Urban Health Indicator Tools of the Physical Environment: a Systematic Review

Pathogenic built environment? Reflections on modeling spatial determinants of health in urban settings considering the example of COVID-19 studies

The triad of host, agent, and environment has become a widely accepted framework for understanding infectious diseases and human health. While modern medicine has traditionally focused on the individual, there is a renewed interest in the role of the environment. Recent studies have shifted from an early-twentieth-century emphasis on individual factors to a broader consideration of contextual factors, including environmental, climatic, and social settings as spatial determinants of health. This shifted focus has been particularly relevant in the context of the COVID-19 pandemic, where the built environment in urban settings is increasingly recognized as a crucial factor influencing disease transmission. However, operationalizing the complexity of associations between the built environment and health for empirical analyses presents significant challenges. This study aims to identify key caveats in the operationalization of spatial determinants of health for empirical analysis and proposes guiding principles for future research. We focus on how the built environment in urban settings was studied in recent literature on COVID-19. Based on a set of criteria, we analyze 23 studies and identify explicit and implicit assumptions regarding the health-related dimensions of the built environment. Our findings highlight the complexities and potential pitfalls, referred to as the 'spatial trap,' in the current approaches to spatial epidemiology concerning COVID-19. We conclude with recommendations and guiding questions for future studies to avoid falsely attributing a built environment impact on health outcomes and to clarify explicit and implicit assumptions regarding the health-related dimensions.

Urban density and child health and wellbeing: A scoping review of the literature

This scoping review explores the relationship between urban density and child health and wellbeing, focusing on how urban density has been measured and its association with various child health outcomes. By analysing 53 studies spanning from 1972 to 2023, we identify significant variability in how urban density is defined and measured and mixed evidence regarding its relationship with different child health outcomes. We also highlight context-specific findings, which may be connected to a range of dynamic and interconnected local and socio-cultural factors. While most studies showed mixed or inconclusive results for physical health and mental health and wellbeing, some consistent findings were observed for positive associations between urban density and growth and nutritional status in studies from Asia and Africa, and for negative impacts on child development in studies from Europe and North America. The review highlights the need for improved reporting standards, consistent terminology, and context-specific approaches to better understand and address the complex interplay between urban density and child health. It underscores the importance of considering broader social determinants and the unique experiences of children within urban environments for improved policy, practice and placemaking, advocating for participatory research methods to capture children's perspectives on urban density.

What Makes a Liveable Neighborhood? Role of Socio-Demographic, Dwelling, and Environmental Factors and Participation in Finnish Urban and Suburban Areas

Quality of residential area, or neighborhood, is one determinant of overall quality of life and associated with health and health behavior. Ensuring that urban and suburban neighborhoods remain liveable and comfortable to reside in is a challenge amidst growing urbanization. Neighborhood quality has been associated with socio-demographic, dwelling-related, and subjective and objective neighborhood factors. However, only a few studies have additionally included participation in neighborhood decision-making and examined whether these associations are stronger among residents who are more settled in the neighborhood. We examined whether subjectively and objectively measured environmental factors and participation are associated with perception of neighborhood liveability and possible effect moderators. We analyzed survey data collected in 2021 among adults (aged 18-97) living in suburbs and urban centers in five Finnish cities (n = 2057; response rate 34%) with logistic regression models. Almost 80% of the respondents perceived their neighborhood as liveable or very liveable. The following factors were most strongly associated with perceiving the neighborhood as liveable: low area-level socioeconomic deprivation; central urban zone; green view from home; satisfaction with neighborhood safety, green areas, blue areas, and maintenance of traffic routes; and good or very good possibilities to influence decisions regarding the neighborhood. Only a few interactions between indicators of being more settled in the neighborhood (e.g., age group and dwelling ownership) modified these associations. In all, our study suggests that to maintain liveability, urban or community planning should consider local residents' favorable perceptions of safety, recreational areas, and engagement in decision-making.

Barriers to integration of health and equity into urban design policies in Regina, Saskatchewan

Although there is extensive literature on the impact of urban design on health, little is known about the barriers to integrating health into urban design policies. As cities increasingly lead efforts to improve health equity and population health, understanding the perspectives and experiences of municipal actors on health and equity is essential. To address this gap, we conducted semi-structured interviews with 30 stakeholders engaged with urban design policy- and decision-making at the City of Regina in Saskatchewan, Canada. We analysed our data using a qualitative thematic framework. Our research uncovered a lack of shared understanding of health among municipal actors. Interviewees identified several barriers to integrating health and equity in urban design policies, including inaccessibility of evidence; insufficient resourcing; fragmented governance structure; limited legal power of local governments in Canada; a deeply ingrained culture of individualism and lack of representation. Our findings underscore the importance of adopting an integrated and holistic approach for healthy and equitable urban design. As urbanization continues to bring a greater share of the world's population into urban areas, it is crucial to understand how municipal governance can foster environments that promote residents' well-being.

