The impact of urban and transport planning on health: Assessment of the attributable mortality burden in Madrid and Barcelona and its distribution by socioeconomic status

Joint effects of environmental and neighborhood socioeconomic factors on cognitive function in the Heinz Nixdorf Recall Study

BACKGROUND

Modifiable physical and social environments are believed to influence cognitive health in older age.

OBJECTIVES

To employ cutting-edge methods to analyze the impact of correlated environmental and socioeconomic neighborhood factors on cognitive function in German older participants.

METHODS

In the German Heinz Nixdorf Recall cohort study, participants underwent neuropsychological testing at the first follow-up examination (2006-2008) to derive a global cognitive score (GCS). Long-term exposure to air pollution was estimated by the land-use regression and chemistry transport models. Road traffic noise was assessed as outdoor weighted 24h and nighttime means. Seven neighborhood-level socioeconomic position (nSEP) characteristics were linked from administrative data. The joint effects of exposure combinations on GCS were estimated using two dimensionality reduction techniques: principal component (PC) analysis (PCA) and self-organizing maps (SOM).

RESULTS

Overall, 3748 individuals were included (median age 65 years; 50.7 % female). In single-exposure linear regression analysis, higher particle matter with aerodynamic diameter ≤2.5 μm (PM2.5) and nitrogen oxides exposure, higher proportion of welfare recipients, and lower living area per resident were negatively associated with GCS. In the PCA, the first principal component (PC), the direction of maximum variance, was positively correlated with all disadvantageous nSEP factors and higher concentrations of all environmental exposures except ozone. This PC was associated with lower GCS. SOM revealed associations with lower GCS for 3 of 6 exposure clusters. These clusters were characterized by low nSEP (Cluster 1), high environmental exposure (Cluster 4) and high concentration of accumulation mode particle number concentration (Cluster 5).

DISCUSSION

We identified associations between distinct combinations of intercorrelated air pollution, road traffic noise, and nSEP disadvantages with poorer cognitive function, using two different dimensionality reduction methods. Our findings highlight the importance of considering combined environmental and social exposures to systematically assess the potential benefits of multimodal urban interventions aimed at mitigating these risk factors.

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.

Exploring methods to assess environmental health inequalities in health impact assessments of local interventions: a systematic review within the JA PreventNCD project

Background

Health Impact Assessment (HIA) procedures can include the assessment of inequalities and inequities associated with the distribution of environmental health risks and benefits, aimed at attenuating the exacerbation of environmental health disparities. This systematic review, conducted as part of the Joint Action Prevent Non-Communicable Diseases initiative, explores methods for assessing health inequalities and equity within HIA frameworks, particularly in local projects affecting the distribution of environmental risks and benefits.

Methods

Adhering to the PRISMA guidelines, a systematic review of the scientific literature was conducted using the MEDLINE/PubMed, Scopus, and Embase databases, searching until March 8, 2024. Furthermore, a grey literature analysis encompassed the Institutional Repository for Information Sharing (IRIS) of the World Health Organization, to identify guidelines and recommendations addressing equity considerations in HIAs. Studies were included based on predefined eligibility criteria if they explored issues related to inequalities, inequities, and vulnerabilities within the context of HIAs. Data extraction focused on methodologies that incorporated equity considerations within the HIA framework, particularly concerning local urban planning initiatives, transport infrastructure, and industrial settings.

Results

A total of 33 studies met the inclusion criteria. Among these, eight documents from the grey literature, identified as guidelines and guidance, underscored the importance of prioritizing equity to ensure that health impacts are addressed fairly across diverse population groups. The remaining 25 peer-reviewed studies employed a combination of quantitative and qualitative methodologies. Quantitative approaches, including exposure-response modeling and Geographic Information System (GIS) mapping, were utilized to evaluate spatial and demographic health disparities. Qualitative methods, such as focus groups, interviews, and participatory tools, provided insights into the lived experiences of vulnerable populations affected by local interventions. Studies addressing urban and transportation planning predominantly emphasized socioeconomic stratification, whereas those focused on industrial settings highlighted occupational hazards and community vulnerabilities.

