Making green infrastructure healthier infrastructure

Greenspaces and Health: Scoping Review of studies in Europe

Objectives

Access to greenspaces and contact with nature can promote physical activity and have positive effects on physical and mental health. This scoping literature review aims to examine current evidence linking greenspaces and (a) behaviour change, (b) health outcomes and (c) co-benefits.

Methods

This review was conducted in accordance with the PRISMA scoping review guidelines. Searches were conducted through PubMed and EMBASE databases for studies published between 2000 and March 2023 with a focus on Europe.

Results

122 scientific articles and grey literature reports were identified. Access to greenspaces is positively associated with physical and mental health, and reduced risk of all-cause mortality and some non-communicable diseases. Greenspace quality is associated with increased physical activity and reduced risk of obesity. Nature-based therapies or green prescription are effective in improving mental health outcomes and overall health. Importantly, numerous co-benefits of greenspaces are identified.

Conclusion

Increasing access to greenspaces for populations with particular attention to greenspace quality is important for co-benefits. Responsible governance and use of greenspaces are crucial to minimize public health risks and human disturbance of nature.

Long-term exposure to PM2.5 and mortality in a national cohort in South Korea: effect modification by community deprivation, medical infrastructure, and greenness

BACKGROUND

Long-term exposure to PM2.5 has been linked to increased mortality risk. However, limited studies have examined the potential modifying effect of community-level characteristics on this association, particularly in Asian contexts. This study aimed to estimate the effects of long-term exposure to PM2.5 on mortality in South Korea and to examine whether community-level deprivation, medical infrastructure, and greenness modify these associations.

METHODS

We conducted a nationwide cohort study using the National Health Insurance Service-National Sample Cohort. A total of 394,701 participants aged 30 years or older in 2006 were followed until 2019. Based on modelled PM2.5 concentrations, 1 to 3-year and 5-year moving averages of PM2.5 concentrations were assigned to each participant at the district level. Time-varying Cox proportional-hazards models were used to estimate the association between PM2.5 and non-accidental, circulatory, and respiratory mortality. We further conducted stratified analysis by community-level deprivation index, medical index, and normalized difference vegetation index to represent greenness.

RESULTS

PM2.5 exposure, based on 5-year moving averages, was positively associated with non-accidental (Hazard ratio, HR: 1.10, 95% Confidence Interval, CI: 1.01, 1.20, per 10 µg/m3 increase) and circulatory mortality (HR: 1.22, 95% CI: 1.01, 1.47). The 1-year moving average of PM2.5 was associated with respiratory mortality (HR: 1.33, 95% CI: 1.05, 1.67). We observed higher associations between PM2.5 and mortality in communities with higher deprivation and limited medical infrastructure. Communities with higher greenness showed lower risk for circulatory mortality but higher risk for respiratory mortality in association with PM2.5.

CONCLUSIONS

Our study found mortality effects of long-term PM2.5 exposure and underlined the role of community-level factors in modifying these association. These findings highlight the importance of considering socio-environmental contexts in the design of air quality policies to reduce health disparities and enhance overall public health outcomes.

Preferred reporting items in green space health research. Guiding principles for an interdisciplinary field

The relationship between green spaces and health is attracting more and more societal and research interest. The research field is however still suffering from its differing monodisciplinary origins. Now in a multidisciplinary environment on its way to a truly interdisciplinary field, there is a need for a common understanding, precision in green space indicators, and coherent assessment of the complexity of daily living environments. In several reviews, common protocols and open-source scripts are considered a high priority to advance the field. Realizing these issues, we developed PRIGSHARE (Preferred Reporting Items in Greenspace Health Research). It is accompanied by an open-source script that supports non-spatial disciplines in assessing greenness and green space on different scales and types. The PRIGSHARE checklist contains 21 items that have been identified as a risk of bias and are necessary for understanding and comparison of studies. The checklist is divided into the following topics: objectives (3 items), scope (3 items), spatial assessment (7 items), vegetation assessment (4 items), and context assessment (4 items). For each item, we include a pathway-specific (if relevant) rationale and explanation. The PRIGSHARE guiding principles should be helpful to support a high-quality assessment and synchronize the studies in the field while acknowledging the diversity of study designs.

