Urban and transport planning pathways to carbon neutral, liveable and healthy cities; A review of the current evidence

Cardiovascular risk posed by the exposome

Chronic non-communicable diseases (NCDs) account for 2/3 of global deaths annually, primarily due to an aging population and external risk factors such as air/water/soil pollution, traffic noise, mental stress, and climate change emanating from the environment. These factors contribute to premature deaths and loss of healthy life years, as reflected by disability-adjusted life years. The exposome concept was proposed 16 years ago as a new research field to investigate environment-health associations, also by considering the underlying pathophysiological pathways. The exposome describes lifelong environmental exposures, besides pollutants also socioeconomic and lifestyle factors, aiming to explain the associated diseases and deaths. The exposome can be divided into the specific and general external environment and further subcategories such as organ-specific exposomes as well as spatially and temporally restricted pollutomes. The exposome also shows considerable interaction with genetic predisposition and pre-established chronic diseases, characteristics of the vulnerable groups. The present overview provides background information on the impact of the environment on health and disease by considering recent data of the Global Burden of Disease Study. We also explain the exposome concept with the help of selected studies, briefly describe how the exposome is measured, and discuss biomarkers identified by exposomic research and their impact on the development and progression of atherosclerosis. Major pathophysiological pathways comprise exacerbated stress hormone signaling, oxidative stress, inflammation and circadian rhythm dysregulation promoting impairment of cardiometabolic function. The present overview highlights the relevance of the exposome for future health research and preventive medicine, especially concerning cardiovascular diseases and therapy.

Bionic Intelligent Interaction Helmet: A Multifunctional-Design Anxiety-Alleviation Device Controlled by STM32

Due to accelerated urbanization, modern urban residents are facing increasing life pressures. Many citizens are experiencing situational aversion in daily commuting, and the deterioration in the traffic environment has led to psychological distress of varying degrees among urban dwellers. Cyclists, who account for about 7% of urban commuters, lack a sense of belonging in the urban space and experience significant deficiencies in the corresponding urban infrastructure, which causes more people to face significant barriers to choosing cycling as a mode of transportation. To address the aforementioned issues, this study proposes a bionic intelligent interaction helmet (BIIH) designed and validated based on the principles of bionics, which has undergone morphological design and structural validation. Constructed around the STM32-embedded development board, the BIIH is an integrated smart cycling helmet engineered to perceive environmental conditions and enable both human-machine interactions and environment-machine interactions. The system incorporates an array of sophisticated electronic components, including temperature and humidity sensors; ultrasonic sensors; ambient light sensors; voice recognition modules; cooling fans; LED indicators; and OLED displays. Additionally, the device is equipped with a mobile power supply, enhancing its portability and ensuring operational efficacy under dynamic conditions. Compared with conventional helmets designed for analogous purposes, the BIIH offers four distinct advantages. Firstly, it enhances the wearer's environmental perception, thereby improving safety during operation. Secondly, it incorporates a real-time interaction function that optimizes the cycling experience while mitigating psychological stress. Thirdly, validated through bionic design principles, the BIIH exhibits increased specific stiffness, enhancing its structural integrity. Finally, the device's integrated power and storage capabilities render it portable, autonomous, and adaptable, facilitating iterative improvements and fostering self-sustained development. Collectively, these features establish the BIIH as a methodological and technical foundation for exploring novel research scenarios and prospective applications.

Heat in the transport sector: measured heat exposure and interventions to address heat-related health impacts in the minibus taxi industry in South Africa

High temperatures, heat and heatwaves are being experienced more frequently and with greater intensity in many parts of the world, including South Africa, and record-breaking maximum temperatures are becoming more common. Exposure to heat has adverse impacts on human health and wellbeing. The transport sector and its users are vulnerable to heat both inside vehicles as well as in places where people wait for public transport. We sought to assess the temperatures experienced in minibus taxis, a common mode of transport in South Africa and in minibus taxi ranks as well as the heat-related perceptions of minibus taxi drivers working in the Chesterville Taxi Association in Durban. We also observed heat-related elements in minibus taxi ranks. Data from temperature loggers showed that temperatures inside minibus taxis reached up to 39 °C and were between 3-4 °C warmer than outdoors. For around 11 h every day, temperatures inside minibus taxis were warmer than 27 °C - the temperature that is linked to heat-health symptoms. Taxi drivers (N = 16) all agreed they feel hot in the minibus taxi and more than 90% said they drink water to try to cool down. Taxi ranks were lacking in supply of drinking water and shade for minibus taxis and seating. With the projected increase in temperatures caused by climate change, it is imperative to co-develop mitigation and adaptation strategies to minimise heat-related human health impacts in minibus taxis and taxi ranks especially in low- and middle-income countries.

Health burden and inequities of urban environmental stressors in Sofia, Bulgaria

BACKGROUND

The number of studies on the health impacts of urban environmental stressors has been growing. However, research for South-Eastern Europe remains limited. We conducted a baseline Health Impact Assessment for Sofia, Bulgaria, focusing on air pollution, green space, road-traffic noise, and urban heat island (UHI) exposure aiming to promote discussions on sustainable, health-centric urban and transport planning policies.

METHODS

The analysis was conducted at the neighbourhood level (n = 4969). The study population included 1,168,382 inhabitants, considering adults and children. Data were retrieved from Europe-wide and local exposure models, local censuses and surveys. We used comparative risk assessment methodology, comparing baseline with optimal scenarios for health, such as meeting World Health Organization (WHO) air quality and road-traffic noise guidelines, green space recommendations, and no UHI effect. We also examined exposure and health impact distributions by area-level socioeconomic status (SES). We approximated differences in baseline disease rates by SES using data from local surveys. The results were stratified by SES quartiles and analysed spatially using global and local bivariate Moran's I statistics, the latter to identify priority areas for intervention based on SES, environmental exposures, and health outcomes.

RESULTS

All Sofia residents lived in neighbourhoods where particulate matter with diameter ≤2.5 μm (PM2.5) and nitrogen dioxide (NO2) levels exceeded the WHO air quality guidelines, with mean noise levels of 62.2 dB(A) Lday, 77 % lacking sufficient availability of green space, and an average summer UHI of 2.5 °C. The largest mortality burden was from PM2.5 exposure (1939 annual deaths (95 % CI: 1349-2571)), followed by NO2 (1172 annual deaths (444-2027)), road-traffic noise (902 annual deaths (556-1311)), insufficient green space (217 annual deaths (169-262)), and UHI (95 summer deaths (58-130)). PM2.5 contributed to 17-21 % of cardiovascular disease cases, while noise accounted for 5 % of Ischaemic Heart Disease and stroke cases. NO2, noise, and UHI exposures tended to be higher in higher SES areas, while PM2.5 tended to be lower. Spatial analysis revealed that central areas, with high-SES populations, and northern, north-eastern, and north-western areas, with lower-SES populations, all experience high exposure and health impacts.

CONCLUSIONS

The analysis showed a significant health burden from urban environmental stressors in Sofia, with an uneven distribution across SES groups. Health-promoting policy interventions should consider both environmental and socioeconomic factors to prioritize areas for action.

Inclusive Mobility: Dismantling transportation injustice at the intersection of race and disability

Transportation impacts population health. Historical trauma, structural inequities, and institutional discrimination have created transportation injustice. Transportation injustice is a product of systemic racism and ableism which perpetuates inequities, discrimination, and exclusion. However, systemic racism and ableism can compound injustice given one's social identities. In aligning with the principles of mobility justice and Crip Mobility Justice, this paper asserts that an intersectional lens is needed to dismantle transportation injustice and create a sustainable transportation system rooted in health equity. Specifically, social identities do not exist independent of each other, creating a complex convergence of oppression in transportation access. To support this viewpoint, we: (1) describe transportation history among two overlapping historically marginalized populations in the United States, Black people and people with disabilities, (2) articulate the impact transportation injustice has had on public health, and (3) advocate for an intersectional lens to dismantle unjust systems, policies, and structures.