HealthyPlan.City: A Web Tool to Support Urban Environmental Equity and Public Health in Canadian Communities

Urban environmental factors such as air quality, heat islands, and access to greenspaces and community amenities impact public health. Some vulnerable populations such as low-income groups, children, older adults, new immigrants, and visible minorities live in areas with fewer beneficial conditions, and therefore, face greater health risks. Planning and advocating for equitable healthy urban environments requires systematic analysis of reliable spatial data to identify where vulnerable populations intersect with positive or negative urban/environmental characteristics. To facilitate this effort in Canada, we developed HealthyPlan.City ( https://healthyplan.city/ ), a freely available web mapping platform for users to visualize the spatial patterns of built environment indicators, vulnerable populations, and environmental inequity within over 125 Canadian cities. This tool helps users identify areas within Canadian cities where relatively higher proportions of vulnerable populations experience lower than average levels of beneficial environmental conditions, which we refer to as Equity priority areas. Using nationally standardized environmental data from satellite imagery and other large geospatial databases and demographic data from the Canadian Census, HealthyPlan.City provides a block-by-block snapshot of environmental inequities in Canadian cities. The tool aims to support urban planners, public health professionals, policy makers, and community organizers to identify neighborhoods where targeted investments and improvements to the local environment would simultaneously help communities address environmental inequities, promote public health, and adapt to climate change. In this paper, we report on the key considerations that informed our approach to developing this tool and describe the current web-based application.

Can the implementation of net gain requirements in England's planning system be applied to health?

This Personal View considers the relationship between spatial planning and health and the potential benefits of requiring health net gain from land use decisions and new developments. We explore how a health net gain objective could be applied in spatial planning policy and practice to improve people's health and wellbeing, using England's implementation of a biodiversity net gain objective as a model. This Personal View emphasises the need for a systems approach to the definition and strategic coordination of health gains, recognising the breadth of health determinants and inter-related economic, environmental, and social policy objectives. By considering the potential application of a net gain principle to health in spatial planning, we offer valuable insights into how the spatial planning system could be used to build the conditions of health creation. A road map is provided for exploration of health net gain in other national contexts in support of the operationalisation of global urban health initiatives.

Advancing Population Health Through Open Environmental Data Platforms

Data stand as the foundation for studying, evaluating, and addressing the multifaceted challenges within environmental health research. This chapter highlights the contributions of the Canadian Urban Environmental Health Research Consortium (CANUE) in generating and democratizing access to environmental exposure data across Canada. Through a consortium-driven approach, CANUE standardizes a variety of datasets - including air quality, greenness, neighborhood characteristics, and weather and climatic factors - into a centralized, analysis-ready, postal code-indexed database. CANUE's mandate extends beyond data integration, encompassing the design and development of environmental health-related web applications, facilitating the linkage of data to a wide range of health databases and sociodemographic data, and providing educational training and events such as webinars, summits, and workshops. The operational and technical aspects of CANUE are explored in this chapter, detailing its human resources, data sources, computational infrastructure, and data management practices. These efforts collectively enhance research capabilities and public awareness, fostering strategic collaboration and generating actionable insights that promote physical and mental health and well-being.

Urban Governance, Multisectoral Action, and Civic Engagement for Population Health, Wellbeing, and Equity in Urban Settings: A Systematic Review

Objectives: To identify the validated and reliable indicators and tools to assess good governance for population health, wellbeing, and equity in urban settings, and assess processes of multisectoral action and civic engagement as reported by peer-reviewed articles. Methods: We conducted a systematic review searching six databases for observational studies reporting strategies of either urban health, multisectoral action or civic engagement for wellbeing, health, or equity. Results: Out of 8,154 studies initially identified we included 17. From the included studies, 14 presented information about high-income countries. The general population was the main target in most studies. Multisectoral action was the most frequently reported strategy (14 studies). Three studies used Urban Health Equity Assessment and Response Tool (Urban HEART). Health indicators were the most frequently represented (6 studies). Barriers and facilitators for the implementation of participatory health governance strategies were reported in 12 studies. Conclusion: Data on the implementation of participatory health governance strategies has been mainly reported in high-income countries. Updated and reliable data, measured repeatedly, is needed to closely monitor these processes and further develop indicators to assess their impact on population health, wellbeing, and equity.

Spatializing stigma-power: Mental health impacts of spatial stigma in a legally-excluded settlement in Mumbai, India

In disadvantaged neighborhoods such as informal settlements (or "slums" in the Indian context), infrastructural deficits and social conditions have been associated with residents' poor mental health. Within social determinants of health framework, spatial stigma, or negative portrayal and stereotyping of particular neighborhoods, has been identified as a contributor to health deficits, but remains under-examined in public health research and may adversely impact the mental health of slum residents through pathways including disinvestment in infrastructure, internalization, weakened community relations, and discrimination. Based on analyses of individual interviews (n = 40) and focus groups (n = 6) in Kaula Bandar (KB), an informal settlement in Mumbai with a previously described high rate of probable common mental disorders (CMD), this study investigates the association between spatial stigma and mental health. The findings suggest that KB's high rate of CMDs stems, in part, from residents' internalization of spatial stigma, which negatively impacts their self-perceptions and community relations. Employing the concept of stigma-power, this study also reveals that spatial stigma in KB is produced through willful government neglect and disinvestment, including the denial of basic services (e.g., water and sanitation infrastructure, solid waste removal). These findings expand the scope of stigma-power from an individual-level to a community-level process by revealing its enactment through the actions (and inactions) of bureaucratic agencies. This study provides empirical evidence for the mental health impacts of spatial stigma and contributes to understanding a key symbolic pathway by which living in a disadvantaged neighborhood may adversely affect health.