Impact of Human Activities on Disease-Spreading Mosquitoes in Urban Areas

Urbanization is one of the leading global trends of the twenty-first century that has a significant impact on health. Among health challenges caused by urbanization, the relationship of urbanization between emergence and the spread of mosquito-borne infectious diseases (MBIDs) is a great public health concern. Urbanization processes encompass social, economic, and environmental changes that directly impact the biology of mosquito species. In particular, urbanized areas experience higher temperatures and pollution levels than outlying areas but also favor the development of infrastructures and objects that are favorable to mosquito development. All these modifications may influence mosquito life history traits and their ability to transmit diseases. This review aimed to summarize the impact of urbanization on mosquito spreading in urban areas and the risk associated with the emergence of MBIDs. Moreover, mosquitoes are considered as holobionts, as evidenced by numerous studies highlighting the role of mosquito-microbiota interactions in mosquito biology. Taking into account this new paradigm, this review also represents an initial synthesis on how human-driven transformations impact microbial communities in larval habitats and further interfere with mosquito behavior and life cycle in urban areas.

Features in and around residential gardens affecting the presence and abundance of questing Ixodes ricinus ticks

People may be exposed to questing Ixodes ricinus ticks in urban settings, e.g. residential gardens. Little is known about the garden characteristics that support a tick population. To determine which features in and around residential gardens support or limit the occurrence and abundance of questing I. ricinus ticks, we sampled them in residential gardens in the Braunschweig region that differed in various intrinsic and extrinsic parameters. We recorded the number of questing nymphal and adult ticks on transects, and by using mixed-effects generalized linear regression models, we related their occurrence and abundance to garden characteristics, meteorological covariates, and landscape features in the vicinity. We detected questing I. ricinus ticks in about 90% of the 103 surveyed gardens. Our occurrence model (marginal R2 = 0.31) predicted the highest probability of questing ticks on transects with hedges or groundcover in gardens, which are located in neighborhoods with large proportions of forest. The abundance of questing ticks was similarly influenced. We conclude that I. ricinus ticks are frequent in residential gardens in Northern Germany and likely associated with intrinsic garden characteristics on a small scale, such as hedges, as well as extrinsic factors on a local scale, such as the proportion of nearby woodland.

Developing an Integrated "Regression-QMRA method" to Predict Public Health Risks of Low Impact Developments (LIDs) for Improved Planning

Worldwide Low Impact Developments (LIDs) are used for sustainable stormwater management; however, both the stormwater and LIDs carry microbial pathogens. The widespread development of LIDs is likely to increase human exposure to pathogens and risk of infection, leading to unexpected disease outbreaks in urban communities. The risk of infection from exposure to LIDs has been assessed via Quantitative Microbial Risk Assessment (QMRA) during the operation of these infrastructures; no effort is made to evaluate these risks during the planning phase of LID treatment train in urban communities. We developed a new integrated "Regression-QMRA method" by examining the relationship between pathogens' concentration and environmental variables. Applying of this methodology to a planned LID train shows that the predicted disease burden of diarrhea from Campylobacter is highest (i.e. 16.902 DALYs/1000 persons/yr) during landscape irrigation and playing on the LID train, followed by Giardia, Cryptosporidium, and Norovirus. These results illustrate that the risk of microbial infection can be predicted during the planning phase of LID treatment train. These predictions are of great value to municipalities and decision-makers to make informed decisions and ensure risk-based planning of stormwater systems before their development.

Has the Pandemic Altered Public Perception of How Local Green Spaces Affect Quality of Life in the United Kingdom?