The epidemiologic case for urban health: conceptualizing and measuring the magnitude of challenges and potential benefits

We discuss how epidemiology has been and can continue to be used to advance understanding of the links between urban areas and health informed by an existing urban-health conceptual framework. This framework considers urban areas as contexts for health, determinants of health and modifiers of health pathways, and part of a complex system that affects health. We highlight opportunities for descriptive epidemiology to inform the context of urban health, for example, by characterizing the social and physical environments that give rise to health and the actions that change those conditions. We then describe inferential tools for evaluating the impact of group-level actions (e.g., interventions, policies) on urban health, providing some examples, and describing assumptions and challenges. Finally, we discuss opportunities and challenges of applying systems thinking and methods to advance urban health. While different conceptual frames lead to different insights, each perspective demonstrates that urban health is a major and growing challenge. The effectiveness of urban health knowledge, action, and policy as the world continues to urbanize can be informed by applying and expanding upon research and surveillance methods described here.

Exposure to different types of residential greenness during pregnancy and early childhood and attention-deficit/hyperactivity disorder diagnosis: A nested case-control study

BACKGROUND

Epidemiological studies suggest that exposure to greenness may protect children attention-deficit/hyperactivity disorder (ADHD) diagnosis. However, evidence to date is limited while no previous research has independently investigated exposure to prenatal greenness.

OBJECTIVE

We conducted a nested case-control study with data from Born in Bradford (BiB) and INfancia y Medio Ambiente (INMA) birth cohorts to investigate the association between exposure to various types of residential greenness and ADHD diagnosis, considering both pregnancy and early childhood exposure periods independently. PM2.5 was tested as a potential mediator of the association.

METHODS

Children with ADHD were identified based on a confirmed medical diagnosis. Pregnancy and early childhood exposure to residential greenness were estimated through Normalized Difference Vegetation Index (NDVI) within 300-m, urban green space and natural green space percentages within 300-m, and the linear distance to the closest green space in meters. We performed a conditional logistic regression to analyze the association between the included greenness metrics and ADHD.

RESULTS

We found no statistically significant associations between any of the pregnancy and early childhood greenness metrics and ADHD diagnosis in the BiB cohort. Further analysis on the INMA cohort found that higher urban green space percentage slightly increased the risk of ADHD diagnosis during both pregnancy (total effects: OR 1.04, 95 % CI 1.01 to 1.07, p = 0.012; direct effects: OR 1.06, 95 % CI 1.03 to 1.10, p < 0.001) and early childhood (total effects: OR 1.03, 95 % CI 1.00 to 1.07, p = 0.042; direct effects: OR 1.04, 95 % CI 1.00 to 1.07, p = 0.033). However, these associations were not supported by the sensitivity analyses.

CONCLUSIONS

This study found both null and inconsistent associations between the included greenness metrics and ADHD. Further research is warranted to elucidate the potential role of exposure to different types of greenness in ADHD diagnosis.

How is health considered in urban transport planning? A review of the literature

OBJECTIVES

Urban transport is an important determinant of population health. Ensuring health is well considered in urban transport planning is important to create healthy cities, healthy populations and sustainable societies. This review aimed to describe how health is considered in urban transport planning.

STUDY DESIGN

A narrative literature review was conducted.

METHODS

Eligible literature included research articles, review articles, perspective articles, policy reports and technical reports published in English since 2013. PubMed, the Transport Research Integrated Database and grey literature sources were searched.

RESULTS

Seventy articles were included, predominantly from high-income countries. Findings indicated that while urban transport is well recognised as a determinant of health, health considerations are often underprioritized in urban transport planning. Key issues identified included systemic power imbalances favouring car-orientated planning, insufficient legislative frameworks to promote health, the non-holistic assessment of health impacts in established environmental assessment processes, transport appraisal methodologies which undervalued health and differences between the health and planning professions in their preferred sources of evidence with associated challenges in knowledge translation. A consistent theme in the literature was that a strategic approach needed to be taken to improve how health is considered in urban transport planning and central to this was building relationships to enable collaborative and partnership working.

CONCLUSION

Health was poorly considered in urban transport planning. Contributing issues related to power, legislation, impact assessment and knowledge translation. A strategic approach is important to address these issues.

Environmental and health effects of the Barcelona superblocks

BACKGROUND

The superblocks model of Barcelona (Spain) seeks to reorganize the city based on reversing the distribution of public space between vehicles and people by prioritizing citizens, thus improving their environmental conditions and quality of life. The objective of this paper was to describe the effects on environmental, health and quality of life of the first three superblocks implemented, discuss the lessons learned, and provide recommendations for the future.

METHODS

The evaluation included different approaches depending on the superblock analyzed: A pre-post-intervention health survey, environmental measures of air quality, the Microscale Audit of Urban Landscapes for Pedestrians (MAPS), an observational study on target areas of physical activity (SOPARC), ethnographic guerrilla studies, and focus groups.

RESULTS

Residents and workers in all three of the evaluated superblocks reported a perceived improvement in well-being, tranquillity and quality of sleep, some reduction in noise and pollution and an increase in social interaction. The built environment of the superblocks clearly influenced walkability, and the lower car traffic volume improved air quality measures. In one of the superblocks, the same intervention calmed traffic in one of the areas but not in another.

CONCLUSIONS

Although on a small scale, this evaluation of the environmental, and health effects of the superblocks provides support for expanding the model to other areas of the city.

Environmental sustainability of urban expansion: Implications for transport emissions, air pollution, and city growth

This study examines the environmental impacts of urban growth in Warsaw since 2006 and models the implications of future urban development for traffic pollutant emissions and pollution levels. Our findings demonstrate that, over the past two decades, urban sprawl has resulted in decreases in accessibility to public transport, social services, and natural areas. We analyse CO2 traffic emissions, NO2 concentrations, and population exposure across urban areas in future scenarios of further sprawling or alternative compacting land-use development. Results indicate that a compact future scenario reduces transport CO2 emissions and urban NO2 levels, though increases in population density raise exposure to air pollution. A sprawl future scenario increases CO2 and NOx emissions due to longer commutes and congestion, and NO2 levels increase up to 25% in parts of the city. Several traffic abatement strategies were simulated, and in all simulations a compact city consistently yields the largest reductions in CO2 emissions and NO2 levels, implying that the best abatement strategy for combating negative consequences of sprawl is to reduce sprawling. In both city layouts, network-wide improvements of public transport travel times gave significantly reduced emissions. Combined, our findings highlight the importance of co-beneficial urban planning strategies to balance CO2 emissions reduction, and air pollution exposure in expanding cities.

Unpacking mobility cultures: a review of conceptual definitions and empirical approaches

While "Mobility Culture" is an emerging concept in transport science and policy, it is often defined and applied in different ways. We conducted a systematic literature review focusing on the definitions of the concept and how it has been approached empirically. We found that definitions of Mobility Culture are heterogeneous, often indirect and implicit, or missing entirely. We assigned papers to five definition groups based on similarity: (1) Objective and subjective characteristics, (2) subjective-only characteristics, (3) social groups and communities, (4) normative-sustainable notions of future transportation, and (5) papers lacking definitions. Among empirical papers, we identified three broader approaches: Comparative (e.g. city typologies or pre-and-post relocation studies), single-culture (e.g. place-specific mode choice, local discourses) and intervention studies. We discuss the suitability of these approaches for different research goals and how they relate to the definition groups. Overall, we observe a lack of conceptual clarity in the Mobility Culture discourse, which is also reflected in the frequent mismatch of definitions and empirical operationalisations. We recommend that future Mobility Culture definitions consistently acknowledge the phenomenon's (i) complexity and multidimensionality, (ii) the relational character among its dimensions and attributes, and (iii) its sensibility for social and geographical differences.

Health impact assessment of urban and transport developments in Barcelona: A case study

BACKGROUND

Urban spaces need to be rethought to address growing health and environmental challenges. Urban density and transport systems contribute significantly to air pollution, negatively impacting public health. Barcelona has begun a transformation by introducing the Superblock model, an urban development with proven health benefits. However, there is a lack of understanding of the health impacts of various planned urban and transport interventions. This study aims to explore planned urban and transport developments in Barcelona (e.g. Superblocks, Low emission zone, tactical urban planning, port electrification) and estimates the health impacts of their related exposures.

METHODS

We utilized modelled NO2 reduction scenarios, which considered changes from implementing Barcelona's Urban Mobility Plan (UMP) of 2018-2024 and the Port electrification project. The UMP includes different interventions such as the low emission zones, tactical urban planning (reducing car traffic lanes), existing superblocks, and street greening. We established a baseline scenario for the year 2019, with no implementation of UMP or Port electrification. We devised three scenarios implementing the UMP: a) no change in private car use b) a 25% reduction in private car use, and c) a 25% reduction in private car use with port electrification. We estimated the effect on NO2 levels and conducted a health impact assessment following a comparative risk assessment methodology to demonstrate the impacts of these scenarios on natural cause of adult mortality.