Integrating Health into Local Plans: A Comparative Review of Health Requirements for Urban Development in Seven Local Planning Authorities in England

A local plan is a statutory policy document that supports urban development decisions across a local government area in England. Local plans are reported to need more specific requirements for development proposals regarding wider health determinants to address potential health outcomes and health inequalities. This study reviews the integration of Health in Local Plans of seven local planning authorities through documentary analysis methods. A review framework was formulated based on health and planning literature regarding local plans, health policy and determinants of health and dialogue with a local government partner. The findings identify opportunities to strengthen the consideration of Health in Local Plans, including ensuring that policies are informed by local health priorities and signpost national guidance, strengthening health-related requirements for developers (e.g., indoor air quality, fuel poverty and security of tenure) and improving implementation of requirements for developers (e.g., through adoption of health management plans and community ownership). The study identifies further research needs regarding how policies are interpreted by developers in practice, and on national guidance for Health Impact Assessment. It highlights the benefit of undertaking a comparative review, contrasting local plan policy language and identifying opportunities to share, adapt and strengthen planning requirements regarding health outcomes.

An Iterative, Participatory Approach to Developing a Neighborhood-Level Indicator System of Health and Wellbeing

Despite increased awareness of the essential role of neighborhood characteristics for residents' health and wellbeing, the development of neighborhood-level indicator systems has received relatively little attention to date. To address this gap, we describe the participatory development process of a small-area indicator system that includes information on local health needs in a pilot neighborhood in the German city of Mannheim. To identify relevant indicators, we partnered with representatives of the city's public health department and used an iterative approach that included multiple Plan-Do-Check-Act cycles with ongoing feedback from local key stakeholders. The described process resulted in a web-based indicator system with a total of 86 indicators. Additionally, 123 indicators were perceived as relevant by stakeholders but could not be included due to data unavailability. Overall, stakeholders evaluated the participatory approach as useful. Even though the onset of the COVID-19 pandemic and the lack of some data elements hindered instrument development, close collaboration with public health partners facilitated the process. To identify and target sub-national health inequalities, we encourage local public health stakeholders to develop meaningful and useful neighborhood-level indicator systems, building on our experiences from the applied development process and considering identified barriers and facilitators.

The Canadian Environmental Quality Index (Can-EQI): Development and calculation of an index to assess spatial variation of environmental quality in Canada's 30 largest cities

BACKGROUND

Multiple characteristics of the urban environment have been shown to influence population health and health-related behaviours, though the distribution and combined effects of these characteristics on health is less understood. A composite measure of multiple environmental conditions would allow for comparisons among different urban areas; however, this measure is not available in Canada.

OBJECTIVES

To develop an index of environmental quality for Canada's largest urban areas and to assess the influence of population size on index values.

METHODS

We conducted a systematic search of potential datasets and consulted with experts to refine and select datasets for inclusion. We identified and selected nine datasets across five domains (outdoor air pollution, natural environments, built environments, radiation, and climate/weather). Datasets were chosen based on known impacts on human health across the life course, complete geographic coverage of the cities of interest, and temporal alignment with the 2016 Canadian census. Each dataset was then summarized into dissemination areas (DAs). The Canadian Environmental Quality Index (Can-EQI) was created by summing decile ranks of each variable based on hypothesized relationships to health outcomes.

RESULTS

We selected 30 cities with a population of more than 100,000 people which included 28,026 DAs and captured approximately 55% of the total Canadian population. Can-EQI scores ranged from 21.1 to 88.9 out of 100, and in Canada's largest cities were 10.2 (95% CI: -10.7, -9.7) points lower than the smallest cities. Mapping the Can-EQI revealed high geographic variability within and between cities.

DISCUSSION

Our work demonstrates a valuable methodology for exploring variations in environmental conditions in Canada's largest urban areas and provides a means for exploring the role of environmental factors in explaining urban health inequalities and disparities. Additionally, the Can-EQI may be of value to municipal planners and decision makers considering the allocation of investments to improve urban conditions.

Incorporating practitioner knowledge to test and improve a new conceptual framework for healthy urban design and planning

There are increasing arguments for bridging diverse knowledges and co-producing new knowledge between researchers, professional communities and citizens to create health-promoting built environments. The new THRIVES Framework (Towards Healthy uRbanism: InclusiVe, Equitable, Sustainable) echoes the call that healthy urbanism processes should be participatory and this principle informed the development of the Framework itself, which involved several stages of informal and formal testing with stakeholders, through a process of action research and 'extended peer review'. Formal feedback about the design of the preliminary Framework and its implementation in built environment practice was gathered through a participatory workshop with 26 built environment and public health professionals in January 2020. Participants were encouraged to share their knowledge, ask questions, critique and provide recommendations. Overall, participants were supportive of the conceptual messages of the THRIVES Framework and more critical of the visual design of the preliminary version. They also questioned whether further resources would be required to implement the Framework. This research created a forum for stakeholders, who may typically be outside the research process, to shape the development of a conceptual framework for healthy urbanism. Further research and collaboration will create resources to bridge the gap between this new conceptualisation and practice.

Towards healthy urbanism: inclusive, equitable and sustainable (THRIVES) - an urban design and planning framework from theory to praxis

The globally distributed health impacts of environmental degradation and widening population inequalities require a fundamental shift in understandings of healthy urbanism - including policies and decisions that shape neighbourhood and building design. The built environment tends to disadvantage or exclude women, children, the elderly, disabled, poor and other groups, starting from design and planning stages through to occupation, and this results in avoidable health impacts. Although these concepts are not new, they are rapidly emerging as built environment research and practice priorities without clear understanding of the interconnected aims of healthy environments that are sustainable, equitable and inclusive. This article promotes a new framework - Towards Healthy uRbanism: InclusiVe Equitable Sustainable (THRIVES) - that extends previous conceptualisations and reorients focus towards the existential threat of environmental breakdown and the social injustice created through inequitable and exclusive urban governance and design processes and outcomes. The Framework was developed through synthesising knowledge from research and practice, and by testing this new conceptualisation in a participatory workshop. Ongoing research is exploring implementation of the Framework in practice. If widely adopted, this Framework may contribute towards achieving the goals of sustainable development through a focus on increasing human health and wellbeing in urban development.