Conclusion

This review highlights the diverse and fragmented approaches used to address health inequalities and equity in HIA. It underscores the need for interdisciplinary and systematic methodologies that integrate quantitative and qualitative perspectives, ensuring equity remains a central consideration in policymaking and project implementation. Finally, it proposes a practical framework for integrating equity into HIA.

Co-benefits of nature-based solutions: A health impact assessment of the Barcelona Green Corridor (Eixos Verds) plan

INTRODUCTION

The Green Corridors Plan (Eixos Verds Plan), proposed by the Barcelona City Council, aims to enhance urban well-being, environmental sustainability, and resilience by transforming one in every three streets into green corridors. Although initially designed for city-wide implementation, only the first phase, focused on the centric Eixample district, has been completed, and the overall plan implementation has been postponed. Our aim is to evaluate the health co-benefits of implementing the Green Corridors plan citywide, focusing on the direct effects of increased exposure to greenness and the impact of temperature reduction on mortality.

METHODS

We conducted a comprehensive Health Impact Assessment (HIA) considering direct effects of expanding green spaces (GS) and the impact on temperature reduction. Preventable mortality at the census tract level for adult residents was estimated, and to address uncertainties, we performed Monte Carlo iterations. We computed the percentage increase in GS (land use) and tree cover and converted them into Normalized Difference Vegetation Index (NDVI) to conduct the HIA, employing a Generalized Additive Model (GAM). We used the Weather Research and Forecasting model (WRF) coupled with the urban parameterizations "Building Effect Parameterization" (BEP) and "Building Energy Model" (BEM) for temperature modelling. Hourly temperatures from 25/06/2015 to 25/07/2015 were simulated, both with and without Green Corridors Plan implementation.

RESULTS

City-wide implementation of the Green Corridors plan would increase average GS by 3.64 % (IQR: 2.17 % - 4.40 %) and NDVI by 0.286 (IQR: 0.256-0.304) per census tract. This could potentially prevent 178 premature deaths annually (95 % CI: 116-247), equating to 13 deaths per 100,000 inhabitants (95 % CI: 9-19). The average daily temperature reduction per census tract was estimated at 0.05 °C, with a maximum reduction of 0.42 °C. Temperature reduction could potentially prevent 5 deaths during the simulated month. Additionally, we estimated a mean decrease in the thermal stress of 0.11 °C, reaching up to 1.48 °C at its peak.

CONCLUSION

The Green Corridors plan can make significant contributions to a healthier urban environment. To address climate and especially heat impacts, complementary strategies to achieve more substantial temperature reduction are needed. Overall, our findings underscore the potential of nature-based solutions (NbS), exemplified by the Green Corridors Plan, in creating more sustainable and health-promoting urban environments.

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.

Ambient air pollution, urban green space and childhood overweight and obesity: A health impact assessment for Barcelona, Spain

BACKGROUND

The burden of childhood overweight and obesity attributable to ambient air pollution and a lack of urban green spaces (UGS) remains unknown. This study aimed to estimate the attributable cases of childhood overweight and obesity due to air pollution and insufficient UGS exposure in Barcelona, Spain.

METHODS

We applied a quantitative health impact assessment approach. We collected childhood overweight and obesity prevalence levels and exposure data from 69 spatial basic health zones in Barcelona. We estimated particulate matter (PM2.5) and nitrogen dioxide (NO2) levels using land use regression models, normalized difference vegetation index (NDVI) levels using remote sensing and percentage of green area (%GA) using land use. We estimated relative risks, population attributable fractions, and preventable overweight/obesity cases in children under following scenarios: Compliance of World Health Organization (WHO) air quality guidelines (AQGs) for (1) PM2.5 and (2) NO2; achieving (3) city-target NDVI levels and (4) 25% green area (%GA) recommendations. The analyses were stratified by socioeconomic deprivation index (in quintiles). Uncertainty was quantified using Monte Carlos simulations.