RESULTS

The scenario with no change in private car use resulted in a 5.9 % reduction in NO2, preventing 67 (34-133 95% CI) premature deaths annually. The scenario with a 25% reduction in private car use led to a 17.6% reduction in NO2, preventing 199 (101-392 95% CI) premature deaths annually. Adding port electrification to the 25% reduction in private car use scenario resulted in a 19.4% reduction in NO2, preventing 228 (115-447 95% CI) premature deaths annually.

CONCLUSION

Our findings suggest that implementing measures to reduce car use and electrifying the port in Barcelona can significantly reduce air pollution and prevent premature deaths in adults. This emphasizes the relevance of ambitious urban and transport policies in improving public health. Policymakers should consider assertive actions and broader implementation of such measures for greater health benefits. Further research is needed to explore additional measures and their potential impacts, facilitating the development of comprehensive urban and transport strategies.

Parking and Public Health

PURPOSE OF REVIEW

Parking is a ubiquitous feature of the built environment, but its implications for public health are under-examined. This narrative review synthesizes literature to describe pathways through which parking may affect population health.

RECENT FINDINGS

We begin by contextualizing the issue, outlining key terminology, the sheer scale of land dedicated to parking, and the historical factors that led to this dominant land use. Next, we delineate four pathways linking parking with public health: 1) Promoting driving and car dependency, affecting air pollution, greenhouse-gas emissions, physical activity, traffic-related injuries and fatalities, and accessibility; 2) Creating impervious surfaces, with consequences for urban heat, flooding, water pollution, and green space; 3) Affecting housing affordability and associated health outcomes of this social determinant; and 4) Design, construction, and maintenance, the health impacts of which include on-street parking's positive and negative impacts on safety for all roadway users, air-quality effects of parking's construction and maintenance, and the potential for green parking lots to mitigate some health consequences of impervious surfaces. While evidence supports each pathway, additional empirical research is needed to evaluate impacts of parking on public-health outcomes. As a dominant feature of the built environment with many health implications, parking warrants attention by public-health research and practice.

Lifestyle interventions for cardiometabolic health

Unhealthy lifestyle behaviors such as poor diets and physical inactivity account for most of the cardiometabolic disease (CMD) burden, including type 2 diabetes and cardiovascular diseases. Much of this burden is mediated by the effects of unhealthy lifestyle behaviors on overweight and obesity, and disproportionally impacts certain population groups-including those from disadvantaged socioeconomic backgrounds. Combined lifestyle interventions (CLIs), which target multiple behaviors, have the potential to prevent CMD, but their implementation, reach and effectiveness in routine practice are often limited. Considering the increasing availability of effective but expensive pharmaceutical options for weight loss, we review the short-term and long-term benefits and cost-effectiveness of CLIs on overweight, obesity and associated CMDs, in controlled studies and in routine care. Against the backdrop of changing living environments, we discuss the effective components of CLIs and the many challenges associated with implementing them. Finally, we outline future directions for research and implications for policy and practice to improve lifestyle behaviors and cardiometabolic health at the population level.

The environmental health citizen interview tool: towards an inclusive qualitative environmental wellbeing approach in support of planetary health

Background

Nature-based Solutions (NbS) are vital for addressing climate change and biodiversity loss, yet their benefits are often unequally distributed. This study introduces the Environmental Health Citizen Interview Tool, aiming to inclusively capture diverse perspectives on environmental wellbeing using qualitative research methods. The principles of epistemic justice and planetary health are central to its development.

Methods

The Environmental Health Citizen Interview Tool was developed as a qualitative tool, incorporating a simple visualization scoring system for responses. Six environmental health determinants were selected, with in-depth open-ended follow-up questions. Content validation involved transdisciplinary expert consultation. A guidebook for using the tool was also developed.

Findings

The tool offers a comprehensive approach to inquire environmental wellbeing, accommodating diverse perspectives through in-depth inquiries. Limitations include the need for further validation and testing.

Interpretation

The Environmental Health Citizen Interview Tool provides a practical framework for inclusive assessment of environmental wellbeing, aligned with planetary health and epistemic justice principles. Its application should be complemented by quantitative environmental monitoring such as air quality and be contextualized by local researchers for reliability and relevance. Future research should focus on refining the tool and exploring its utility in diverse settings to inform equitable local policy interventions.

Synergistic control of urban heat island and urban pollution island effects using green infrastructure

Urban heat island (UHI) and urban pollution island (UPI) effects are two major challenges that affect the liveability and sustainability of cities under the circumstance of climate change. However, existing studies mostly addressed them separately. Urban green infrastructure offers nature-based solutions to alleviate urban heat, enhance air quality and promote sustainability. This review paper provides a comprehensive synthesis of the roles of urban green spaces, street trees, street hedges, green roofs and vertical greenery in mitigating UHI and UPI effects. These types of green infrastructure can promote the thermal environment and air quality, but also potentially lead to conflicting impacts. Medium-sized urban green spaces are recommended for heat mitigation because they can provide a balance between cooling efficiency and magnitude. Conversely, street trees pose a complex challenge since they can provide cooling through shading and evapotranspiration while hindering pollutant dispersion due to reduced air ventilation. Integrated research that considers simultaneous UHI and UPI mitigation using green infrastructure, their interaction with building features, and the urban geographical environment is crucial to inform urban planning and maximize the benefits of green infrastructure installations.

A cross-cultural investigation of active transportation and community participation: Results from the WHO survey of Global Ageing and Adult Health

Little is known about how the associations between active transportation and community participation may vary across national contexts. Using representative datasets from China, Ghana, India, Mexico, Russia, and South Africa collected in the Study on Global Ageing and Adult Health (N = 33,535), we estimated multi-group confirmatory factor analyses, tests of measurement invariance, and predictive models. Standardized coefficients were equivalent across countries and showed a modest positive association between active transportation and community participation (the variance explained by active transportation ranged from 1.3% to 7.5% across countries). These results suggest that supporting active transportation can help mitigate negative environmental and health changes associated with increased vehicular travel and support social capital via community participation.

Comprehensive evaluation of global health cities development levels

Introduction

How to scientifically assess the health status of cities and effectively assist in formulating policies and planning for health city development remains a profound challenge in building a global "health community."

Methods

This study employs the Building Research Establishment's International Healthy Cities Index (BRE HCI), encompassing ten environmental categories and fifty-eight indicators, to guide and support the scientific development of healthy cities. The entropy weight-TOPSIS method and the rank sum ratio (RSR) method were applied to comprehensively rank and categorize the health development levels of fifteen global cities. Furthermore, through cluster analysis, this research identifies universal and unique indicators that influence the development of healthy cities.

Results

The results indicate that: (1) Within the scope of 58 evaluation indicators, the precedence in weight allocation is accorded to the kilometres of bicycle paths and lanes per 100,000 population (0.068), succeeded by m2 of public indoor recreation space per capita (0.047), and kilometres of bicycle paths and lanes per 100,000 population (0.042). (2) Among the ten environmental categories, the top three in terms of weight ranking are transport (0.239), leisure and recreation (0.172), and resilience (0.125). Significant disparities exist between different cities and environmental categories, with the issue of uneven health development within cities being particularly prominent. (3) The study categorizes the development levels of healthy cities into three tiers based on composite scores: it classifies Singapore, Shanghai, and Amsterdam at an excellent level; places Dubai and Johannesburg at a comparatively poor level; and situates the remaining ten cities at a moderate level. (4) The analysis identifies 53 international common indicators and 5 characteristic indicators from the 58 indicators based on the significance of the clustering analysis (p < 0.05).

Discussion

The study proposes four strategic recommendations based on these findings: establishing a comprehensive policy assurance system, refining urban spatial planning, expanding avenues for multi-party participation, and augmenting distinctive health indicators. These measures aim to narrow the developmental disparities between cities and contribute to healthy global cities' balanced and sustainable growth. However, due to existing limitations in sample selection, research methodology application, and the control of potential confounding variables, further in-depth studies are required in the future.