Urban Environment, Green Urban Areas, and Life Quality of Citizens-The Case of Warsaw

The increased migration of people from rural areas to cities has prompted researchers to take an interest in the problem of the quality of life (QOL) of the urban population in different contexts. The aim of the study was to determine the relationship between the level of satisfaction of Warsaw residents with urban infrastructure (SUI) and their QOL, the impact of the SUI on the perception of a neighborhood as an ideal place to live and the relationship between the amount of green areas and and the SUI of Warsaw residents and their QOL. The quantitative survey was conducted using the CAWI method on a sample of 381 adults. The WHOQOL-BREF questionnaire was used to measure QOL, the scale used in earlier surveys was used to assess SUI, areas of of Warsaw with different amounts of green space were distinguished using cluster analysis. The study showed a relationship between the SUI declared by residents and their QOL, mainly in the environmental domain. The discriminant analysis showed that satisfaction with greenery is one of the most important determinants of the subjective perception of a neighborhood as an ideal place to live. There was no direct effect of the amount of green areas in objective terms on the QOL of Warsawians, but a relationship was noted between the amount of green areas and SUI, with the highest level of satisfaction noted for the Green-balanced Cluster, characterized by the most favorable combination of quality and utility of urban area.

Participatory Systems Mapping for Municipal Prioritization and Planning

Rapidly growing cities face new and compounding health challenges, leading governments and donors to seek innovative ways to support healthier, more resilient urban growth. One such approach is the systems mapping process developed by Engaging Inquiry (EI) for the USAID-funded Building Healthy Cities project (BHC) in four cities in Asia. This paper provides details on the theory and methods of the process. While systems mapping is not new, the approach detailed in this paper has been uniquely adapted to the purpose of municipal planning. Strategic stakeholder engagement, including participatory workshops with a diverse group of stakeholders, is at the core of this approach and led to deeper insights, greater buy-in, and shared understanding of the city's unique opportunities and challenges. This innovative mapping process is a powerful tool for defining municipal priorities within growing cities across the globe, where the situation is rapidly evolving. It can be used to provide evidence-based information on where to invest to gain the biggest impact on specific goals. This paper is part of a collection in this issue providing a detailed accounting of BHC's systems mapping approach across four project cities.

The neighborhood environment and its association with the spatio-temporal footprint of tobacco consumption and changes in smoking-related behaviors in a Swiss urban area

This study aimed to evaluate the association of the neighborhood environment with the spatio-temporal dependence of tobacco consumption and changes in smoking-related behaviors in a Swiss urban area. Data were obtained from the CoLaus cohort (2003-2006, 2009-2012, and 2014-2017) in Lausanne, Switzerland. Local Moran's I was performed to assess the spatial dependence of tobacco consumption. Prospective changes in tobacco consumption and the location of residence of participants were assessed through Cox regressions. Analyses were adjusted by individual and neighborhood data. The neighborhood environment was spatially associated with tobacco consumption and changes in smoking-related behaviors independently of individual factors.

Impact of the COVID-19 Pandemic Era on Residential Property Features: Pilot Studies in Poland

Flats/houses in the COVID-19 pandemic era became the central place for living, working, learning, studying and entertainment. According to Maslow’s pyramid, all the basic needs had to be satisfied within a single space, which caused a change in the importance of certain locational and physical features of the flat/house. This study aimed to investigate how the COVID-19 pandemic changed the perception of the environmental features and the physical features of flats/houses. The research material was obtained from a questionnaire study disseminated through different online channels. The study was conducted in Poland, and citizens’ preferences are linked to the prevailing spatial and socio-economic determinants. A group of respondents were presented with 23 features describing the location and 17 features describing the physical features of flats/houses. They were also asked questions about the level of satisfaction with the current location and housing features. The results were analysed, and the statistical significance of the difference in the perception of the location features and the physical features of the flat/house was verified using a Chi-squared test. The results demonstrated a change in the importance of certain attributes concerning both external and internal factors. The physical features of the flat/house appeared to be more important (from the respondents’ perspective) than the features related to the location, as most changes occurred in that group. The respondents indicated that access to medical care facilities had gained importance (+8%), while good access to public transport had declined (−9%). For the physical features of flats/houses, respondents from other countries also indicated the importance of other attributes, i.e., the floor area (+12%), number of rooms (+14%), additional rooms (+14%), and access to broadband Internet and digital platforms (+28%). The study showed that over 30% of respondents would change their flats/houses if their financial means permitted.