RESULTS

Compliance of WHO AQGs could prevent 0.4% [253 (95%CI, -604; 1086)] and 4.2% [3000 (95%CI, 1009; 4943)] of childhood overweight/obesity cases due to excess PM2.5 and NO2 levels in Barcelona, respectively. Compliance of NDVI and %GA targeted levels could prevent 6% [4094 (95%CI, 1698; 6379)] and 10% [6853 (95%CI, 1440; 12779)] of childhood overweight/obesity cases respectively. The preventable burdens of childhood overweight/obesity cases were slightly higher in middle-class socioeconomic areas due to the higher adverse exposure levels at baseline (high air pollution, less UGS).

DISCUSSION

Compliance with WHO AQGs and achieving UGS targets can reduce childhood overweight and obesity levels in Barcelona, and potentially in other locations as well. This underscores the need for policies that foster healthier urban environments of high environmental quality in order to protect child health.

Impact of urban facilities spatial inequality on sustainable travel mode

With the implementation of sustainable development objectives in developing countries, urban planning, land use regulation, and urban mobility policies are expected to help reduce inequalities in access to urban facilities. Urban transport policies are also expected to encourage travel by non-motorised modes and public transport. These are considered to be the sustainable modes of urban transport. In this paper, we investigate how inequality of urban facilities impacts trips made by sustainable modes in the city of Santiago de Chile. We use a Poisson regression model and its geographical extension, the geographically weighted Poisson regression model (GWPR). The results suggest that the inequality of urban facilities impacts trips made by sustainable modes. The variables with the highest relevance are the spatial distribution of mixed land use, the spatial distribution of urban services related to transport infrastructure, primary and secondary education, as well as the spatial distribution of demographic variables related to people's life cycle.

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.

Navigating health challenges: the interplay between occupation-imposed movement restrictions, healthcare access, and community resilience

BACKGROUND

Transportation plays a significant role in health, community resilience, and access to basic needs such as healthcare, social services, education, and job opportunities. Health and community resilience are, however, impacted by a multitude of complex and unequal factors, such as transportation restrictions exacerbated by the Israeli occupation. The goal of the research was to examine the intricate relationships that exist in Palestine between movement restrictions imposed by occupation, health outcomes, and community resilience.

METHOD

A self-structured questionnaire, devised based on expert conversations and previous literature, was used in this descriptive, quantitative study to explore health and resilience outcomes. Age, gender, marital status, place of residence, and means of transportation were among the various factors that were utilized to describe the socio-demographics of the study sample (n = 202). The researchers employed stepwise multiple regression and descriptive statistics for the data analysis.

RESULTS

Study findings indicated that transportation restrictions have significant direct and indirect health consequences. A significant direct effect is observed, signifying a negative correlation between restrictions and health; increased transportation restrictions are consistently correlated with a decline in health. The study emphasized how place of residence affects health outcomes, with higher scores for campers and people living in green line areas. It also underscores that public means of transportation are found to be better for health outcomes than private cars.

CONCLUSION

This study emphasized that roadblocks, checkpoints, and military incursions make it difficult for Palestinians to receive medical care, which has a detrimental impact on their health and well-being. It also underscores the need for significant reforms in Palestinian health and transportation systems to enhance infrastructure and healthcare access. The Palestinian Authority should invest in public transportation and community resilience programs to address transportation-related health issues, especially in villages, due to frequent settler attacks.

Toward Heart-Healthy and Sustainable Cities: A Policy Statement From the American Heart Association

Nearly 56% of the global population lives in cities, with this number expected to increase to 6.6 billion or >70% of the world's population by 2050. Given that cardiometabolic diseases are the leading causes of morbidity and mortality in people living in urban areas, transforming cities and urban provisioning systems (or urban systems) toward health, equity, and economic productivity can enable the dual attainment of climate and health goals. Seven urban provisioning systems that provide food, energy, mobility-connectivity, housing, green infrastructure, water management, and waste management lie at the core of human health, well-being, and sustainability. These provisioning systems transcend city boundaries (eg, demand for food, water, or energy is met by transboundary supply); thus, transforming the entire system is a larger construct than local urban environments. Poorly designed urban provisioning systems are starkly evident worldwide, resulting in unprecedented exposures to adverse cardiometabolic risk factors, including limited physical activity, lack of access to heart-healthy diets, and reduced access to greenery and beneficial social interactions. Transforming urban systems with a cardiometabolic health-first approach could be accomplished through integrated spatial planning, along with addressing current gaps in key urban provisioning systems. Such an approach will help mitigate undesirable environmental exposures and improve cardiovascular and metabolic health while improving planetary health. The purposes of this American Heart Association policy statement are to present a conceptual framework, summarize the evidence base, and outline policy principles for transforming key urban provisioning systems to heart-health and sustainability outcomes.

