Advancing urban green and blue space contributions to public health

Urban greenspace under a changing climate: Benefit or harm for allergies and respiratory health?

An increasing proportion of the world's population lives in urban settings that have limited greenspace. Urbanization puts pressure on existing greenspace and reduces its access. Climate impacts, including increased temperature and extreme weather events, challenge the maintenance of urban vegetation, reducing its ecosystem services and benefits for human health. Although urban greenspace has been positively associated with numerous health indicators, the evidence for allergies and respiratory health is much less clear and mixed. To address these uncertainties, a workshop with 20 global participants was held in Munich, Germany, in May 2024, focusing on the impact of greenspace-related co-exposures on allergies and respiratory health. This narrative review captures key insights from the workshop, including the roles of urban greenspace in (1) climate change mitigation, (2) interactions with pollen, and (3) emissions of biogenic volatile organic compounds and their byproducts, such as ozone. Additionally, it presents research and stakeholder recommendations from the workshop. Future studies that integrate advanced greenspace exposure assessments and consider the interplay of greenspace with pollen and biogenic volatile organic compounds, along with their relevant byproducts are needed. Increased public awareness and policy actions will also be essential for developing urban greenspace that maximizes health benefits, minimizes risks, and ensures resilience amid a changing climate and rapid urbanization.

The links between soil and water pollution and cardiovascular disease

Soil and water pollution represent significant threats to global health, ecosystems, and biodiversity. Healthy soils underpin terrestrial ecosystems, supporting food production, biodiversity, water retention, and carbon sequestration. However, soil degradation jeopardizes the health of 3.2 billion people, while over 2 billion live in water-stressed regions. Pollution of soil, air, and water is a leading environmental cause of disease, contributing to over 9 million premature deaths annually. Soil contamination stems from heavy metals, synthetic chemicals, pesticides, and plastics, driven by industrial activity, agriculture, and waste mismanagement. These pollutants induce oxidative stress, inflammation, and hormonal disruption, significantly increasing risks for non-communicable diseases (NCDs) such as cardiovascular disease (CVD). Emerging contaminants like micro- and nanoplastics amplify health risks through cellular damage, oxidative stress, and cardiovascular dysfunction. Urbanization and climate change exacerbate soil degradation through deforestation, overfertilization, and pollution, further threatening ecosystem sustainability and human health. Mitigation efforts, such as reducing chemical exposure, adopting sustainable land-use practices, and advancing urban planning, have shown promise in lowering pollution-related health impacts. Public health initiatives, stricter pollution controls, and lifestyle interventions, including antioxidant-rich diets, can also mitigate risks. Pollution remains preventable, as demonstrated by high-income nations implementing cost-effective solutions. Policies like the European Commission's Zero-Pollution Vision aim to reduce pollution to safe levels by 2050, promoting sustainable ecosystems and public health. Addressing soil pollution is critical to combating the global burden of NCDs, particularly CVDs, and fostering a healthier environment for future generations.

Association between urbanization levels and frailty among middle-aged and older adults in China: evidence from the CHARLS

BACKGROUND

Rapid urbanization is underway in China. However, the impact of urbanization on frailty remains unclear. This study aims to investigate the relationship between urbanization and frailty among middle-aged and older adults.

METHODS

We analyzed nationally representative data from the China Health and Retirement Longitudinal Study (CHARLS) spanning 2011 to 2018. After applying inclusion and exclusion criteria, 10,758 non-frail individuals at baseline were analyzed. The exposure of interest was the comprehensive urbanization level. Urbanization level (0.072-0.689) was assessed using the entropy method. Frailty was assessed using the frailty index (FI), which ranges from 0 to 100. Frailty was defined as FI ≥ 25, and the urbanization-frailty association was assessed using - the restricted cubic spline (RCS) expressions and Cox proportional hazards models. Least absolute shrinkage and selection operator (LASSO) regression were employed to evaluate major factors associated with frailty.