Health-Oriented Emission Control Strategy of Energy Utilization and Its Co-CO2 Benefits: A Case Study of the Yangtze River Delta, China

Reducing air pollutants and CO2 emissions from energy utilization is crucial for achieving the dual objectives of clean air and carbon neutrality in China. Thus, an optimized health-oriented strategy is urgently needed. Herein, by coupling a CO2 and air pollutants emission inventory with response surface models for PM2.5-associated mortality, we shed light on the effectiveness of protecting human health and co-CO2 benefit from reducing fuel-related emissions and generate a health-oriented strategy for the Yangtze River Delta (YRD). Results reveal that oil consumption is the primary contributor to fuel-related PM2.5 pollution and premature deaths in the YRD. Significantly, curtailing fuel consumption in transportation is the most effective measure to alleviate the fuel-related PM2.5 health impact, which also has the greatest cobenefits for CO2 emission reduction on a regional scale. Reducing fuel consumption will achieve substantial health improvements especially in eastern YRD, with nonroad vehicle emission reductions being particularly impactful for health protection, while on-road vehicles present the greatest potential for CO2 reductions. Scenario analysis confirms the importance of mitigating oil consumption in the transportation sector in addressing PM2.5 pollution and climate change.

Healthy city evaluation based on factor analysis-Taking cities in the Guangxi Zhuang Autonomous Region as an example

As urbanization speeds up, the concept of healthy cities is receiving more focus. This article compares Chongzuo and Nanning in Guangxi with Beijing to assess the development gaps in cities in Guangxi. An indicator system for healthy cities was designed from six dimensions-healthy economy, healthy population, healthy healthcare, healthy environment, healthy facilities, and healthy transportation-and 26 secondary indicators, which were selected from 2005 to 2022, and an improved factor analysis was used to synthesize a healthy city index (HCI). The number of factors was determined by combining characteristic roots and the variance contribution rate, and the HCI was weighted using the entropy-weighted Topsis method. A comprehensive evaluation of the urban health status of these cities was conducted. The results showed that extracting six common factors had the greatest effect, with a cumulative variance contribution rate of 93.83%. Chongzuo city scored higher in the field of healthcare. The healthy environment score of Nanning was relatively high, which may be related to continuous increases in green measures. In terms of the healthy economy dimension, Beijing was far ahead. However, in recent years, the healthy economy level in Chongzuo has increased, and the GDP growth rate has ranked among the highest in Guangxi. In addition, the growth rate of healthy facilities in Nanning was relatively fast and has been greater than that in Chongzuo in recent years, which indicates that the Nanning Municipal Government believes urban construction and municipal supporting facilities are highly important. In terms of healthy transportation, Chongzuo and Nanning scored higher than Beijing. This may be because the transportation in these two cities is convenient and the traffic density is more balanced than that in Beijing, thereby reducing traffic congestion. Chongzuo had the highest score for a healthy population, and a steadily growing population provides the city with stable human resources, which helps promote urban economic and social development. Finally, relevant policy recommendations were put forwards to enhance the health level of the cities.

The impact of urban configuration types on urban heat islands, air pollution, CO2 emissions, and mortality in Europe: a data science approach

BACKGROUND

The world is becoming increasingly urbanised. As cities around the world continue to grow, it is important for urban planners and policy makers to understand how different urban configuration patterns affect the environment and human health. However, previous studies have provided mixed findings. We aimed to identify European urban configuration types, on the basis of the local climate zones categories and street design variables from Open Street Map, and evaluate their association with motorised traffic flows, surface urban heat island (SUHI) intensities, tropospheric NO2, CO2 per person emissions, and age-standardised mortality.

METHODS

We considered 946 European cities from 31 countries for the analysis defined in the 2018 Urban Audit database, of which 919 European cities were analysed. Data were collected at a 250 m × 250 m grid cell resolution. We divided all cities into five concentric rings based on the Burgess concentric urban planning model and calculated the mean values of all variables for each ring. First, to identify distinct urban configuration types, we applied the Uniform Manifold Approximation and Projection for Dimension Reduction method, followed by the k-means clustering algorithm. Next, statistical differences in exposures (including SUHI) and mortality between the resulting urban configuration types were evaluated using a Kruskal-Wallis test followed by a post-hoc Dunn's test.

FINDINGS

We identified four distinct urban configuration types characterising European cities: compact high density (n=246), open low-rise medium density (n=245), open low-rise low density (n=261), and green low density (n=167). Compact high density cities were a small size, had high population densities, and a low availability of natural areas. In contrast, green low density cities were a large size, had low population densities, and a high availability of natural areas and cycleways. The open low-rise medium and low density cities were a small to medium size with medium to low population densities and low to moderate availability of green areas. Motorised traffic flows and NO2 exposure were significantly higher in compact high density and open low-rise medium density cities when compared with green low density and open low-rise low density cities. Additionally, green low density cities had a significantly lower SUHI effect compared with all other urban configuration types. Per person CO2 emissions were significantly lower in compact high density cities compared with green low density cities. Lastly, green low density cities had significantly lower mortality rates when compared with all other urban configuration types.

INTERPRETATION

Our findings indicate that, although the compact city model is more sustainable, European compact cities still face challenges related to poor environmental quality and health. Our results have notable implications for urban and transport planning policies in Europe and contribute to the ongoing discussion on which city models can bring the greatest benefits for the environment, climate, and health.

FUNDING

Spanish Ministry of Science and Innovation, State Research Agency, Generalitat de Catalunya, Centro de Investigación Biomédica en red Epidemiología y Salud Pública, and Urban Burden of Disease Estimation for Policy Making as a Horizon Europe project.

Greenness, air pollution, and temperature exposure effects in predicting premature mortality and morbidity: A small-area study using spatial random forest model

BACKGROUND

Although studies have provided negative impacts of air pollution, heat or cold exposure on mortality and morbidity, and positive effects of increased greenness on reducing them, a few studies have focused on exploring combined and synergetic effects of these exposures in predicting these health outcomes, and most had ignored the spatial autocorrelation in analyzing their health effects. This study aims to investigate the health effects of air pollution, greenness, and temperature exposure on premature mortality and morbidity within a spatial machine-learning modeling framework.

METHODS

Years of potential life lost reflecting premature mortality and comparative illness and disability ratio reflecting chronic morbidity from 1673 small areas covering Greater Manchester for the year 2008-2013 obtained. Average annual levels of NO2 concentration, normalized difference vegetation index (NDVI) representing greenness, and annual average air temperature were utilized to assess exposure in each area. These exposures were linked to health outcomes using non-spatial and spatial random forest (RF) models while accounting for spatial autocorrelation.

RESULTS

Spatial-RF models provided the best predictive accuracy when accounted for spatial autocorrelation. Among the exposures considered, air pollution emerged as the most influential in predicting mortality and morbidity, followed by NDVI and temperature exposure. Nonlinear exposure-response relations were observed, and interactions between exposures illustrated specific ranges or sweet and sour spots of exposure thresholds where combined effects either exacerbate or moderate health conditions.

CONCLUSION

Air pollution exposure had a greater negative impact on health compared to greenness and temperature exposure. Combined exposure effects may indicate the highest influence of premature mortality and morbidity burden.

Unraveling near real-time spatial dynamics of population using geographical ensemble learning

Dynamic gridded population data are crucial in fields such as disaster reduction, public health, urban planning, and global change studies. Despite the use of multi-source geospatial data and advanced machine learning models, current frameworks for population spatialization often struggle with spatial non-stationarity, temporal generalizability, and fine temporal resolution. To address these issues, we introduce a framework for dynamic gridded population mapping using open-source geospatial data and machine learning. The framework consists of (i) delineation of human footprint zones, (ii) construction of muliti-scale population prediction models using automated machine learning (AutoML) framework and geographical ensemble learning strategy, and (iii) hierarchical population spatial disaggregation with pycnophylactic constraint-based corrections. Employing this framework, we generated hourly time-series gridded population maps for China in 2016 with a 1-km spatial resolution. The average accuracy evaluated by root mean square deviation (RMSD) is 325, surpassing datasets like LandScan, WorldPop, GPW, and GHSL. The generated seamless maps reveal the temporal dynamic of population distribution at fine spatial scales from hourly to monthly. This framework demonstrates the potential of integrating spatial statistics, machine learning, and geospatial big data in enhancing our understanding of spatio-temporal heterogeneity in population distribution, which is essential for urban planning, environmental management, and public health.