Urban green spaces and behavioral and cognitive development in children: A health impact assessment of the Barcelona "Eixos Verds" Plan (Green Axis Plan)

BACKGROUND

Urban environments lack natural features, while nature exposure in cities has been associated with health benefits, including children's neurodevelopment. Through extensive street greening, Barcelona's Eixos Verds (Green Axis) Plan enhances safety, environment, and climate resilience. We aimed to assess the Eixos Verds Plan's potential impact on children's behavioral and cognitive development due to the increased green space expected under the Eixos Verds implementation.

METHODS

We performed a quantitative health impact assessment for Barcelona children at census-tract level (n = 1068). We assessed the Eixos Verds Plan's impact by comparing baseline green space distribution with the proposed plan, translating it into percentage green area (%GA) and Normalized Difference Vegetation Index (NDVI). By combining these exposure metrics with child-specific risk estimates and population data, we estimated potential improvements in children's behavioral and cognitive development due to full Eixos Verds implementation.

RESULTS

With the full Eixos Verds implementation, citywide, %GA increased by 6.9% (IQR: 6.4%; range: 0-23.1%) and NDVI by 0.065 (IQR: 0.083; range: 0.000-0.194). Child behavioral and cognitive development outcomes are expected to improve compared to the baseline. Based on NDVI increases, children's Total Difficulties and Hyperactivity/Inattention scores, based on the Strengths and Difficulties Questionnaire (SDQ), are projected to decrease by 5% (95% CI: 0-15%) and 6% (95% CI: 0-17%). Working Memory and Superior Working Memory scores are expected to increase by 4% and 5%, respectively, based on the computerized n-back test, while the Inattentiveness score could be reduced by 1%, based on the computerized attentional test (ANT).

INTERPRETATION

Urban greening as planning tool can improve behavioral and cognitive development in city children. Methods and results of our study are applicable to many cities worldwide, and similar results for children of real-life urban greening interventions can be expected.

Environmental health impacts and inequalities in green space and air pollution in six medium-sized European cities

BACKGROUND

The GoGreenRoutes project aims to introduce co-created nature-based solutions (NBS) to enhance environmental quality in six medium-sized cities (Burgas, Lahti, Limerick, Tallinn, Umeå, and Versailles). We estimated the mortality and economic impacts attributed to suboptimal exposure to green space and air pollution, economic impacts, and the distribution thereof the adult population by socioeconomic status.

METHODS

We retrieved data from publicly accessible databases on green space (NDVI and % Green Area), air pollution (NO2 and PM2.5) and population (≥20 years, n = 804,975) at a 250m × 250m grid-cell level, and mortality for each city for 2015. We compared baseline exposures at the grid-cell to World Health Organization's recommendations and guidelines. We applied a comparative risk assessment to estimate the mortality burden attributable to not achieving the recommendations and guidelines. We estimated attributable mortality distributions and the association with income levels.

RESULTS

We found high variability in air pollution and green spaces levels. Around 60% of the population lacked green space and 90% were exposed to harmful air pollution. Overall, we estimated age-standardized mortality rates varying from 10 (Umeå) to 92 (Burgas) deaths per 100,000 persons attributable to low NDVI levels; 3 (Lahti) to 38 (Burgas) per 100,000 persons to lack of % Green Area; 1 (Umeå) to 88 (Tallinn) per 100,000 persons to exceedances of NO2 guidelines; and 1 (Umeå) to 206 (Burgas) per 100,000 persons to exceedances of PM2.5 guidelines. Lower income associated with higher or lower mortality impacts depending on whether deprived populations lived in the densely constructed, highly-trafficked city centre or greener, less polluted outskirts.