RESULTS

The results revealed a U-shaped nonlinear association between urbanization level and frailty incidence, with a turning point at 0.3 (Pnonlinear < 0.001). In the Cox model, for urbanization scores below 0.3, each ten-percentile increase was associated with an HR of 0.871 (95% CI 0.843-0.900, P < 0.05). Conversely, scores at or above 0.3 had an HR of 1.178 (95% CI 1.053-1.319, P < 0.05) per ten-percentile increase. In the subgroup analysis of participants with urbanization scores below 0.3, there was a significant interaction between current work status and subgroups with dyslipidemia. LASSO regression showed that, for urbanization scores < 0.3, total retail sales (coefficient =  - 0.129) and per capita income (coefficient =  - 0.071) were most protective against frailty. For scores ≥ 0.3, key urbanization factors associated with increased frailty risk included the number of college students per 10,000 people (coefficient = 0.080) and the proportion of built-up land in the urban area (coefficient = 0.060).

CONCLUSIONS

Urbanization level had U-shaped association with frailty incidence. Factors such as total retail sales of consumer goods per capita, per capita disposable income of urban residents, and the number of college students per 10,000 people may be key in formulating a strategy for frailty prevention.

Associations of green and blue spaces with visual acuity in youths from Shandong Province, China: A large population-based study

While growing evidence highlights the benefits of green and blue spaces for physical and mental health, their combined effects on youth visual acuity remain unclear. This study aimed to evaluate the associations of green and blue spaces with visual acuity in youths. We analyzed data from the 2023 Common Disease and Health Risk Factors Surveillance and Intervention Program among students in Shandong Province, China. Generalized linear mixed-effects models were employed to investigate the independent associations of green and blue spaces with visual acuity in youths. To explore potential interactions, an interaction term for green and blue spaces was incorporated. Quantile g-computation (Qgcomp) models were applied to evaluate their combined effects. Compared to the lowest quartile, higher quartiles (Q2, Q3, and Q4) of the normalized difference vegetation index (NDVI), enhanced vegetation index (EVI), normalized difference water index (NDWI), and modified normalized difference water index (MNDWI) were significantly associated with improved visual acuity in both eyes. Additionally, each 0.1 unit increase in NDVI500, EVI500, NDWI500, and MNDWI500 was associated with 0.008 (95 % confidence interval [CI]: 0.007, 0.010), 0.003 (0.002, 0.004), 0.054 (0.028, 0.080), and 0.010 (0.002, 0.018) improvements in right-eye visual acuity, with similar findings for the left eye. A significant interaction was observed between NDVI and NDWI (all P for interaction < 0.001), and combined exposure to green and blue spaces was positively associated with visual acuity (all P < 0.001). Furthermore, demographic and lifestyle factors modified the associations of blue and green spaces with visual acuity levels in youths. Greater exposure to green and blue spaces may benefit visual health in youths, with potential interactive and combined effects. Implementing policies to enhance the availability of green and blue spaces around schools may offer opportunities to alleviate visual impairment in youths.

Soil and water pollution and cardiovascular disease

Healthy, uncontaminated soils and clean water support all life on Earth and are essential for human health. Chemical pollution of soil, water, air and food is a major environmental threat, leading to an estimated 9 million premature deaths worldwide. The Global Burden of Disease study estimated that pollution was responsible for 5.5 million deaths related to cardiovascular disease (CVD) in 2019. Robust evidence has linked multiple pollutants, including heavy metals, pesticides, dioxins and toxic synthetic chemicals, with increased risk of CVD, and some reports suggest an association between microplastic and nanoplastic particles and CVD. Pollutants in soil diminish its capacity to produce food, leading to crop impurities, malnutrition and disease, and they can seep into rivers, worsening water pollution. Deforestation, wildfires and climate change exacerbate pollution by triggering soil erosion and releasing sequestered pollutants into the air and water. Despite their varied chemical makeup, pollutants induce CVD through common pathophysiological mechanisms involving oxidative stress and inflammation. In this Review, we provide an overview of the relationship between soil and water pollution and human health and pathology, and discuss the prevalence of soil and water pollutants and how they contribute to adverse health effects, focusing on CVD.

