Strength and limitation. Using data from the Global Burden of Disease (GBD) Project (Institute for Health Metrics and Evaluation, 2014), this implementation of ITHIM calculates health benefits on disease-specific deaths and DALYs for which the relationships between physical activity and associated health benefits are well established in medical and public health research. In addition to premature mortalities, XXXXx also incorporates the concept of morbidities (i.e., measured by years living with disability0 for assessment of the burden of disease, realistically reflecting potential impacts on quality of life and overall economic costs incurred. The method for calculating expected numbers of traffic fatalities and injuries used in this implementation of ITHIM considers that miles traveled by the victims (i.e., pedestrians and bicyclists) and striking vehicles. The miles traveled by increased pedestrians and bicyclists were subtracted from automobile VMTs. In addition, crash risks used in calculation also differentiate by roadway types (i.e., arterials vs. local roads). Thus, increasing bicycle and transit miles can reasonably show decreased traffic fatalities and injuries when substantial VMTs were replaced by active transportation and transit. Currently, all existing implementations of ITHIM do not consider the differential travel behavior and health impacts by age and gender, which in reality influence travel patterns and health outcomes significantly. Future implementations of ITHIM may need to incorporate additional data to address this issue. Similarly, substitution of travel-related for non-travel related (i.e., leisure-time) physical activity is not considered. That is, leisure time physical activity data used in health benefit calculation were not adjusted in scenarios that increased walking or cycling for transportation. It is reasonable to expected that additional time used for active transportation may diminish the time available for leisure time physical activity. Future research needs to identify the extent to which active transportation substitutes leisure time physical activity to properly adjust the baseline leisure time activity levels in the population.
Strength and limitation. Strength ⮚ This study used qualitative method to supplement the result and also to explore ideas that are not addressed by quantitative survey ⮚ The study interviewed both husbands and wives.
Strength and limitation. This review has several strengths. The key strength is that we searched documents combining two different kinds of methods; (i) Search of the Google database, and (ii) Search within the official websites for the governments, health institutions, or safety and labor institutions. Each region and country may have different categorizations, definitions, and wordings to describe worker’s health in the food-producing industry. Thus, this combination was effective in identifying intended documents in different regions and countries. The second strength is that, in addition to countries, we selected targets for search from the Specialized Agencies of the United Nations such as WHO and FAO, and other regional agencies such as ECDC. Since these agencies cover information from their member states, I was able to obtain guidance information that covers broad areas, in addition to detailed guidance information from each country. Furthermore, I selected documents whose contents were guidance even if the documents were not defined as guidelines or guidance. This criterion was helpful in supplemental information in addition to guidance or guidelines. There were some limitations in this study. First, I might have potentially missed English guidance or guidelines issued in English-speaking countries where English is not an official or primary language. I selected target countries from countries where English or Japanese is a primary language or an official language to search English or Japanese documents containing details. Second, we have not extracted all of the information from the selected documents. I extracted information based on the topic we identified because the level of details was significantly different among regions or countries. Furthermore, the dates of issue or updates of the selected documents for food workers ranged from 2020 to 2021. For example, most selected documents were issued or updated in 2020, and some documents, such as the CDC interim guidance documents, were updated in 2021. However, the information regarding COVID-19 has been updating rapidly. Thus, the data that supports each document might be different depending on the timing of issuing or updating.