An Innovative Index for Evaluating Urban Vulnerability on Pandemic Using LambdaMART Algorithm

The COVID-19 pandemic has significantly changed urban life and increased attention has been paid to the pandemic in discussions of urban vulnerability. There is a lack of methods to incorporate dynamic indicators such as urban vitality into evaluations of urban pandemic vulnerability. In this research, we use machine learning to establish an urban Pandemic Vulnerability Index (PVI) that measures the city’s vulnerability to the pandemic and takes dynamic indicators as an important aspect of this. The proposed PVI is constructed using 140 statistic variables and 10 dynamic variables, using data from 47 prefectures of Japan. Factor Analysis is used to extract factors from variables that may affect city vulnerability, and the LambdaMART algorithm is used to aggregate factors and predict vulnerability. The results show that the proposed PVI can predict the relative seriousness of the COVID-19 pandemic in two weeks with a precision of more than 0.71, which is meaningful for taking controlling measures in advance and shaping the society’s response. Further analysis revealed the key factors affecting urban pandemic vulnerability, including city size, transit station vitality, and medical facilities, emphasizing precautions for public transport systems and new planning concepts such as the compact city. This research explores the application of machine learning techniques in the indicator establishment and incorporates dynamic factors into vulnerability assessments, which contribute to improvements in urban vulnerability assessments and the planning of sustainable cities while facing the challenges of the COVID-19 pandemic.

Integrating Urban Land Tenure Security in Health Determinants: The Design of Indicators for Measuring Land Tenure Security and Health Relationships in Developing Country Contexts

Both urban land tenure insecurity and poor urban health outcomes are research topics of urban geographers and health experts. However, health outcomes or patterns are hardly measured in relation to land tenure security. There are no clear measures or indicators of if and how these two issues interrelate and which type of land tenure deficiency is likely to lead to which kind of health outcomes or patterns. To address this knowledge quandary, we reviewed literature to identify which characteristics of land tenure could relate to which types of health outcomes. The review found four specific land tenure security pathways which significantly influence health outcomes. For each of these, it is possible to identify a set of indicators which could measure the extent of interrelation between land tenure security and health. The result of this process is the design of a list of 46 land tenure-enabled indicators that can be applied empirically. The indicators demonstrate how to design a transdisciplinary approach that connects land management and global urban health knowledge spaces.

Operationalising the 20-minute neighbourhood

Background

Recent rapid growth in urban areas and the desire to create liveable neighbourhoods has brought about a renewed interest in planning for compact cities, with concepts like the 20-minute neighbourhood (20MN) becoming more popular. A 20MN broadly reflects a neighbourhood that allows residents to meet their daily (non-work) needs within a short, non-motorised, trip from home. The 20MN concept underpins the key planning strategy of Australia’s second largest city, Melbourne, however the 20MN definition has not been operationalised. This study aimed to develop and operationalise a practical definition of the 20MN and apply this to two Australian state capital cities: Melbourne (Victoria) and Adelaide (South Australia).

Methods

Using the metropolitan boundaries for Melbourne and Adelaide, data were sourced for several layers related to five domains: 1) healthy food; 2) recreational resources; 3) community resources; 4) public open space; and 5) public transport. The number of layers and the access measures required for each domain differed. For example, the recreational resources domain only required a sport and fitness centre (gym) within a 1.5-km network path distance, whereas the public open space domain required a public open space within a 400-m distance along a pedestrian network and 8 ha of public open space area within a 1-km radius. Locations that met the access requirements for each of the five domains were defined as 20MNs.

Results

In Melbourne 5.5% and in Adelaide 7.6% of the population were considered to reside in a 20MN. Within areas classified as residential, the median number of people per square kilometre with a 20MN in Melbourne was 6429 and the median number of dwellings per square kilometre was 3211. In Adelaide’s 20MNs, both population density (3062) and dwelling density (1440) were lower than in Melbourne.

Conclusions

The challenge of operationalising a practical definition of the 20MN has been addressed by this study and applied to two Australian cities. The approach can be adapted to other contexts as a first step to assessing the presence of existing 20MNs and monitoring further implementation of this concept.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-021-01243-3.

Urban areas, human health and technosols for the green deal

Authors aim to carry out a bibliographic review as an initial approach to state of the art related to the quality of urban soils, as well as its possible link with human health. This concern arises from the need to highlight the consequences that soil could face, derived from the growth and aging of the population, as well as its predicted preference for urban settlement. Urban development may pose a challenge to the health of urban soils, due to degradative processes that it entails, such as land take, sealing, contamination or compaction. A healthy soil is the one which maintains the capacity to support ecosystem services, so it can provide numerous benefits to human health and well-being (carbon sequestration, protection against flooding, retention and immobilization of pollutants and a growth media for vegetation and food production). This article addresses threats facing urban soils, the strategies put forward by the European Union to deal with them, as well as the issues that require further attention. Greening cities could be a consensual solution, so authors analyze whether soils of cities are ready for that challenge and what resources need to maintain soil ecosystem functions. This review proposes to use made by waste Technosols for a sustainable green city. Although the use of Technosols as a type of soil is very recent, the interest of the scientific community in this field continues to grow.

Integrating health indicators into urban and transport planning: A narrative literature review and participatory process

Today, urban and transport planners face considerable challenges in designing and retrofitting cities that are prepared for increasing urban populations, and their service and mobility needs. When it comes to health-promoting urban and transport developments, there is also a lack of standardized, quantitative indicators to guide the integration of health components right from the outset, i.e. in the formal planning or zoning phase. We narratively reviewed the literature and organized stakeholder workshops to identify and tailor planning principles and indicators that can be linked to health outcomes. We defined four core planning objectives that previous authoritative studies have suggested to result in positive health outcomes among city dwellers, which are: I) development of compact cities, II) reduction of private motorized transport, III) promotion of active (i.e. walking and cycling) and public transport, IV) development of green and public open space. Built on the review and stakeholder consensus, we identified 10 urban and transport planning principles that work towards achieving the four core objectives thought to provide health benefits for European city dwellers. These 10 planning principles are: 1) land use mix, 2) street connectivity, 3) density, 4) motorized transport reductions, 5) walking, 6) cycling, 7) public transport, 8) multi-modality, 9) green and public open space, and 10) integration of all planning principles. A set of indicators was developed and tailored for each planning principle. The final output of this work is a checklist ready to be applied by urban and transport professionals to integrate health into urban and transport developments in urban environments right from the outset.