Association of urban green and blue space with accelerated ageing: A cohort Study in the UK Biobank

OBJECTIVE

We investigated the associations between urban green and blue spaces and the incidence of accelerated ageing, which have rarely been studied.

METHODS

Analyzed UK Biobank data (2006-2010) on 440,785 participants, focusing on urban green and blue space (UGBS). General linear models and logistics models assessed links between UGBS and accelerated ageing (Klemera-Doubal method, telomere length and frailty). Mediation analysis examined the role of pollution and other factors.

RESULTS

After controlling for random effects and various types of covariates, we found that 1) populations with higher levels of UGBS exposure are associated with accelerated ageing and slowing down; 2) UGBS has the greatest impact on accelerated ageing within a 1000-m street network buffer distance; 3) Participants living in heavily polluted areas should pay more attention to UGBS; 4) Intermediary analysis found that UGBS mainly accelerates aging by reducing harm, rather than affecting the population's ability to recover and build.

CONCLUSIONS

UGBS with a composite weighted score showed a better correlation with accelerated ageing than green spaces. Other factors such as gender, race and lifestyle also influence the impact of the environment on accelerated ageing.

Inequality in green space distribution and its association with preventable deaths across urban neighbourhoods in the UK, stratified by Index of Multiple Deprivation

BACKGROUND

This study investigated inequalities in the distribution of green space (GS) and the association between inequalities in amounts of GS and preventable deaths across urban neighbourhoods with different Index of Multiple Deprivation (IMD) scores in the UK.

METHODS

Data on preventable deaths, IMD, percentage of grassland and woodland, urban/rural, population size, and density were sourced for each of 6791 middle-layer super output areas (MSOAs) in England, 410 MSOAs in Wales, 1279 intermediate zones (IZs) in Scotland, and 890 super output areas (SOAs) in Northern Ireland (NI). While appreciating the potential for ecological fallacy we related area-based measures of deprivation to deaths. Concentration curves, Lorenz dominance tests, and negative binomial regression models were used to analyse the data.

RESULTS

In urban areas of England, Scotland, and NI, the percentage of grassland was significantly lower among the more deprived neighbourhoods (Lorenz test, p<0.0001). In England, a 1% increase in grassland area was associated with a 37% reduction in annual preventable deaths among the most deprived urban MSOAs (incidence rate ratio (IRR) 0.63, 95% CI 0.52 to 0.76). In NI and Scotland, a 1% increase in grassland area was associated with a 37% (IRR 0.63, 95% CI 0.43 to 0.91) and 41% (IRR 0.59, 95% CI 0.42 to 0.81) reduction in 5-year accumulated preventable deaths in the most deprived urban SOAs/IZs, respectively.

CONCLUSIONS

Results suggest that investment in GS in urban areas may be an important public health prevention strategy. There is evidence that investments in the most deprived urban neighbourhoods where the highest inequality currently exists would see the largest effect on preventable deaths.

The influence of freshwater blue spaces on human health and well-being:A systematic review based on assessment method

An increasing number of studies have explored the positive effects of blue spaces on human health, much of which involves the impacts of various blue space exposures on human health indicators, recognizing that the diversity in assessment methods may influence the final results. However, there are currently few systematic reviews that comprehensively synthesize this evidence. Additionally, current reviews in this field predominantly focus on coastal environments, while Freshwater Blue Spaces(FBS)receive less attention. Given that more than 50% of the global population lives within 3 km of freshwater bodies, it is crucial to understand the health impacts of these unique environments. Therefore, this study aims to systematically review the existing literature on the effects of FBS on human health and identify knowledge gaps. We systematically reviewed 34 articles following the PRISMA protocol. The results showed six main FBS exposure assessment methods and ten related health indicators. Additionally, we identified 74 health indicators and their relation to FBS exposure assessments. Our findings revealed: (i) FBS exposure assessment methods are becoming more diverse and refined, but challenges and limitations persist in their application; (ii) the studies employed a range of health indicators to explore different dimensions of human health, yet significant differences exist in their focus and methodologies; (iii) The results on the association between FBS and health exhibit heterogeneity, which not only depends on the health focus and indicators of each study but is also related to the exposure assessment methods used, the characteristics of FBS, sample differences, and the rigor of bias evaluation and control of confounding factors. Based on our findings, we propose a series of recommendations to further investigate the intrinsic connections between FBS and human health, providing opportunities to enhance human health and well-being.