Comprehensive analysis of air pollution and the influence of meteorological factors: a case study of adiyaman province

Adıyaman, a city recently affected by an earthquake, is facing significant air pollution challenges due to both anthropogenic activities and natural events. The sources of air pollution have been investigated using meteorological variables. Elevated southerly winds, especially prominent in spring and autumn, significantly contribute to dust transport, leading to a decline in local air quality as detected by the HYSPLIT model. Furthermore, using Suomi-NPP Thermal Anomaly satellite product, it is detected and analyzed for crop burning activities. Agricultural practices, including stubble burning, contribute to the exacerbation of PM10 pollution during the summer months, particularly when coupled with winds from all directions except the north. In fall and winter months, heating is identified as the primary cause of pollution. The city center located north of the station is the dominant source of pollution throughout all seasons. The study established the connection between air pollutants and meteorological variables. Furthermore, the Spearman correlation coefficients reveal associations between PM10 and SO2, indicating moderate positive correlations under pressure conditions (r = 0.35, 0.52). Conversely, a negative correlation is observed with windspeed (r = -0.35, -0.50), and temperature also exhibits a negative correlation (r = -0.39, -0.54). During atmospheric conditions with high pressure, PM10 and SO2 concentrations are respectively 41.2% and 117.2% higher. Furthermore, pollutant concentration levels are 29.2% and 53.3% higher on days with low winds. Last, practical strategies for mitigating air pollution have been thoroughly discussed and proposed. It is imperative that decision-makers engaged in city planning and renovation give careful consideration to the profound impact of air pollution on both public health and the environment, particularly in the aftermath of a recent major earthquake.

Impact of green space and built environment on metabolic syndrome: A systematic review with meta-analysis

Metabolic Syndrome presents a significant public health challenge associated with an increased risk of noncommunicable diseases such as cardiovascular conditions. Evidence shows that green spaces and the built environment may influence metabolic syndrome. We conducted a systematic review and meta-analysis of observational studies published through August 30, 2023, examining the association of green space and built environment with metabolic syndrome. A quality assessment of the included studies was conducted using the Office of Health Assessment and Translation (OHAT) tool. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) assessment was used to evaluate the overall quality of evidence. Our search retrieved 18 studies that met the inclusion criteria and were included in our review. Most were from China (n = 5) and the USA (n = 5), and most used a cross-sectional study design (n = 8). Nine studies (50 %) reported only green space exposures, seven (39 %) reported only built environment exposures, and two (11 %) reported both built environment and green space exposures. Studies reported diverse definitions of green space and the built environment, such as availability, accessibility, and quality, particularly around participants' homes. The outcomes focused on metabolic syndrome; however, studies applied different definitions of metabolic syndrome. Meta-analysis results showed that an increase in normalized difference vegetation index (NDVI) within a 500-m buffer was associated with a lower risk of metabolic syndrome (odds ratio [OR] = 0.90, 95%CI = 0.87-0.93, I2 = 22.3 %, n = 4). A substantial number of studies detected bias for exposure classification and residual confounding. Overall, the extant literature shows a 'limited' strength of evidence for green space protecting against metabolic syndrome and an 'inadequate' strength of evidence for the built environment associated with metabolic syndrome. Studies with more robust study designs, better controlled confounding factors, and stronger exposure measures are needed to understand better what types of green spaces and built environment features influence metabolic syndrome.

Environmental noise is positively associated with socioeconomically less privileged neighborhoods in the Netherlands

BACKGROUND

Environmental noise has detrimental effects on various health outcomes. Although disparities in some environmental exposures (e.g., air pollution) are well-documented, there is still a limited and uncertain understanding of the extent to which specific populations are disproportionately burdened by noise.

AIM

To assess whether environmental noise levels are associated with demographic and socioeconomic neighborhood compositions.

METHODS

We cross-sectionally examined long-term noise levels for 9,372 neighborhoods in the Netherlands. We linked these noise levels with administrative data on neighborhood characteristics for the year 2021. Linear and non-linear spatial regression models were fitted to explore the associations between noise, demographic, and socioeconomic neighborhood characteristics.

RESULTS

Our results showed that 46 % of the neighborhoods exhibited noise levels surpassing the recommended threshold of 53 dB to prevent adverse health effects. The regressions uncovered positive and partially non-linear neighborhood-level associations between noise and non-Western migrants, employment rates, low-incomers, and address density. Conversely, we found negative associations with higher-educated neighborhoods and those with a greater proportion of younger residents. Neighborhoods with older populations displayed a U-shaped association.

CONCLUSIONS

This national study showed an inequality in the noise burden, adversely affecting vulnerable, marginalized, and less privileged neighborhoods. Addressing the uneven distribution of noise and its root causes is an urgent policy imperative for sustainable Dutch cities.

The Urban Environment and Cardiometabolic Health

Urban environments contribute substantially to the rising burden of cardiometabolic diseases worldwide. Cities are complex adaptive systems that continually exchange resources, shaping exposures relevant to human health such as air pollution, noise, and chemical exposures. In addition, urban infrastructure and provisioning systems influence multiple domains of health risk, including behaviors, psychological stress, pollution, and nutrition through various pathways (eg, physical inactivity, air pollution, noise, heat stress, food systems, the availability of green space, and contaminant exposures). Beyond cardiometabolic health, city design may also affect climate change through energy and material consumption that share many of the same drivers with cardiometabolic diseases. Integrated spatial planning focusing on developing sustainable compact cities could simultaneously create heart-healthy and environmentally healthy city designs. This article reviews current evidence on the associations between the urban exposome (totality of exposures a person experiences, including environmental, occupational, lifestyle, social, and psychological factors) and cardiometabolic diseases within a systems science framework, and examines urban planning principles (eg, connectivity, density, diversity of land use, destination accessibility, and distance to transit). We highlight critical knowledge gaps regarding built-environment feature thresholds for optimizing cardiometabolic health outcomes. Last, we discuss emerging models and metrics to align urban development with the dual goals of mitigating cardiometabolic diseases while reducing climate change through cross-sector collaboration, governance, and community engagement. This review demonstrates that cities represent crucial settings for implementing policies and interventions to simultaneously tackle the global epidemics of cardiovascular disease and climate change.

Green Space and Internalizing or Externalizing Symptoms Among Children

Importance

Evidence suggests that living near green space supports mental health, but studies examining the association of green space with early mental health symptoms among children are rare.

Objective

To evaluate the association between residential green space and early internalizing (eg, anxiety and depression) and externalizing (eg, aggression and rule-breaking) symptoms.

Design, Setting, and Participants

Data for this cohort study were drawn from the Environmental Influences on Child Health Outcomes cohort; analysis was conducted from July to October 2023. Children born between 2007 and 2013 with outcome data in early (aged 2-5 years) and/or middle (aged 6-11 years) childhood who resided in 41 states across the US, drawing from clinic, hospital, and community-based cohorts, were included. Cohort sites were eligible if they recruited general population participants and if at least 30 children had outcome and residential address data to measure green space exposure. Nine cohorts with 13 sites met these criteria. Children diagnosed with autism or developmental delay were excluded, and 1 child per family was included.

Exposures

Green space exposure was measured using a biannual (ie, summer and winter) Normalized Difference Vegetation Index, a satellite image-based indicator of vegetation density assigned to monthly residential history from birth to outcome assessment.

Main Outcome and Measures

Child internalizing and externalizing symptoms were assessed using the Child Behavior Checklist for Ages 1½ to 5 or 6 to 18. The association between green space and internalizing and externalizing symptoms was modeled with multivariable linear regression using generalized estimating equations, adjusting for birthing parent educational level, age at delivery, child sex, prematurity, and neighborhood socioeconomic vulnerability. Models were estimated separately for early and middle childhood samples.

Results

Among 2103 children included, 1061 (50.5%) were male; 606 (29.1%) identified as Black, 1094 (52.5%) as White, 248 (11.9%) as multiple races, and 137 (6.6%) as other races. Outcomes were assessed at mean (SD) ages of 4.2 (0.6) years in 1469 children aged 2 to 5 years and 7.8 (1.6) years in 1173 children aged 6 to 11 years. Greater green space exposure was associated with fewer early childhood internalizing symptoms in fully adjusted models (b = -1.29; 95% CI, -1.62 to -0.97). No associations were observed between residential green space and internalizing or externalizing symptoms in middle childhood.

Conclusions and Relevance

In this study of residential green space and children's mental health, the association of green space with fewer internalizing symptoms was observed only in early childhood, suggesting a sensitive period for nature exposure. Policies protecting and promoting access to green space may help alleviate early mental health risk.