Unhealthy Neighbourhood “Syndrome”: A Useful Label for Analysing and Providing Advice on Urban Design Decision-Making?

Even before the COVID-19 pandemic, there was growing interest in designing healthier neighbourhoods. Adopting this perspective brings attention to how conditions in neighbourhoods (directly and indirectly) affect their inhabitants’ physical health and mental wellbeing. However, considerably less attention has been paid to how to alleviate such conditions through integrated interventions designed to operate specifically at the neighbourhood scale. To address this gap, this paper introduces the term “unhealthy neighbourhood syndrome” (UNS). The conceptual clarity and practical utility offered by using this term are critically examined. The paper contains a rigorous review and critical analysis of academic and grey literature on what are held to be the relationships between key features of the built environment and people’s health and wellbeing. It also examines literature offering advice on how urban designers should make neighbourhoods healthier. It illustrates the complexity of the range of issues involved and the complicated web of top down, bottom up and middling out actors that need to be involved in making decisions about them. Despite having inherent weaknesses, the term “unhealthy neighbourhood syndrome” is judged to be useful. It illustrates how seemingly separate issues operate in urban design, promoted for tackling specific symptoms of ill health, need to be addressed jointly through an integrated programme of parallel work streams operating at the neighbourhood scale. The paper is innovative in identifying the wide cluster of symptoms used to describe unhealthy neighbourhoods in the literature as being a “syndrome”. Its significance lies in its injunction that this syndrome needs to be tackled through integrated streams of remedial action drawing on experience and expertise that lie beyond those offered by the traditional membership of urban design teams.

Measuring perceptions of social environments for walking: A scoping review of walkability surveys

The neighborhood pedestrian environment is an important determinant of physical activity and health. Despite widespread acknowledgment that neighborhoods' social and physical characteristics contribute to a walkable place, constructs and metrics remain focused primarily on the built environment. This scoping review documents the current state of the practice to measure perceived social elements of pedestrian environments in order to identify measurement strategies to understand and support walking, particularly in socially diverse neighborhoods. We identified 20 survey instruments focused on pedestrian environments, walkability, or physical activity at the local (neighborhood) scale and designed to capture residents' perceptions of outdoor walking environments. Across the 20 instruments, we identified and categorized 182 distinct items that measured social environments into four domains (social capital, personal safety, physical signifiers, and general neighborhood descriptors) and thirteen subdomains. Many items emphasized negative social elements, such as crime and disorder. Only a few items focused on community identity. Most instruments cover some aspects of the social environment well, but few provide a holistic inventory of the social environment across domains and subdomains. We also observe that the state of the practice seems frozen, with most instruments in use having originated in 2010 or earlier.

Assessing Urban Health Inequities through a Multidimensional and Participatory Framework: Evidence from the EURO-HEALTHY Project

Urban health inequities often reflect and follow the geographic patterns of inequality in the social, economic and environmental conditions within a city-the so-called determinants of health. Evidence of patterns within these conditions can support decision-making by identifying where action is urgent and which policies and interventions are needed to mitigate negative impacts and enhance positive impacts. Within the scope of the EU-funded project EURO-HEALTHY (Shaping EUROpean policies to promote HEALTH equitY), the City of Lisbon was selected as a case study to apply a multidimensional and participatory assessment approach of urban health whose purpose was to inform the evaluation of policies and interventions with potential to address local health gaps. In this paper, we present the set of indicators identified as drivers of urban health inequities within the City of Lisbon, exploring the added value of using a spatial indicator framework together with a participation process to orient a place-based assessment and to inform policies aimed at reducing health inequities. Two workshops with a panel of local stakeholders from health and social care services, municipal departments (e.g. urban planning, environment, social rights and education) and non-governmental and community-based organizations were organized. The aim was to engage local stakeholders to identify locally critical situations and select indicators of health determinants from a spatial equity perspective. To support the analysis, a matrix of 46 indicators of health determinants, with data disaggregated at the city neighbourhood scale, was constructed and was complemented with maps. The panel identified critical situations for urban health equity in 28 indicators across eight intervention axes: economic conditions, social protection and security; education; demographic change; lifestyles and behaviours; physical environment; built environment; road safety and healthcare resources and performance. The geographical distribution of identified critical situations showed that all 24 city neighbourhoods presented one or more problems. A group of neighbourhoods systematically perform worse in most indicators from different intervention axes, requiring not only priority action but mainly a multi- and intersectoral policy response. The indicator matrices and maps have provided a snapshot of urban inequities across different intervention axes, making a compelling argument for boosting intersectoral work across municipal departments and local stakeholders in the City of Lisbon. This study, by integrating local evidence in combination with social elements, pinpoints the importance of a place-based approach for assessing urban health equity.