Green spaces unquestionably improve both physical and mental health, but there is little information on how they affect quality of life. This study investigates whether the public perception of how local green spaces and their impact on quality of life have altered as a result of restrictions imposed by the U.K.’s SARS-CoV-2 pandemic containment strategy. Qualitative data were collected using an online questionnaire distributed via social media platforms and postal flyers. The results clearly demonstrate that 90% of participants believe that green spaces improved their quality of life during the pandemic, with over 85% thinking that green spaces will continue to have a positive impact on their quality of life once the pandemic is over. Whether this is a permanent change in public thinking or a short-term adaptation to the stresses of the pandemic can be assessed in future research studies. More detailed research is required to understand more clearly the aspects and types of green spaces that are the most valuable for improving quality of life so that future ones can be designed to provide maximum benefits.

Socio-ecological drivers of multiple zoonotic hazards in highly urbanized cities

The ongoing COVID-19 pandemic is a stark reminder of the devastating consequences of pathogen spillover from wildlife to human hosts, particularly in densely populated urban centers. Prevention of future zoonotic disease is contingent on informed surveillance for known and novel threats across diverse human-wildlife interfaces. Cities are a key venue for potential spillover events because of the presence of zoonotic pathogens transmitted by hosts and vectors living in close proximity to dense human settlements. Effectively identifying and managing zoonotic hazards requires understanding the socio-ecological processes driving hazard distribution and pathogen prevalence in dynamic and heterogeneous urban landscapes. Despite increasing awareness of the human health impacts of zoonotic hazards, the integration of an eco-epidemiological perspective into public health management plans remains limited. Here we discuss how landscape patterns, abiotic conditions, and biotic interactions influence zoonotic hazards across highly urbanized cities (HUCs) in temperate climates to promote their efficient and effective management by a multi-sectoral coalition of public health stakeholders. We describe how to interpret both direct and indirect ecological processes, incorporate spatial scale, and evaluate networks of connectivity specific to different zoonotic hazards to promote biologically-informed and targeted decision-making. Using New York City, USA as a case study, we identify major zoonotic threats, apply knowledge of relevant ecological factors, and highlight opportunities and challenges for research and intervention. We aim to broaden the toolbox of urban public health stakeholders by providing ecologically-informed, practical guidance for the evaluation and management of zoonotic hazards.

Examining the paradox of urban disease ecology by linking the perspectives of Urban One Health and Ecology with Cities

The ecology of zoonotic, including vector-borne, diseases in urban social-ecological systems is influenced by complex interactions among human and environmental factors. Several characteristics contribute to the emergence and spread of infectious diseases in urban places, such as high human population densities, favorable habitat for vectors, and humans' close proximity to animals and their pathogens. On the other hand, urban living can contribute to the improvement of public health through better access to health services and creation of ecological and technological infrastructure that reduces disease burdens. Therefore, urbanization creates a disease ecology paradox through the interplay of urban health penalties and advantages for individual and community outcomes. To address this contradiction, we advocate a holistic Urban One Health perspective for managing urban systems, especially their green spaces and animal populations, in ways that more effectively control the spread of zoonotic diseases. This view should be coupled with an Ecology with Cities approach which emphasizes actionable science needed for urban planning, management and policymaking; developing disease and vector surveillance programs using citizen and community science methods; and improving education and communication actions that help diverse stakeholders understand the complexities of urban disease ecology. Such measures will enable scholars from many disciplines to collaborate with professionals, government officials, and others to tackle challenges of the urban disease paradox and create more sustainable, health-promoting environments.

Green Infrastructure and Health

The health benefits of green space are well known, but the health effects of green infrastructure less so. Green infrastructure goes well beyond the presence of green space and refers more to a strategically planned network of natural and seminatural areas, with other environmental features designed and managed to deliver a wide range of ecosystem services and possibly to improve human health. In this narrative review, we found that small green infrastructure, such as green roofs and walls, has the potential to mitigate urban flooding, attenuate indoor temperatures and heat islands, improve air quality, and muffle noise, among other benefits, but these effects have not been linked directly to health. Larger green infrastructure has been associated with reduced temperatures, air pollution, and crimes and violence, but less so with health, although some evidence suggests that it may be beneficial for health (e.g., good health, decreased mortality). Finally, parks and street trees show many health benefits, but it is not clear if they can always be considered green infrastructure.