Cities, planetary boundaries, and degrowth

Cities are the main hubs of human activity and the engines of economic growth. In pursuit of such growth, cities are transgressing their local environmental boundaries. Ongoing urbanisation increasingly contributes to the human pressure on planetary boundaries and negatively affects planetary health. In a telecoupled world, cities externalise impacts by shifting production and many other functions away from their boundaries. At the same time, urban inhabitants and people who follow urban lifestyles but live outside cities are increasingly disconnected from nature. This Viewpoint highlights the role of degrowth in keeping an urban planet within planetary boundaries and suggests areas for further research and policy. Degrowth calls for meaningfully connecting planetary boundaries with cities and ensuring everyone receives a fair share of their ecological capacity. Degrowth calls for lower use of existing resources, highlights political power asymmetries, and moves beyond pricing interventions. Degrowth addresses three key aspects that connect cities and urban lifestyles to planetary boundaries: reducing production and consumption, connecting people and nature, and including nature (to a more substantial extent) in the design of cities and in what is used and consumed in cities. A radical degrowth transformation of cities is necessary to stay within a safe operating space for humanity.

Urban environment and health: a cross-sectional multiregional project based on population health surveys in Spain (DAS-EP project) - study protocol

INTRODUCTION

The European Environment Agency estimates that 75% of the European population lives in cities. Despite the many advantages of city life, the risks and challenges to health arising from urbanisation need to be addressed in order to tackle the growing burden of disease and health inequalities in cities. This study, Urban environment and health: a cross-sectional multiregional project based on population health surveys in Spain (DAS-EP project), aims to investigate the complex association between the urban environmental exposures (UrbEEs) and health.

METHODS AND ANALYSIS

DAS-EP is a Spanish multiregional cross-sectional project that combines population health surveys (PHS) and geographical information systems (GIS) allowing to collect rich individual-level data from 17 000 adult citizens participating in the PHS conducted in the autonomous regions of the Basque Country, Andalusia, and the Valencian Community, and the city of Barcelona in the years 2021-2023. This study focuses on the population living in cities or metropolitan areas with more than 100 000 inhabitants. UrbEEs are described by objective estimates at participants' home addresses by GIS, and subjective indicators present in PHS. The health outcomes included in the PHS and selected for this study are self-perceived health (general and mental), prevalence of chronic mental disorders, health-related quality of life, consumption of medication for common mental disorders and sleep quality. We aim to further understand the direct and indirect effects between UrbEEs and health, as well as to estimate the impact at the population level, taking respondents' sociodemographic and socioeconomic characteristics, and lifestyle into consideration.

ETHICS AND DISSEMINATION

The study was approved by the regional Research Ethics Committee of the Basque Country (Ethics Committee for Research Involving Medicinal Products in the Basque Country; PI2022138), Andalusia (Biomedical Research Ethics Committee of the Province of Granada; 2078-N-22), Barcelona (CEIC-PSMar; 2022/10667) and the Valencian Community (Ethics Committee for Clinical Research of the Directorate General of Public Health and Center for Advanced Research in Public Health; 20221125/04). The results will be communicated to the general population, health professionals, and institutions through conferences, reports and scientific articles.

Exploring associations of greenery, air pollution and walkability with cardiometabolic health in people at midlife and beyond

AIM

To examine associations of neighborhood greenery, air pollution and walkability with cardiometabolic disease in adults aged ≥45 years in the Frankston-Mornington Peninsula region, Victoria, Australia.

METHODS

A cross-sectional, ecological study design was used. We assessed mean annual neighborhood greenery using the Normalized Difference Vegetation Index; air pollution (fine particulate matter of diameter ≤2.5 μm [PM2.5] and NO2) using land-use regression models; and walkability using Walk Score (possible values 0-100). Medically diagnosed diabetes (~95% type-2), heart disease and stroke were self-reported in the Australian Census (2021). Multivariable regression was used to model associations between environmental exposures and area-level (neighborhood) cardiometabolic disease prevalence (age group ≥45 years), with socioeconomic status, age and sex as covariates. Air pollution was examined as a mediator of associations between greenery and disease prevalence.

RESULTS

Our sample comprised 699 neighborhoods with the following mean (SD) values: Normalized Difference Vegetation Index 0.47 (0.09), PM2.5, 8.5 (0.6) μg/m3 and NO2, 5.2 (1.6) ppb. Disease prevalences were: heart disease, mean 8.9% (4.5%); diabetes, mean 10.3% (4.7%); and stroke, median 1.2% (range 0-10.9%). Greenery was negatively associated with diabetes (β = -5.85, 95% CI -9.53, -2.17) and stroke prevalence (β = -1.26, 95% CI -2.11, -0.42). PM2.5 and NO2 were positively associated with diabetes (β = 1.59, 95% CI 1.00, 2.18; β = 0.42, 95% CI 0.22, 0.62) and stroke prevalence (β = 0.15, 95% CI 0.01, 0.29; β = 0.06, 95% CI 0.01, 0.10). The association between greenery and diabetes was partially mediated by PM2.5 (mediated effect -5.38, 95% CI -7.84, -3.03).

CONCLUSIONS

Greenery and air pollutants were associated with lower and higher prevalence, respectively, of self-reported diabetes and, to a lesser extent, stroke. These ecological findings require further exploration with stronger, longitudinal study designs to inform public health policy and directions. Geriatr Gerontol Int 2024; 24: 208-214.

The ABC of mobility

The use of cars in cities has many negative impacts, including pollution, noise and the use of space. Yet, detecting factors that reduce the use of cars is a serious challenge, particularly across different regions. Here, we model the use of various modes of transport in a city by aggregating Active mobility (A), Public Transport (B) and Cars (C), expressing the modal share of a city by its ABC triplet. Data for nearly 800 cities across 61 countries is used to model car use and its relationship with city size and income. Our findings suggest that with longer distances and the congestion experienced in large cities, Active mobility and journeys by Car are less frequent, but Public Transport is more prominent. Further, income is strongly related to the use of cars. Results show that a city with twice the income has 37% more journeys by Car. Yet, there are significant differences across regions. For cities in Asia, Public Transport contributes to a substantial share of their journeys. For cities in the US, Canada, Australia, and New Zealand, most of their mobility depends on Cars, regardless of city size. In Europe, there are vast heterogeneities in their modal share, from cities with mostly Active mobility (like Utrecht) to cities where Public Transport is crucial (like Paris or London) and cities where more than two out of three of their journeys are by Car (like Rome and Manchester).

Research and innovation paving the way for climate neutrality in urban transport: Analysis of 362 cities on their journey to zero emissions

The EU Mission on Climate Neutral and Smart Cities is an ambitious initiative aiming to involve a wide range of stakeholders and deliver 100 climate-neutral and smart cities by 2030. We analysed the information submitted in the expressions of interest by 362 candidate cities. The majority of the cities' strategies for climate neutrality include urban transport as a main sector and combine the introduction of new technologies with the promotion of public transport and active mobility. We combined the information from the EU Mission candidate cities with data from the CORDIS and TRIMIS databases, and applied a clustering algorithm to measure proximity to foci of H2020 funding. Our results suggest that preparedness for the EU Mission is correlated with research and innovation activities on transport and mobility. Horizon 2020 activities specific to transport and mobility significantly increased the likelihood of a city to be a candidate. Among the various transport technology research pathways, smart mobility appears to have a major role in the development of solutions for climate neutrality.

Shaping urban environments to improve respiratory health: recommendations for research, planning, and policy

Urban areas carry a large burden of acute (infectious) and chronic respiratory diseases due to environmental conditions such as high levels of air pollution and high population densities. Car-dominated cities often lack walkable areas, which reduces opportunities for physical activity that are fundamentally important for healthy lungs. The already restricted amount of green space available-with often poorly selected plants-could produce pollen and subsequently provoke or worsen allergic diseases. Less affluent neighbourhoods often carry a larger respiratory disease burden. A multisectoral approach with more diverse policy measures and urban innovations is needed to reduce air pollution (eg, low emission zones), to increase public space for walking and cycling (eg, low traffic neighbourhoods, superblocks, 15-minute cities, and car-free cities), and to develop green cities (eg, planting of low-allergy trees). Stricter EU air quality guidelines can push these transformations to improve the respiratory health of citizens. Advocacy by medical respiratory societies can also make an important contribution to such changes.

Associations of the neighbourhood built and natural environment with cardiometabolic health indicators: A cross-sectional analysis of environmental moderators and behavioural mediators

BACKGROUND

Most studies examining the effects of neighbourhood urban design on cardiometabolic health focused solely on the built or natural environment. Also, they did not consider the roles of neighbourhood socio-economic status (SES) and ambient air pollution in the observed associations, and the extent to which these associations were mediated by physical activity and sedentary behaviours.