Comparing the Use of Spatially Explicit Indicators and Conventional Indicators in the Evaluation of Healthy Cities: A Case Study in Shenzhen, China

Various indicator systems have been developed to monitor and assess healthy cities. However, few of them contain spatially explicit indicators. In this study, we assessed four health determinants in Shenzhen, China, using both indicators commonly included in healthy city indicator systems and spatially explicit indicators. The spatially explicit indicators were developed using detailed building information or social media data. Our results showed that the evaluation results of districts and sub-districts in Shenzhen based on spatially explicit indicators could be positively, negatively, or not associated with the evaluation results based on conventional indicators. The discrepancy may be caused by the different information contained in the two types of indicators. The spatially explicit indicators measure the quantity of the determinants and the spatial accessibility of these determinants, while the conventional indicators only measure the quantity. Our results also showed that social media data have great potential to represent the high-resolution population distribution required to estimate spatially explicit indicators. Based on our findings, we recommend that spatially explicit indicators should be included in healthy city indicator systems to allow for a more comprehensive assessment of healthy cities.

Healthy built environment: Spatial patterns and relationships of multiple exposures and deprivation in Toronto, Montreal and Vancouver

BACKGROUND

Various aspects of the urban environment and neighbourhood socio-economic status interact with each other to affect health. Few studies to date have quantitatively assessed intersections of multiple urban environmental factors and their distribution across levels of deprivation.

OBJECTIVES

To explore the spatial patterns of urban environmental exposures within three large Canadian cities, assess how exposures are distributed across socio-economic deprivation gradients, and identify clusters of favourable or unfavourable environmental characteristics.

METHODS

We indexed nationally standardized estimates of active living friendliness (i.e. "walkability"), NO₂ air pollution, and greenness to 6-digit postal codes within the cities of Toronto, Montreal and Vancouver. We compared the distribution of within-city exposure tertiles across quintiles of material deprivation. Tertiles of each exposure were then overlaid with each other in order to identify potentially favorable (high walkability, low NO₂, high greenness) and unfavorable (low walkability, high NO₂, and low greenness) environments.

RESULTS

In all three cities, high walkability was more common in least deprived areas and less prevalent in highly deprived areas. We also generally saw a greater prevalence of postal codes with high vegetation indices and low NO₂ in areas with low deprivation, and a lower greenness prevalence and higher NO₂ concentrations in highly deprived areas, suggesting environmental inequity is occurring. Our study showed that relatively few postal codes were simultaneously characterized by desirable or undesirable walkability, NO₂and greenness tertiles.

DISCUSSION

Spatial analyses of multiple standardized urban environmental factors such as the ones presented in this manuscript can help refine municipal investments and policy priorities. This study illustrates a methodology to prioritize areas for interventions that increase active living and exposure to urban vegetation, as well as lower air pollution. Our results also highlight the importance of considering the intersections between the built environment and socio-economic status in city planning and urban public health decision-making.

Use of Urban Health Indicator Tools by Built Environment Policy- and Decision-Makers: a Systematic Review and Narrative Synthesis

Global initiatives have raised awareness of the need for cross-departmental and cross-sectoral activities to support urban health, sustainability, and equity, with respective indicators routinely used as a way to catalyze and monitor action toward pre-defined goals. Despite the existence of at least 145 urban health indicator (UHI) tools globally, there has been very little research on the use of indicators by policy- and decision-makers; more attention has been devoted to their development and validation. This paper describes the second part of a two-part systematic review of the characteristics (part A) and use (part B, this part) of UHI tools by municipal built environment policy- and decision-makers. Part B is a narrative synthesis of studies on the use of UHI tools. This PRISMA-P compliant review follows a mixed methods sequential explanatory design. The search was conducted using seven bibliographic databases, grey literature searches, and key journal hand searches. Ten studies describing the use of ten UHI tools in seven countries were included in the narrative synthesis, resulting in development of a theory of change (ToC). We found that both expert-led and participatory indicator projects can be underpinned by research evidence and residents' knowledge. Our findings contradict the dominant view of indicator use in policy-making as a linear process, highlighting a number of technical, organizational, political, knowledge, and contextual factors that affect their use. Participatory UHI tools with community involvement were generally more effective at supporting "health in all policies" and "whole-of-society" approaches to governing healthy cities than expert-led processes. UHI tool producers proposed a range of techniques to address urban health complexity characteristics. Finally, in combining data from both parts of the review, we found that potentially important UHI tool features, such as neighbourhood-scale data, were influential in the use of indicators by built environment policy- and decision-makers.

Developing an Indicator System for a Healthy City: Taking an Urban Area as a Pilot

PURPOSE

The Healthy Cities Project is an important strategy for global health. This study aimed to develop a scientific and appropriate indicator system for the evaluation of a Healthy City in Chongqing, China.

METHODS

Data were collected via a review of government documents, focus group discussions, and in-depth interviews. A total of 34 government documents were reviewed to build the indicator database based on our previous studies. The first round of focus group discussions, which involved eight health-related experts, was conducted to form the indicator system framework. In-depth interviews with 15 experts from government departments were conducted to design the improved indicator system. The second round of focus group discussions, which featured four experts, was conducted to obtain the final recommended list of indicators. A thematic framework was used to analyze the detailed interview notes.

RESULTS

The indicator system for the Healthy City consisted of 5 first-level indicators, 21 second-level indicators (e.g., health literacy), 73 third-level indicators (e.g., incidence of myopia), and three characteristic indicators. This indicator system spanned the scope of the environment, society, health services, healthy people, and health behaviors.