Green Space and Health in Mainland China: A Systematic Review

Non-communicable diseases (NCDs) have become a major cause of premature mortality and disabilities in China due to factors concomitant with rapid economic growth and urbanisation over three decades. Promoting green space might be a valuable strategy to help improve population health in China, as well as a range of co-benefits (e.g., increasing resilience to climate change). No systematic review has so far determined the degree of association between green space and health outcomes in China. This review was conducted to address this gap. Five electronic databases were searched using search terms on green space, health, and China. The review of 83 publications that met eligibility criteria reports associations indicative of various health benefits from more green space, including mental health, general health, healthier weight status and anthropometry, and more favorable cardiometabolic and cerebrovascular outcomes. There was insufficient evidence to draw firm conclusions on mortality, birth outcomes, and cognitive function, and findings on respiratory and infectious outcomes were inconsistent and limited. Future work needs to examine the health benefits of particular types and qualities of green spaces, as well as to take advantage of (quasi-)experimental designs to test greening interventions within the context of China's rapid urbanization and economic growth.

A Review of Urban Green and Blue Infrastructure from the Perspective of Food-Energy-Water Nexus

Small scale urban green-blue infrastructure (indicated as GBI hereafter) comprises huge underexploited areas for urban development and planning. This review article aims to highlight the relevance and knowledge gaps regarding GBI from the perspective of the food–energy–water (FEW) nexus, these being key resources for the survival of human communities. In particular, this review was focused on publications on urban ecosystem services (positive effects) and dis-services (negative effects) associated with different GBI typologies. The review proved that GBI can contribute environmentally, socially, and economically to FEW security and urban sustainability. Yet, such positive effects must be considered against ecosystem dis-services tradeoffs, including urban food production, commonly connected with heavy water and energy consumption, specifically under dry climate conditions, and sometimes related to an excessive use of manure, pesticides, or fertilizers. These conditions could pose either a risk to water quality and local insect survival or serve enhanced mosquito breeding because of irrigation. Up to now, the review evidenced that few nexus modeling techniques have been discussed in terms of their benefits, drawbacks, and applications. Guidance is provided on the choice of an adequate modeling approach. Water, energy, and food are intrinsically associated physically. However, depending on their management, their tradeoffs are often increased. There is a need to minimize these tradeoffs and to build up synergies between food, energy, and water using a holistic approach. This is why the FEW nexus approach offers good insights to address the relation between three important individual resource components of sustainability.

An ecosystem service perspective on urban nature, physical activity, and health

Nature underpins human well-being in critical ways, especially in health. Nature provides pollination of nutritious crops, purification of drinking water, protection from floods, and climate security, among other well-studied health benefits. A crucial, yet challenging, research frontier is clarifying how nature promotes physical activity for its many mental and physical health benefits, particularly in densely populated cities with scarce and dwindling access to nature. Here we frame this frontier by conceptually developing a spatial decision-support tool that shows where, how, and for whom urban nature promotes physical activity, to inform urban greening efforts and broader health assessments. We synthesize what is known, present a model framework, and detail the model steps and data needs that can yield generalizable spatial models and an effective tool for assessing the urban nature-physical activity relationship. Current knowledge supports an initial model that can distinguish broad trends and enrich urban planning, spatial policy, and public health decisions. New, iterative research and application will reveal the importance of different types of urban nature, the different subpopulations who will benefit from it, and nature's potential contribution to creating more equitable, green, livable cities with active inhabitants.