METHODS

We used data from the AusDiab3 study (N = 4141), a national cohort study of Australian adults to address the above-mentioned knowledge gaps. Spatial data were used to compute indices of neighbourhood walkability (population density, intersection density, non-commercial land use mix, commercial land use), natural environment (parkland and blue spaces) and air pollution (annual average concentrations of nitrogen dioxide (NO2) and fine particulate matter <2.5 μm in diameter (PM2.5)). Census indices were used to define neighbourhood SES. Clinical assessments collected data on adiposity, blood pressure, blood glucose and blood lipids. Generalised additive mixed models were used to estimate associations.

RESULTS

Neighbourhood walkability showed indirect beneficial associations with most indicators of cardiometabolic health via resistance training, walking and sitting for different purposes; indirect detrimental associations with the same indicators via vigorous gardening; and direct detrimental associations with blood pressure. The neighbourhood natural environment had beneficial indirect associations with most cardiometabolic health indicators via resistance training and leisure-time sitting, and beneficial direct associations with adiposity and blood lipids. Neighbourhood SES and air pollution moderated only a few associations of the neighbourhood environment with physical activity, blood lipids and blood pressure.

CONCLUSIONS

Within a low-density and low-pollution context, denser, walkable neighbourhoods with good access to nature may benefit residents' cardiometabolic health by facilitating the adoption of an active lifestyle. Possible disadvantages of living in denser neighbourhoods for older populations are having limited opportunities for gardening, higher levels of noise and less healthy dietary patterns associated with eating out.

A decade beyond the economic recession: A study of health-related lifestyles in urban and rural Spain (2006-2017)

The 2008 economic recession may have affected health-related indicators differently depending on the living environment. We analyze health-related indicators in Spain using data from four Spanish health surveys (2006, 2011, 2014, and 2017, 95 924 individuals aged ≥16 years). In 2006-2011, physical activity decreased among men and women, while in 2006-2017, physical activity only decreased among urban women. Daily vegetable intake, except in rural women, increased in 2006-2011 but decreased in 2006-2017 in all groups. Smoking decreased among urban women in 2006-2011 and 2006-2014 but only decreased among men, and even increased among rural women, in 2006-2017. In 2006-2017, obesity increased among men and urban women, good self-rated health status increased in all groups and flu vaccination declined. Blood pressure and cholesterol control decreased in urban women in 2006-2011 but increased in 2006-2017 in all groups, as well as mammographic and cytological control. Our findings highlight the differential impact of the economic recession on health-related lifestyles according to sex and place of residence, underscoring the need for targeted health policies to address evolving health disparities over time.

Drastic mobility restrictions during SARS-CoV-2 pandemic: an opportunity to learn about constraints on the way to a pollution-free city

Road traffic is one of the main sources of pollution in modern cities. If there is a desire to move towards healthier cities, it may be necessary to modify the current model of mobility. The SARS-CoV-2 pandemic, together with the measures applied by most governments in the world to control the mobility of citizens, offered a unique opportunity to assess the changes in pollution levels after a drastic reduction in road traffic. In this study, air and noise pollution levels and road traffic flow were analyzed in the city of Cáceres, Spain, before and during the state of emergency imposed by the Spanish government. The values obtained were compared with the quality limits established by both the Spanish government and the World Health Organization (WHO). A traffic noise prediction model has been employed to evaluate the acoustic impact resulting from the reduction in traffic flow. As a result of this study, it was found that air pollution was indeed reduced due to the mobility restrictions imposed to control the pandemic, but that the WHO's recommendations for the values of the day-evening-night noise indicator (Lden) and the night-time noise indicator (Ln) for road traffic noise, which should not be exceeded, were not met. These findings highlight the need to review current urban mobility models if the WHO's recommendations are to be reached with regard to reducing the effects of exposure of the population to urban noise.

Critical factors influencing visitor emotions: analysis of "restorativeness" in urban park visits in Fuzhou, China

Objective

To date, a comprehensive analysis of urban green space (UGS) visitors' emotional remains largely unexplored. In this study, we focus on how UGS environmental preferences, restorativeness, other physical factors (sound, air, and thermal environments), and individual characteristics affecting visitor emotions. Such a comprehensive analysis would allow relevant practitioners to check the environmental quality of UGSs and improve certain conditions to promote visitor emotions.

Methods

A total of 904 questionnaire responses with concurrently monitored physical factors were analyzed by independent sample t-tests, one-way ANOVA and path analysis.

Results

The thermal evaluation had the largest impact on positive emotions (β = 0.474), followed by perceived restorativeness (β = 0.297), which had β values of -0.120 and -0.158, respectively, on negative emotions. Air evaluation was more effective for increasing positive emotions (β = 0.293) than reducing negative emotions (β = -0.115). Sound evaluation also had similar results (β = 0.330 vs. β = -0.080). Environmental preference significantly influenced only positive emotions (β = 0.181) but could still indirectly impact negative emotions. Moreover, objective physical factors can indirectly affect visitors' emotions by enhancing their evaluations..

Conclusion

The influence of different UGS environmental factors on visitors' emotions vary, as does their impacts on positive versus negative emotions. Positive emotions were generally more affected than negative emotions by UGS. Visitor emotions were mainly influenced by physical and psychological factors. Corresponding suggestions are proposed for UGS design and management in this study.

The contribution of the exposome to the burden of cardiovascular disease

Large epidemiological and health impact assessment studies at the global scale, such as the Global Burden of Disease project, indicate that chronic non-communicable diseases, such as atherosclerosis and diabetes mellitus, caused almost two-thirds of the annual global deaths in 2020. By 2030, 77% of all deaths are expected to be caused by non-communicable diseases. Although this increase is mainly due to the ageing of the general population in Western societies, other reasons include the increasing effects of soil, water, air and noise pollution on health, together with the effects of other environmental risk factors such as climate change, unhealthy city designs (including lack of green spaces), unhealthy lifestyle habits and psychosocial stress. The exposome concept was established in 2005 as a new strategy to study the effect of the environment on health. The exposome describes the harmful biochemical and metabolic changes that occur in our body owing to the totality of different environmental exposures throughout the life course, which ultimately lead to adverse health effects and premature deaths. In this Review, we describe the exposome concept with a focus on environmental physical and chemical exposures and their effects on the burden of cardiovascular disease. We discuss selected exposome studies and highlight the relevance of the exposome concept for future health research as well as preventive medicine. We also discuss the challenges and limitations of exposome studies.

Changes in public bike usage after the COVID-19 outbreak: A survey of Seoul public bike sharing users

When the COVID-19 pandemic swept across the world, people tended to seek more individualized and viable transportation modes, such as a bicycle. In this study, we examined the factors influencing changes in public bike sharing (PBS) in Seoul, to assess this trend post-pandemic. We conducted an online survey of 1,590 Seoul PBS users between July 30 and August 7, 2020. Using a difference-in-differences analysis, we found that participants who were affected by the pandemic used PBS 44.6 h more than unaffected individuals throughout the year. In addition, we used a multinomial logistic regression analysis to identify the factors affecting changes in PBS usage. In this analysis, the discrete dependent variables of increased, unchanged, and decreased were considered, representing the changes in PBS usage after the COVID-19 outbreak. Results revealed that PBS usage increased among female participants during weekday trips such as commuting to work and when there were perceived health benefits of using PBS. Conversely, PBS usage tended to decrease when the weekday trip purpose was for leisure or working out. Our findings offer insight into PBS user behaviors within the context of the COVID-19 pandemic and present policy implications to revitalize PBS usage.