Air pollution abatement from Green-Blue-Grey infrastructure

Green-blue-grey infrastructure (GBGI) offers environmental benefits in urban areas, yet its impact on air pollution is under-researched, and the literature fragmented. This review evaluates quantitative studies on GBGI's capability to mitigate air pollution, compares their specific pollutant removal processes, and identifies areas for further investigation. Of the 51 GBGI types reviewed, only 22 provided quantitative pollution reduction data. Street trees and mixed-GBGI are the most studied GBGIs, with efficacy influenced by wind, GBGI type vegetation characteristics, and urban morphology. Negative percentages denote worsening air quality, while positive reflect improvement. The 22 different GBGI grouped into eight main categories provide an average (± s.d.) reduction in air pollution of 16 ± 21%, with substantial reduction shown by linear features (23 ± 21%), parks (22 ± 34%), constructed GI (14 ± 25%), and other non-sealed urban areas (14 ± 20%). Other individual GBGI reducing air pollutants include woodlands (21 ± 38%), hedges (14 ± 25%), green walls (14 ± 27%), shrubland (12 ± 20%), green roofs (13 ± 23%), parks (9±36%), and mixed-GBGI (7 ± 23 %). On average, GBGI reduced PM1, PM2.5, PM10, UFP and BC by 13 ± 21%, 1 ± 25%, 7 ± 42%, 27 ± 27%, and 16 ± 41%, respectively. GBGI also lowered gaseous pollutants CO, O3 and NOx by 10 ± 21%, 7 ± 21%, and 12 ± 36%, on average, respectively. Linear (e.g., street trees and hedges) and constructed (e.g., green walls) features can impact local air quality, positively or negatively, based on the configuration and density of the built environment. Street trees generally showed adverse effects in street canyons and beneficial outcomes in open-road conditions. Climate change could worsen air pollution problems and impact GBGI effectiveness by shifting climate zones. In Europe and China, climate shifts are anticipated to affect 8 of the 22 GBGIs, with the rest expected to remain resilient. Despite GBGI's potential to enhance air quality, the meta-analysis highlights the need for a standardised reporting structure or to enable meaningful comparisons and effectively integrate findings into urban pollution and climate strategies.

Residential blue space, cognitive function, and the role of air pollution in middle-aged and older adults: A cross-sectional study based on UK biobank

This study examines the relationship between residential exposure to blue spaces (e.g., rivers, lakes, and seas) and cognitive function in middle-aged and older adults in the United Kingdom, with a specific focus on the mediating effects of air pollution, particularly nitrogen dioxide (NO₂) and fine particulate matter (PM2.5). Cognitive function was assessed using touch screens at UK Biobank Assessment Centre, while residential blue space exposure within a 300-meter radius was estimated from land-use data. Annual average levels of air pollution, specifically NO₂ and PM2.5, were calculated through a land-use regression model. Logistic regression models analyzed the association between blue space exposure and cognitive function, and restricted cubic splines were employed to assess potential nonlinear relationships. Causal mediation analysis quantified the indirect effects of air pollution on this relationship. The study included 35,669 participants, revealing that high blue space exposure (≥75 %) was associated with a 13.2 % lower risk of cognitive impairment compared to those with low exposure (<25 %). Notably, NO₂ and PM2.5 significantly mediated this association, with indirect effects estimated at 9.5 % and 15.85 %, respectively. These findings indicate that increased residential exposure to blue spaces is linked to a reduced risk of cognitive impairment, highlighting the protective role of blue environments in the context of air pollution. This research underscores the importance of environmentally sensitive urban planning and policies to promote public health and cognitive well-being among vulnerable populations.