CONCLUSION

This indicator system was based on the current status of the construction of the Healthy City in the pilot district. The indicator system could be dynamically adjusted according to the development of the Healthy City in the pilot district. Government departments play an important decision-making role in the development process of this indicator system.

Goals, beneficiaries, and indicators of waterfront revitalization in Great Lakes Areas of Concern and coastal communities

Cleanup of Great Lakes Areas of Concern (AOCs) restores environmental benefits to waterfront communities and is an essential condition for revitalization. We define waterfront revitalization as policies or actions in terrestrial waterfront or adjacent aquatic areas that promote improvements in human socioeconomic well-being while protecting or improving the natural capital (the stocks of natural assets, biodiversity) that underlies all environmental, social, and economic benefits. Except for economic measures such as development investments, visitation rates, or commercial activity, evidence of waterfront revitalization in the Great Lakes is mostly anecdotal. We offer a perspective on waterfront revitalization that links indicators and metrics of sustainable revitalization to community goals and human beneficiaries. We compiled environmental, social, economic, and governance indicators and metrics of revitalization, many of which are based on or inspired by Great Lakes AOC case studies and community reutilization or sustainability plans. We highlight the role of indicators in avoiding unintended consequences of revitalization including environmental degradation and social inequity. Revitalization indicators can be used in planning for comparing alternative designs, and to track restoration progress. The relevancy of specific indicators and metrics will always depend on the local context.

Identifying community priorities for neighborhood livability: Engaging neighborhood residents to facilitate community assessment

Identifying community-driven priorities to improve health outcomes is crucial toward achieving health equity. Seldom are communities experiencing health disparities included in community health assessment (CHA) and health improvement planning efforts (Pennel, McLeroy, Burdine, Matarrita-Cascante, & Wang, 2017). The purpose of this project was to conduct a CHA using a socio-ecological framework and community engagement (CE) process. In this paper we describe an exemplar engaging local residents as community facilitators to assess indicators of neighborhood livability, challenges and lessons learned, and implications for public health and community/public health nursing. Community residents were trained to facilitate focus groups and participated in analyzing these data. Data analysis yielded five neighborhood livability indicators and priorities reflecting the social determinants of health. Engaging community residents as stakeholders in CHA and health improvement planning is critical for identifying structural factors affecting neighborhood livability and priorities to improve health and well-being. Public health and health care system partnerships employing inclusive CE practices are necessary to improve overall population health outcomes. Public health nursing's role as strategy and system leaders can contribute toward the success of these cross-sector partnerships with diverse communities and populations.

A Community EcoHealth Index from EnviroAtlas Ecosystem Services Metrics

Human health is inextricably tied to ecosystem services (ES), including those associated with greenspace in urban communities. EnviroAtlas provides close to 100 maps of ES metrics based on high-resolution land cover data in featured communities across the contiguous United States. Using selected EnviroAtlas ES metrics, a Community EcoHealth Index (CEHI) was created based on an ecohealth framework including health promotion and hazard buffering domains. Aggregation of eight selected ES metrics in these domains entailed a weighted distance measure, where objective, data-driven weights were generated. CEHI was calculated by Census Block Group (CBG) at both the local level and the national level for 22 EnviroAtlas communities. Results were mapped to show one- to five-star CBGs or neighborhoods within and across all 22 featured communities. At the national level, CEHI favors communities in forested ecoregions. The local version of CEHI is more appropriate to inform social, economic, and environmental decision-making for improving community ES associated with human health.

Extending Data for Urban Health Decision-Making: a Menu of New and Potential Neighborhood-Level Health Determinants Datasets in LMICs

Area-level indicators of the determinants of health are vital to plan and monitor progress toward targets such as the Sustainable Development Goals (SDGs). Tools such as the Urban Health Equity Assessment and Response Tool (Urban HEART) and UN-Habitat Urban Inequities Surveys identify dozens of area-level health determinant indicators that decision-makers can use to track and attempt to address population health burdens and inequalities. However, questions remain as to how such indicators can be measured in a cost-effective way. Area-level health determinants reflect the physical, ecological, and social environments that influence health outcomes at community and societal levels, and include, among others, access to quality health facilities, safe parks, and other urban services, traffic density, level of informality, level of air pollution, degree of social exclusion, and extent of social networks. The identification and disaggregation of indicators is necessarily constrained by which datasets are available. Typically, these include household- and individual-level survey, census, administrative, and health system data. However, continued advancements in earth observation (EO), geographical information system (GIS), and mobile technologies mean that new sources of area-level health determinant indicators derived from satellite imagery, aggregated anonymized mobile phone data, and other sources are also becoming available at granular geographic scale. Not only can these data be used to directly calculate neighborhood- and city-level indicators, they can be combined with survey, census, administrative and health system data to model household- and individual-level outcomes (e.g., population density, household wealth) with tremendous detail and accuracy. WorldPop and the Demographic and Health Surveys (DHS) have already modeled dozens of household survey indicators at country or continental scales at resolutions of 1 × 1 km or even smaller. This paper aims to broaden perceptions about which types of datasets are available for health and development decision-making. For data scientists, we flag area-level indicators at city and sub-city scales identified by health decision-makers in the SDGs, Urban HEART, and other initiatives. For local health decision-makers, we summarize a menu of new datasets that can be feasibly generated from EO, mobile phone, and other spatial data-ideally to be made free and publicly available-and offer lay descriptions of some of the difficulties in generating such data products.