CONCLUSIONS

We attributed a considerable mortality burden to lack of green spaces and higher air pollution, which was unevenly distributed across different social groups. NBS and health-promoting initiatives should consider socioeconomic aspects to regenerate urban areas while providing equally good environments.

An urban green space intervention with benefits for mental health: A health impact assessment of the Barcelona "Eixos Verds" Plan

BACKGROUND

Mental health disorders account for over 30% of the global burden of disease. There is a positive association between green space exposure and better mental health, and therefore urban greening can be an effective public health tool. Barcelona is a compact city with one of the highest population and traffic densities in Europe, with limited green spaces. Under the umbrella of the Superblock model, the Barcelona City council is implementing the Eixos Verds Plan for extensive street greening. We estimated the potential mental health benefits of this plan.

METHODS

We performed a quantitative health impact assessment at the Barcelona grid-cell level (n = 1,096). We compared the baseline green space situation (2015) with the proposed plan and translated the increase in green space into a) percentage of green area (%GA) and b) NDVI. We combined exposure data with Barcelona-specific mental health risk estimates, adult population (n = 1,235,375), and mental health data, and calculated preventable cases.

FINDINGS

Under the Eixos Verds Plan, we estimated an average increase of 5·67 %GA (range: 0·00% - 15·77%) and 0·059 NDVI (range: 0·000 - 0·312). We estimated that with the Eixos Verds Plan implementation, 31,353 (95%CI: 18,126-42,882) cases of self-perceived poor mental health (14·03% of total), 16,800 (95%CI: 6828-25,700) visits to mental health specialists (13·37% of total), 13,375 (95%CI: 6107-19,184) cases of antidepressant use (13·37% of total), and 9476 (95%CI: 802-16,391) cases of tranquilliser/ sedative use (8·11% of total) could be prevented annually, along corresponding to over 45 M € annual savings in mental health costs annually.

INTERPRETATION

Our results highlight the importance of urban greening as a public health tool to improve mental health in cities. Similar results for green interventions in other cities could be expected.

Agent-based modeling of urban exposome interventions: prospects, model architectures, and methodological challenges

With ever more people living in cities worldwide, it becomes increasingly important to understand and improve the impact of the urban habitat on livability, health behaviors, and health outcomes. However, implementing interventions that tackle the exposome in complex urban systems can be costly and have long-term, sometimes unforeseen, impacts. Hence, it is crucial to assess the health impact, cost-effectiveness, and social distributional impacts of possible urban exposome interventions (UEIs) before implementing them. Spatial agent-based modeling (ABM) can capture complex behavior-environment interactions, exposure dynamics, and social outcomes in a spatial context. This article discusses model architectures and methodological challenges for successfully modeling UEIs using spatial ABM. We review the potential and limitations of the method; model components required to capture active and passive exposure and intervention effects; human-environment interactions and their integration into the macro-level health impact assessment and social costs benefit analysis; and strategies for model calibration. Major challenges for a successful application of ABM to UEI assessment are (1) the design of realistic behavioral models that can capture different types of exposure and that respond to urban interventions, (2) the mismatch between the possible granularity of exposure estimates and the evidence for corresponding exposure-response functions, (3) the scalability issues that emerge when aiming to estimate long-term effects such as health and social impacts based on high-resolution models of human-environment interactions, (4) as well as the data- and computational complexity of calibrating the resulting agent-based model. Although challenges exist, strategies are proposed to improve the implementation of ABM in exposome research.

Trends, Issues and Future Directions of Urban Health Impact Assessment Research: A Systematic Review and Bibliometric Analysis