Adapting to heat-health vulnerability in temperate climates: current adaptation and mitigation responses and future predictions in Aotearoa New Zealand

INTRODUCTION

Climate change is raising global temperatures, leading to more extreme heat events, even in temperate climates like Aotearoa|New Zealand (A|NZ). The impact of rising temperatures and the adequacy of planning measures remain underexplored. This paper highlights A|NZ's anticipated heat-health challenges by analyzing vulnerable populations and assessing current response systems, thereby reinforcing the need for system-level redress, mitigation and adaptation.

CONTENT

A scoping review examined the impact of heat and existing mitigation and adaptation responses for vulnerable populations in temperate regions, with a focus on A|NZ. Additionally, temperature trend analysis was conducted for current and projected trends using Climate CHIP for six major heat-affected cities in A|NZ to assess the recognition of heat as a societal concern.

SUMMARY AND OUTLOOK

The review identified mitigation and adaptation strategies for existing vulnerable groups and discovered other potential vulnerable groups in A|NZ, including Indigenous people (Māori), Pacific communities, low-income groups, migrants, and visitors. Temperature trends show an increasing pattern, suggesting heightened future heat-related impacts on these populations. This review reveals A|NZ's growing vulnerability to rising temperatures, particularly among high-risk groups, and calls for stronger mitigation and adaptation strategies to address future heat-health risks.

Associations between blue space exposure and rheumatoid arthritis: The modifying effect of genetic susceptibility and air pollutants

Studies on the interaction among genetic susceptibility, blue space exposure, and rheumatoid arthritis (RA) risk have been lacking. Therefore, we examined the association between blue space exposure and RA incidence and assess the modifying effect of genetic susceptibility and air pollutants. Form the UK Biobank, 322,783 participants without RA were enrolled in this study. The association between blue space exposure and RA incidence was estimated using a cox proportional hazards model. The combined effect of blue space and genetic factors on the risk of RA was further evaluated. The polygenic risk score (PRS) for RA was calculated to represent individual genetic risk, and the potential modification effect of air pollution on the relationship between blue space, PRS, and RA were explored. During a median follow-up of 12.4 years, 3659 RA cases were identified. A 10 % increase in blue space300 m was associated with a 22.6 % reduction in RA incidence (HR=0.774, 95 % CI: 0.670, 0.895), exhibiting a consistent downward trend in the exposure-response curve. A high PRS was an independent risk factor for RA (HR=1.393, 95 % CI: 1.347, 1.439). The associations between blue space exposure, PRS, and the risk of RA were dose-dependent, with the lowest risk observed among those with high levels of blue space and lower PRS (HRbluespace300m=0.501, 95 % CI: 0.431, 0.583; HRbluespace1000m=0.476, 95 % CI: 0.408, 0.555). Interaction analysis indicated that increased concentrations of air pollutants strengthened the relationship between PRS and RA. Blue space exposure mitigated the risk of RA development, particularly in individuals with low genetic risk.

How Green Space Justice in urban built-up areas affects public mental health: a moderated chain mediation model

Background

Green and blue spaces, as crucial components of urban ecosystems, significantly impact the physical and mental health of residents. However, the mechanisms through which Green/Blue Space Justice influence residents' health remain unclear.

Methods

This study aims to explore the impact of green spaces on public psychological responses, physical activity, and mental health from a justice perspective, and to examine the moderating role of blue spaces in this relationship. The research was conducted in selected communities within the Chang-Zhu-Tan urban agglomeration in Hunan Province, China. A total of 801 valid questionnaires were collected through field visits and online surveys. The study uses an improved Gaussian-based two-step floating catchment area (2SFCA) method to assess green space accessibility. Data were analyzed using structural equation modeling (SEM) and moderation effect analysis to reveal the relationships between variables.