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

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

Why a New Research Agenda on Green Spaces and Health Is Needed in Latin America: Results of a Systematic Review

(1) Background: Increasing and improving green spaces have been suggested to enhance health and well-being through different mechanisms. Latin America is experiencing fast population and urbanization growth; with rising demand for interventions to improve public health and mitigate climate change. (2) Aim: This study aimed to review the epidemiological evidence on green spaces and health outcomes in Latin America. (3) Methods: A systematic literature review of green spaces and health outcomes was carried out for studies published in Latin America before 28 September 2020. A search strategy was designed to identify studies published in Medline via PubMed and LILACS. The search strategy included terms related to green spaces combined with keywords related to health and geographical location. No time limit for the publication was chosen. The search was limited to English, Spanish, Portuguese, and French published articles and humans’ studies. (4) Findings: This systematic review found 19 epidemiological studies in Latin America related to green spaces and health outcomes. Nine studies were conducted in Brazil, six in Mexico, three in Colombia, and one in Chile. In terms of study design, 14 were cross-sectional studies, 3 ecological, and 2 cohort studies. The population included among the studies ranged from 120 persons to 103 million. The green space definition used among studies was green density or proximity (eight studies), green presence (five studies), green spaces index (four studies), and green space visit (two studies). The health outcomes included were mental health (six studies), overweight and obesity (three studies), quality of life (three studies), mortality (two studies), cardiorespiratory disease (one study), disability (one study), falls (one study), and life expectancy (one study). Eleven studies found a positive association between green spaces and health, and eight studies found no association. (5) Conclusion: This systematic review identified 19 epidemiological studies associating green spaces and health outcomes in Latin America. Most of the evidence suggests a positive association between green spaces and health in the region. However, most of the evidence was supported by cross-sectional studies. Prioritizing longitudinal studies with harmonized exposure and outcome definitions and including vulnerable and susceptible populations is needed in the region.

A tool for assessing the climate change mitigation and health impacts of environmental policies: the Cities Rapid Assessment Framework for Transformation (CRAFT)

Background: A growing number of cities, including Greater London, have set ambitious targets, including detailed policies and implementation plans, to reach global goals on sustainability, health, and climate change. Here we present a tool for a rapid assessment of the magnitude of impact of specific policy initiatives to reach these targets. The decision-support tool simultaneously quantifies the environmental and health impacts of specified selected policies. Methods: The 'Cities Rapid Assessment Framework for Transformation (CRAFT)' tool was applied to Greater London. CRAFT quantifies the effects of ten environmental policies on changes in (1) greenhouse gas (GHG) emissions, (2) exposures to environmental hazards, (3) travel-related physical activity, and (4) mortality (the number of attributable deaths avoided in one typical year). Publicly available data and epidemiological evidence were used to make rapid quantitative estimates of these effects based on proportional reductions in GHG emissions and environmental exposures from current baseline levels and to compute the mortality impacts. Results: The CRAFT tool estimates that, of roughly 50,000 annual deaths in Greater London, the modelled hazards (PM 2.5 (from indoor and outdoor sources), outdoor NO 2, indoor radon, cold, overheating) and low travel-related physical activity are responsible for approximately 10,000 premature environment-related deaths. Implementing the selected polices could reduce the annual mortality number by about 20% (~1,900 deaths) by 2050. The majority of these deaths (1,700) may be avoided through increased uptake in active travel. Thus, out of ten environmental policies, the 'active travel' policy provides the greatest health benefit. Also, implementing the ten policies results in a GHG reduction of around 90%. Conclusions: The CRAFT tool quantifies the effects of city policies on reducing GHG emissions, decreasing environmental health hazards, and improving public health. The tool has potential value for policy makers through providing quantitative estimates of health impacts to support and prioritise policy options.