Health impact assessment (HIA) has been regarded as an important means and tool for urban planning to promote public health and further promote the integration of health concept. This paper aimed to help scientifically to understand the current situation of urban HIA research, analyze its discipline co-occurrence, publication characteristics, partnership, influence, keyword co-occurrence, co-citation, and structural variation. Based on the ISI Web database, this paper used a bibliometric method to analyze 2215 articles related to urban HIA published from 2012 to 2021. We found that the main research directions in the field were Environmental Sciences and Public Environmental Occupational Health; China contributed most articles, the Tehran University of Medical Sciences was the most influential institution, Science of the Total Environment was the most influential journal, Yousefi M was the most influential author. The main hotspots include health risk assessment, source appointment, contamination, exposure, particulate matter, heavy metals and urban soils in 2012–2021; road dust, source apposition, polycyclic aromatic hydrocarbons, air pollution, urban topsoil and the north China plain were always hot research topics in 2012–2021, drinking water and water quality became research topics of great concern in 2017–2021. There were 25 articles with strong transformation potential during 2020–2021, but most papers carried out research on the health risk assessment of toxic elements in soil and dust. Finally, we also discussed the limitations of this paper and the direction of bibliometric analysis of urban HIA in the future.

Impact of road traffic noise on annoyance and preventable mortality in European cities: A health impact assessment

BACKGROUND

Road traffic is the main source of environmental noise in European cities and one of the main environmental risks to health and wellbeing. In this study we aimed to provide an in-depth assessment of available road traffic noise data and to estimate population exposure and health impacts for cities in Europe.

METHODS

We conducted the analysis for 724 cities and 25 greater cities in 25 European countries. We retrieved road traffic strategic noise maps delivered under the Environmental Noise Directive (END) or available from local sources. We assessed noise exposure using the 24 h day-evening-night noise level indicator (L_den) starting at exposure levels of 55 dB L_den - based on data availability - for the adult population aged 20 and over (n = 123,966,346). For the adults exposed to noise levels above 55 dB L_den we estimated the health impacts of compliance with the World Health Organization (WHO) recommendation of 53 dB L_den. Two primary health outcomes were assessed: high noise annoyance and Ischemic Heart Disease (IHD), using mortality from IHD causes as indicator. Exposure Response Functions (ERFs) relating road traffic noise exposure to annoyance and IHD mortality were retrieved from the literature. Uncertainties in input parameters were propagated using Monte Carlo simulations to obtain point estimates and empirical 95% Confidence Intervals (CIs). Lastly, the noise maps were categorized as high, moderate and low quality following a qualitative approach.

RESULTS

Strategic noise map data was delivered in three distinct formats (i.e. raster, polygon or polyline) and had distinct noise ranges and levels of categorization. The majority of noise maps (i.e. 83.2%) were considered of moderate or low quality. Based on the data provided, almost 60 million adults were exposed to road traffic noise levels above 55 dB L_den, equating to a median of 42% (Interquartile Range (IQR): 31.8-64.8) of the adult population across the analysed cities. We estimated that approximately 11 million adults were highly annoyed by road traffic noise and that 3608 deaths from IHD (95% CI: 843-6266) could be prevented annually with compliance of the WHO recommendation. The proportion of highly annoyed adults by city had a median value of 7.6% (IQR: 5.6-11.8) across the analysed cities, while the number preventable deaths had a median of 2.2 deaths per 100,000 population (IQR: 1.4-3.1).

CONCLUSIONS

Based on the provided strategic noise maps a considerable number of adults in European cities are exposed to road traffic noise levels harmful for health. Efforts to standardize the strategic noise maps and to increase noise and disease data availability at the city level are needed. These would allow for a more accurate and comprehensive assessment of the health impacts and further help local governments to address the adverse health effects of road traffic noise.

The Impact of Transport on Population Health and Health Equity for Māori in Aotearoa New Zealand: A Prospective Burden of Disease Study

BACKGROUND

The land transport system influences health via a range of pathways. This study aimed to quantify the amount and distribution of health loss caused by the current land transport system in Aotearoa New Zealand (NZ) through the pathways of road injury, air pollution and physical inactivity.

METHODS

We used an existing multi-state life table model to estimate the long-term health impacts (in health-adjusted life years (HALYs)) and changes in health system costs of removing road injury and transport related air pollution and increasing physical activity to recommended levels through active transport. Health equity implications were estimated using relative changes in HALYs and life expectancy for Māori and non-Māori.