Results

The findings indicate that Green Space Justice has a significant positive impact on psychological responses, physical activity, and mental health; psychological responses and physical activity play crucial mediating roles between Green Space Justice and mental health; and Green Space Justice significantly affects mental health through a chain mediation path involving psychological responses and physical activity. Moreover, Blue Space Justice significantly moderates the impact of Green Space Justice on psychological responses and physical activity, but does not have a significant direct impact on mental health.

Conclusion

This study enriches the theory of Green Space Justice by revealing the mechanisms through which it influences mental health via psychological responses and physical activity. It provides a scientific basis for the development of healthy cities. Additionally, it recommends that urban planning should prioritize the equitable distribution and high accessibility of both green and blue spaces to comprehensively enhance residents' physical and mental well-being. Policymakers should consider prioritizing the accessibility of high-quality green spaces for vulnerable communities during urban renewal and expansion processes to reduce social health inequalities and promote broader public health outcomes.

Nature-based social prescribing programmes: opportunities, challenges, and facilitators for implementation

BACKGROUND

Evidence on the health benefits of spending time in nature has highlighted the importance of provision of blue and green spaces where people live. The potential for health benefits offered by nature exposure, however, extends beyond health promotion to health treatment. Social prescribing links people with health or social care needs to community-based, non-clinical health and social care interventions to improve health and wellbeing. Nature-based social prescribing (NBSP) is a variant that uses the health-promoting benefits of activities carried out in natural environments, such as gardening and walking. Much current NBSP practice has been developed in the UK, and there is increasing global interest in its implementation. This requires interventions to be adapted for different contexts, considering the needs of populations and the structure of healthcare systems.

METHODS

This paper presents results from an expert group participatory workshop involving 29 practitioners, researchers, and policymakers from the UK and Germany's health and environmental sectors. Using the UK and Germany, two countries with different healthcare systems and in different developmental stages of NBSP practice, as case studies, we analysed opportunities, challenges, and facilitators for the development and implementation of NBSP.

RESULTS

We identified five overarching themes for developing, implementing, and evaluating NBSP: Capacity Building; Accessibility and Acceptability; Networks and Collaborations; Standardised Implementation and Evaluation; and Sustainability. We also discuss key strengths, weaknesses, opportunities, and threats for each overarching theme to understand how they could be developed to support NBSP implementation.

CONCLUSIONS

NBSP could offer significant public health benefits using available blue and green spaces. We offer guidance on how NBSP implementation, from wider policy support to the design and evaluation of individual programmes, could be adapted to different contexts. This research could help inform the development and evaluation of NBSP programmes to support planetary health from local and global scales.

New models of health and social care for people in later life: mapping of innovation in services in two regions of the United Kingdom using a mixed method approach

BACKGROUND

Innovation for reforming health and social care is high on the policy agenda in the United Kingdom in response to the growing needs of an ageing population. However, information about new innovations of care being implemented is sparse.

METHODS

We mapped innovations for people in later life in two regions, North East England and South East Scotland. Data collection included discussions with stakeholders (n = 51), semi-structured interviews (n = 14) and website searches that focused on technology, evaluation and health inequalities. We analysed qualitative data using framework and thematic analyses. Quantitative data were analysed descriptively.

