these involve laws, regulations, and governmental programs that attempt to reduce harms and improve the health-promoting qualities of environments; often with powerful opposition.  

The ‘Los Angeles (LA) fast food ban’ is a great example. We might think that banning fast food outlets from opening could reduce obesity, but when this was tried in LA, it didn’t have this impact at all. Among many reasons, this was because the ban that came into effect in LA only applied to standalone fast-food outlets at the kerbside. It did not prevent new fast-food outlets opening in malls, nor did it force the closure of existing outlets. In retrospect, the fast-food ban did not have the teeth to make a difference in the short-term but it was a start that could have been built on. Unfortunately, its lack of immediate success may have emboldened ‘naysayers’ and discouraged others from having a go and building on it. 

To bring about positive, sustained and meaningful change, large-scale structural interventions addressing environmental injustices need to be incremental in implementation, requiring strong political will to see things through without falling at the first hurdle. 

What’s your next big project? 

I am leading an international collaboration with colleagues in UNSW, University of Glasgow, UK’s Medical Research Council, the University of Wollongong, University of Queensland, and CSIRO. Funded by the National Health and Medical Research Council and UK Research and Innovation, we are re-conceptualizing ways of measuring green space quality and testing their potential impacts on mental health and prevention of cardiometabolic diseases using longitudinal cohort studies in Australia and the UK. The findings will directly inform efforts in both countries to improve access to high quality green space and to reduce inequities in healthy ageing.

What advice would you give to someone considering a career in research and population health? 

Population health research can be very rewarding. Three things which motivated me were: (1) the freedom to develop and lead projects I knew I was interested in and that mattered to other people; (2) the possibilities of working with and learning from people in a variety of disciplines and sectors; and (3) the opportunities to foster new generations of scholars and future decision-makers who are well-versed in population health and capable of making a difference - because we will only succeed if we work together!

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