Nassani A, H. Binsaeed R, Zaman K. Green investing in China's air cargo industry: Opportunities and challenges for sustainable transportation

Aviation cargo remains vital in the economic activities to transported goods from one place to another. The developed and developing countries mainly consider the transaction routes for air transportation for safe and quickest mode. Chinese economy is attracting the global World through its exports. The country's air cargo system is mainly reliant on gasoline and petroleum-based fuels, which harms the country's green transportation agenda. The high use of fuel combustions in the aviation sector needed greenfield investment that helps to use green energy as an alternative sustainable fuel. Further, sustainable aviation insurance and financial coverage are needed to mitigate the adverse negative externalities from air cargo operations. Based on the crucial facts, the study used air cargo operations, transportation fuel combustions, private investment in the transportation and insurance coverage in the pollution damage function for the China economy using data from 1975 to 2020. The research employed a non-linear ARDL Bounds testing strategy to break down the sequence of variables into dynamic positive and negative multipliers. Positive shocks in air freight, insurance services, and greenfield investment have been shown to reduce carbon emissions immediately and over the long term. In the short term, carbon damages are exacerbated by the negative shocks resulting from the use of transportation fuel and the availability of insurance. Moreover, both the positive and negative shocks associated with transportation fuel combustions and air transportation freights contribute to a rise in carbon damage. The variance decomposition analysis validated the asymmetric correlations between the aforementioned variables in the intertemporal environment. Based on the findings, negative shocks from total fuel combustions are expected to impose the greatest carbon damages over the next decade, followed by insurance services and air freight operations. The study concludes that air cargo operations need to be sustainable transacting routes fueled by biofuel energy sources, greenfield investment, and sustainable aviation insurance coverage to achieve the 'green is clean' transportation agenda.

Nowhere to go - Effects on elderly's travel during Covid-19

The COVID-19 pandemic has presented numerous, significant challenges for elderly in their daily life. In order to reach a deeper understanding of the feelings and thoughts of the elderly related to their possibilities to travel and engage in activities during the pandemic, this study takes a qualitative approach to exploring the views of the elderly themselves. The study focuses on experiences during the COVID-19 pandemic. A number of in-depth semi-structured interviews with elderly aged 70 and above, were conducted in June 2020. Applied Thematic Analysis (ATA) was applied, as a first stage, to investigate meaningful segments of data. In a second stage these identified segments were combined into a number of themes. This study reports the outcome of the ATA analysis. More specifically we report experiences, motivations and barriers for travel and activity participation, and discuss how these relate to the health and well-being of elderly, and vice versa. These findings highlight the strong need to develop a transport system that to a higher extent addresses the physical as well as the mental health of old people, with a particular focus on facilitating social interactions.

Spatial and sector-specific contributions of emissions to ambient air pollution and mortality in European cities: a health impact assessment

BACKGROUND

Ambient air pollution is a major risk to health and wellbeing in European cities. We aimed to estimate spatial and sector-specific contributions of emissions to ambient air pollution and evaluate the effects of source-specific reductions in pollutants on mortality in European cities to support targeted source-specific actions to address air pollution and promote population health.

METHODS

We conducted a health impact assessment of data from 2015 for 857 European cities to estimate source contributions to annual PM_2·5 and NO₂ concentrations using the Screening for High Emission Reduction Potentials for Air quality tool. We evaluated contributions from transport, industry, energy, residential, agriculture, shipping, and aviation, other, natural, and external sources. For each city and sector, three spatial levels were considered: contributions from the same city, the rest of the country, and transboundary. Mortality effects were estimated for adult populations (ie, ≥20 years) following standard comparative risk assessment methods to calculate the annual mortality preventable on spatial and sector-specific reductions in PM_2·5 and NO₂.

FINDINGS

We observed strong variability in spatial and sectoral contributions among European cities. For PM_2·5, the main contributors to mortality were the residential (mean contribution of 22·7% [SD 10·2]) and agricultural (18·0% [7·7]) sectors, followed by industry (13·8% [6·0]), transport (13·5% [5·8]), energy (10·0% [6·4]), and shipping (5·5% [5·7]). For NO₂, the main contributor to mortality was transport (48·5% [SD 15·2]), with additional contributions from industry (15·0% [10·8]), energy (14·7% [12·9]), residential (10·3% [5·0]), and shipping (9·7% [12·7]). The mean city contribution to its own air pollution mortality was 13·5% (SD 9·9) for PM_2·5 and 34·4% (19·6) for NO₂, and contribution increased among cities of largest area (22·3% [12·2] for PM_2·5 and 52·2% [19·4] for NO₂) and among European capitals (29·9% [12·5] for PM_2·5 and 62·7% [14·7] for NO₂).

INTERPRETATION

We estimated source-specific air pollution health effects at the city level. Our results show strong variability, emphasising the need for local policies and coordinated actions that consider city-level specificities in source contributions.

FUNDING

Spanish Ministry of Science and Innovation, State Research Agency, Generalitat de Catalunya, Centro de Investigación Biomédica en red Epidemiología y Salud Pública, and Urban Burden of Disease Estimation for Policy Making 2023-2026 Horizon Europe project.

Potential for greenhouse gas (GHG) emissions savings from replacing short motorcycle trips with active travel modes in Vietnam

In reducing greenhouse gas (GHG) emissions, there is a recognition triggered by the pandemic of the role that walking and cycling (active travel) can make to substitute motorized travel, particularly on short trips. However, there is a lack of evidence at the micro level on the realistic, empirically derived, potential of these options. Here, we used reliable tracing data to examine the potential of these mitigation options for reducing GHG emissions in Vietnam. Apart from similar categories of travel purposes as in other studies, we decided to categorize "visit relatives" and "eating out" as two more separate categories of travel purposes in Vietnamese case, which together accounts for nearly 16% of total trips. We discovered that 65% of all motorcycle trips in this case study were less than 3 miles in duration, therefore active travel was able to create a significant impact on GHG emissions from personal travel. Active travel can replace 62% of short motorcycle trips if considering travel patterns and constraints while saving 18% of GHG emissions that would have come from motorized transport. If active travel can further replace all shopping trips normally done by motorcycles, in total being equivalent to 84% of short trips, 22% of GHG emissions from motorcycles can be reduced. It should be noticed that active travels have time cost implications, impacting economy at both household and city levels, but from a comprehensive "co-benefit" standpoint, this transformation could act as a catalyst for addressing traffic congestion, air pollution, and even community health and well-being in urban areas.

Health impact assessment of road traffic noise exposure based on different densification scenarios in Malmö, Sweden

While urbanization provides many opportunities to those arriving in thriving urban areas, a greater number of residents necessitates the expansion of housing and infrastructure. This is often achieved through densification, which can lead to increased noise, particularly through increased road traffic. A key challenge of promoting healthy urban planning is to understand potential health effects, especially on the local level. The aim of the present study is, therefore, to estimate and compare the health impacts of road traffic noise exposure for various urban densification scenarios within a neighborhood (Lorensborg) in Malmö, Sweden. The three scenarios include 1) Present-day, representing the study area as it is presently organized; 2) Planned municipal strategy (the city of Malmö's own densification plans) and 3) Health-centred, which involves major structural alterations and reflects an effort prioritize a health-centred approach. Noise was modelled using the Nordic prediction method for road traffic. Health outcomes included noise annoyance, adverse sleep disturbance, ischemic heart disease (IHD) incidence and mortality. Within all scenarios, a large proportion of the study population was exposed above the WHO's health-based guideline value (L_den 53 dB): >80% for Present-day and Planned municipal strategy scenarios, and almost 50% in the Health-centred scenario. Still, densifying Lorensborg (population ≈9,600) according to the Health-centred scenario could prevent 549 cases of highly annoyed, 193 cases of adverse sleep disturbance, 4.7 new cases of IHD (8.9% of total cases), and 1.5 deaths due to IHD (17.8% of IHD mortality) annually. The results demonstrated that it is possible to considerably lower the health impact with a more health-centred densification strategy. Important co-benefits for public and environmental health include air pollution reduction and green space creation, although their health effects were not quantified in the present study. Urban planning initiatives must be more ambitious in order to create healthy, sustainable cities.

Cyclists' exposure to air pollution, noise, and greenery: a population-level spatial analysis approach

Urban travel exposes people to a range of environmental qualities with significant health and wellbeing impacts. Nevertheless, the understanding of travel-related environmental exposure has remained limited. Here, we present a novel approach for population-level assessment of multiple environmental exposure for active travel. It enables analyses of (1) urban scale exposure variation, (2) alternative routes' potential to improve exposure levels per exposure type, and (3) by combining multiple exposures. We demonstrate the approach's feasibility by analysing cyclists' air pollution, noise, and greenery exposure in Helsinki, Finland. We apply an in-house developed route-planning and exposure assessment software and integrate to the analysis 3.1 million cycling trips from the local bike-sharing system. We show that especially noise exposure from cycling exceeds healthy thresholds, but that cyclists can influence their exposure by route choice. The proposed approach enables planners and individual citizens to identify (un)healthy travel environments from the exposure perspective, and to compare areas in respect to how well their environmental quality supports active travel. Transferable open tools and data further support the implementation of the approach in other cities.