RESULTS

If the NZ resident population alive in 2011 was exposed to no further air pollution from transport, had no road traffic injuries and achieved at least the recommended weekly amount of physical activity through walking and cycling from 2011 onwards, 1.28 (95% UI: 1.11-1.5) million HALYs would be gained and $7.7 (95% UI: 10.2 to 5.6) billion (2011 NZ Dollars) would be saved from the health system over the lifetime of this cohort. Māori would likely gain more healthy years per capita than non-Māori, which would translate to small but important reductions (2-3%) in the present gaps in life expectancy.

CONCLUSION

The current transport system in NZ, like many other car-dominated transport systems, has substantial negative impacts on health, at a similar level to the effects of tobacco and obesity. Transport contributes to health inequity, as Māori bear greater shares of the negative health impacts. Creating a healthier transport system would bring substantial benefits for health, society and the economy.

Study protocol of the European Urban Burden of Disease Project: a health impact assessment study

INTRODUCTION

Cities have long been known to be society's predominant engine of innovation and wealth creation, yet they are also hotspots of pollution and disease partly due to current urban and transport practices. The aim of the European Urban Burden of Disease project is to evaluate the health burden and its determinants related to current and future potential urban and transport planning practices and related exposures in European cities and make this evidence available for policy and decision making for healthy and sustainable futures.

METHODS AND ANALYSIS

Drawing on an established comparative risk assessment methodology (ie, Urban and Transport Planning Health Impact Assessment) tool), in nearly 1000 European cities we will (1) quantify the health impacts of current urban and transport planning related exposures (eg, air pollution, noise, excess heat, lack of green space) (2) and evaluate the relationship between current levels of exposure, health impacts and city characteristics (eg, size, density, design, mobility) (3) rank and compare the cities based on exposure levels and the health impacts, (4) in a number of selected cities assess in-depth the linkages between urban and transport planning, environment, physical activity and health, and model the health impacts of alternative and realistic urban and transport planning scenarios, and, finally, (5) construct a healthy city index and set up an effective knowledge translation hub to generate impact in society and policy.

ETHICS AND DISSEMINATION

All data to be used in the project are publicly available data and do not need ethics approval. We will request consent for personal data on opinions and views and create data agreements for those providing information on current and future urban and transport planning scenarios.For dissemination and to generate impact, we will create a knowledge translation hub with information tailored to various stakeholders.

Green space and mortality in European cities: a health impact assessment study

BACKGROUND

Natural outdoor environments including green spaces play an important role in preserving population health and wellbeing in cities, but the number of deaths that could be prevented by increasing green space in European cities is not known. We aimed to estimate the number of natural-cause deaths among adult residents that could be prevented in cities in 31 European countries, if the WHO recommendation for universal access to green space was achieved.

METHODS

In this health impact assessment study we focused on adult residents (aged ≥20 years; n=169 134 322) in 978 cities and 49 greater cities, in 31 European countries. We used two green space proxies: normalised difference vegetation index (NDVI), and percentage of green area (%GA). The exposure was estimated at a fine grid-cell level (250 m × 250 m) and the preventable mortality burden for 2015 was estimated at the local city-level.

FINDINGS

For 2015 we found that meeting the WHO recommendation of access to green space could prevent 42 968 (95% CI 32 296-64 177) deaths annually using the NDVI proxy (ie, 20% [95% CI 15-30] of deaths per 100 000 inhabitants-year), which represents 2·3% (95% CI 1·7-3·4) of the total natural-cause mortality and 245 (95% CI 184-366) years of life lost per 100 000 inhabitants-year. For the %GA proxy 17 947 (95%CI 0-35 747) deaths could be prevented annually. For %GA the number of attributable deaths were half of that of the NDVI and results were non-significant due to the exposure response function considered. The distribution of NDVI and %GA varied between cities and was not equally distributed within cities. Among European capitals, Athens, Brussels, Budapest, Copenhagen, and Riga showed some of the highest mortality burdens due to the lack of green space. The main source of uncertainty for our results was the choice of the age-structures of the population for the NDVI analysis, and exposure-response function for the %GA analysis.

INTERPRETATION

A large number of premature deaths in European cities could be prevented by increasing exposure to green space, while contributing to sustainable, liveable and healthy cities.

FUNDING

GoGreenRoutes, Internal ISGlobal fund, and the United States Department of Agriculture Forest Service.