Friends in All the Green Spaces: Weather Dependent Changes in Urban Mosquito (Diptera: Culicidae) Abundance and Diversity

Simple Summary

Many female mosquitoes require vertebrate blood for egg production. Cities are becoming increasingly important points of contact between mosquitoes and their prey, as large-scale urbanization continues. Human settlements represent unique but fragmented habitats that are permanently warmer than rural areas. Because of this, there is a growing demand to better understand urban mosquito populations and the factors affecting them in various circumstances. The aim of this study was to investigate the weather conditions influencing mosquito species and abundance in a Northern European town. Thus, a three-year-long mosquito collection effort was undertaken in Estonia. Results indicated that the number of active mosquitoes decreased with wind and higher temperatures. Interestingly, there was a significant negative correlation between temperature and humidity. Furthermore, while mosquitoes belonging to the Culex pipiens/Culex torrentium group were consistently abundant during the end of the warm season, other dominant species varied considerably between the months and the three study years. Overall, springtime hydrological conditions seemed to greatly influence the mosquito season. Urbanization could generate both higher temperatures and drier environments, resulting in fewer mosquitoes in some areas. This study also revealed the mosquito species most likely to contribute to disease transmission in Estonian towns.

Abstract

Mosquitoes (Diptera: Culicidae) are universally recognized as troublesome pests and vectors of various pathogens and parasites. Understandably, the species makeup and diversity of individual populations depends on local and broad scale environmental trends, especially on temperature and hydrological variations. Anthropogenic landscapes make for unique habitats, but their effect on insects likely varies across climatic regions. The aim of this study was to investigate the diversity and seasonal patterns of urban mosquitoes in the boreal region. Specimens were collected with an insect net from May to September during three years and determined to species or species group level. Weather information was added to each data point and results analyzed using multivariate regression models. Fieldwork yielded 1890 mosquitoes from four genera. Both abundance and the effective number of species (ENS) significantly decreased during the study period. The number of collected mosquitoes had a negative correlation with wind speed and temperature, latter of which exhibited a negative association with humidity. Species succession followed predictable patterns, but with some variation between years. Still, Culex pipiens/Culex torrentium were the most abundant throughout the study. Importantly, all dominant species were known disease vectors. Our work showed that higher temperatures could result in fewer mosquitoes in boreal towns.

Dealing with Green Gentrification and Vertical Green-Related Urban Well-Being: A Contextual-Based Design Framework

Urbanization and climate change have generated ever-increased pressure to the ecosystem, bringing critical resilience challenges to densely congested cities. The resulted displaced and encroached habitat in need of recuperation demands a comprehensive overhaul to the customary urban planning practices; further, the deteriorating public health state of urban residents calls for strategies in dealing with green deprivation and gentrification issues. Frequently, urban greening strategies are envisaged at a macro-scale on a dedicated horizontal track of land, rendering local implementation in a densely built neighborhood a challenged undertaking. Communities lacking green and land resources could promote vertical greening to enable and enhance social and psychological well-being. This study ascertains that vertical greenery closest to the inhabitants could be allocated on a building facade. It can contribute to a more sustainable ecology. The article presents the systemic design approach to urban vertical greening thinking and its role in well-being provision. We propose an interdisciplinary multicriteria contextual-based scalable framework to assess vertical green infrastructure; the prototype requires an innovative approach to balance architecture, human needs, and the local environment. The vertical greening application provides an alternative paradigm in the design implementation for urban green. We proposed the locality and place to be incorporated into the vertical greening design framework. The research concludes the three-tiered consideration framework resulted: (1) in line with the human-habitat ecosystem, the local environment-social dimension is explored; (2) the well-being criteria encourage the design practice’s support for localized driven community vitality; (3) the design paradigm requires integration with the increasing demand for green space as well as taking into account the impact of severe climate; and (4) the framework should achieve the strengthening of health and well-being of the community.