RESULTS

One hundred eleven innovations were identified across the two regions. Interviewees reported a wide range of technologies that had been rapidly introduced during the COVID-19 pandemic and many remained in use. Digital exclusion of certain groups of older people was an ongoing concern. Innovations fell into two groups; system-level ones that aimed to alleviate systems pressures such as preventing hospital (re)admissions, and patient-level ones which sought to enhance health and wellbeing directly. Interviewees were aware of the importance of health inequalities but lacked data to monitor the impact of innovations on these, and evaluation was challenging due to lack of time, training, and support. Quantitative findings revealed that two thirds of innovations (n = 74, 67%) primarily focused on the system level, whilst a third (n = 37, 33%) primarily focused on the patient-level. Overall, over half (n = 65, 59%) of innovations involved technologies although relatively few (n = 12, 11%) utilised advanced technologies. Very few (n = 16, 14%) focused on reducing health inequalities, and only a minority of innovations (n = 43, 39%) had undergone evaluation (most of which were conducted by the service providers themselves).

CONCLUSIONS

We found a wide range of innovative care services being developed for people in later life, yet alignment with key policy priorities, such as addressing health inequalities, was limited. There was a strong focus on technology, with little consideration for the potential to widen the health inequality gap. The absence of robust evaluation was also a concern as most innovations were implemented without support to monitor effectiveness and/or without plans for sustainability and spread.

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.

Large walking and wellbeing behaviour benefits of co-designed sustainable park improvements: A natural experimental study in a UK deprived urban area

There is little robust evidence of how sustainable park interventions impact on physical activity and other behaviours important for wellbeing. This controlled natural experimental study aimed to examine the effects of co-designing a sustainable park intervention, in a deprived UK urban area, on walking and other wellbeing behaviours. Behaviour observations were conducted at two intervention sites and two matched comparison sites (n = 4,783). Walking observations (primary outcome), wellbeing behaviours (vigorous, sedentary, social and take notice activities) and demographic characteristics were assessed at pre-intervention, and post-intervention (3 and 15 months). Outcomes were compared between intervention and comparison groups, controlling for pre-intervention using multilevel negative binomial regression models. Additional behaviour observations were conducted in two unchanged nearby sites to assess changes in general local activity. Intercept surveys (n = 623) assessed change in self-reported outdoor space usage at intervention and control areas. Post-intervention, walking increased 203 % at 3 months (IRR 2·03, 95 % CI 1·01-4·09) and 351 % at 15 months (IRR 3·51, 95 % CI 2·07-5·93), for intervention sites relative to comparison sites. Large increases for other wellbeing behaviours were also observed. The proportion of non-white persons increased substantially post-intervention, compared to comparison sites. Nearby unchanged sites showed little evidence of general increased activity. Self-reported outdoor usage increased more in the intervention sites (p=<0·001). Sustainable solutions can yield large increases in walking and wellbeing in deprived areas, especially where interventions are co-designed with residents. More collaborative and robust natural experimental studies like this are needed to better inform decision-makers how to maximise health and wellbeing outcomes from sustainable interventions.

National plans and awareness campaigns as priorities for achieving global brain health

Neurological conditions are the leading cause of death and disability combined. This public health crisis has become a global priority with the introduction of WHO's Intersectoral Global Action Plan on Epilepsy and Other Neurological Disorders 2022-2031 (IGAP). 18 months after this plan was adopted, global neurology stakeholders, including representatives of the OneNeurology Partnership (a consortium uniting global neurology organisations), take stock and advocate for urgent acceleration of IGAP implementation. Drawing on lessons from relevant global health contexts, this Health Policy identifies two priority IGAP targets to expedite national delivery of the entire 10-year plan: namely, to update national policies and plans, and to create awareness campaigns and advocacy programmes for neurological conditions and brain health. To ensure rapid attainment of the identified priority targets, six strategic drivers are proposed: universal community awareness, integrated neurology approaches, intersectoral governance, regionally coordinated IGAP domestication, lived experience-informed policy making, and neurological mainstreaming (advocating to embed brain health into broader policy agendas). Contextualised with globally emerging IGAP-directed efforts and key considerations for intersectoral policy design, this novel framework provides actionable recommendations for policy makers and IGAP implementation partners. Timely, synergistic pursuit of the six drivers might aid WHO member states in cultivating public awareness and policy structures required for successful intersectoral roll-out of IGAP by 2031, paving the way towards brain health for all.