A tool for assessing the climate change mitigation and health impacts of environmental policies: the Cities Rapid Assessment Framework for Transformation (CRAFT)

Background: A growing number of cities, including Greater London, have set ambitious targets, including detailed policies and implementation plans, to reach global goals on sustainability, health, and climate change. Here we present a tool for a rapid assessment of the magnitude of impact of specific policy initiatives to reach these targets. The decision-support tool simultaneously quantifies the environmental and health impacts of specified selected policies. Methods: The 'Cities Rapid Assessment Framework for Transformation (CRAFT)' tool was applied to Greater London. CRAFT quantifies the effects of ten environmental policies on changes in (1) greenhouse gas (GHG) emissions, (2) exposures to environmental hazards, (3) travel-related physical activity, and (4) mortality (the number of attributable deaths avoided in one typical year). Publicly available data and epidemiological evidence were used to make rapid quantitative estimates of these effects based on proportional reductions in GHG emissions and environmental exposures from current baseline levels and to compute the mortality impacts. Results: The CRAFT tool estimates that, of roughly 50,000 annual deaths in Greater London, the modelled hazards (PM 2.5 (from indoor and outdoor sources), outdoor NO 2, indoor radon, cold, overheating) and low travel-related physical activity are responsible for approximately 10,000 premature environment-related deaths. Implementing the selected polices could reduce the annual mortality number by about 20% (~1,900 deaths) by 2050. The majority of these deaths (1,700) may be avoided through increased uptake in active travel. Thus, out of ten environmental policies, the 'active travel' policy provides the greatest health benefit. Also, implementing the ten policies results in a GHG reduction of around 90%. Conclusions: The CRAFT tool quantifies the effects of city policies on reducing GHG emissions, decreasing environmental health hazards, and improving public health. The tool has potential value for policy makers through providing quantitative estimates of health impacts to support and prioritise policy options.

It Is Not Easy Being Green: Recognizing Unintended Consequences of Green Stormwater Infrastructure

Green infrastructure designed to address urban drainage and water quality issues is often deployed without full knowledge of potential unintended social, ecological, and human health consequences. Though understood in their respective fields of study, these diverse impacts are seldom discussed together in a format understood by a broader audience. This paper takes a first step in addressing that gap by exploring tradeoffs associated with green infrastructure practices that manage urban stormwater including urban trees, stormwater ponds, filtration, infiltration, rain gardens, and green roofs. Each green infrastructure practice type performs best under specific conditions and when targeting specific goals, but regular inspections, maintenance, and monitoring are necessary for any green stormwater infrastructure (GSI) practice to succeed. We review how each of the above practices is intended to function and how they could malfunction in order to improve how green stormwater infrastructure is designed, constructed, monitored, and maintained. Our proposed decision-making framework, using both biophysical (biological and physical) science and social science, could lead to GSI projects that are effective, cost efficient, and just.

Designing Urban Green Blue Infrastructure for Mental Health and Elderly Wellbeing

The main objective of this essay is to illustrate the state-of-the-art on ‘mental health-sensitive’ open space design in the built environment. Urban Green Blue Infrastructure can contribute to urbanites’ mental health and wellbeing as well as healthy aging, while providing co-benefits balancing the negative impacts of climate change, through the provision of integrated ecosystem services. There are a number of ways that exposure to and affiliation with Nature have shown to support mental health, but we are still missing the necessary evidence of the actual benefits achieved, as well as the key performance indicators and metrics to monitor and adapt our open space to the growing urban challenges. After introducing the key concepts of degenerative mental disorders as they are growing in the urban environment, and the emerging green blue infrastructure design approach, the authors present international case studies describing how evidence-based design and Nature-based Solutions have been found to be beneficial, especially to those diagnosed with mental disorders. Subsequently, in a comparative critical analysis, the authors look closer at a number of design solutions capable, at different scales, to support healthy aging through exposure to, and affiliation with, biodiversity.

Green spaces and mortality: a systematic review and meta-analysis of cohort studies

BACKGROUND

Green spaces have been proposed to be a health determinant, improving health and wellbeing through different mechanisms. We aimed to systematically review the epidemiological evidence from longitudinal studies that have investigated green spaces and their association with all-cause mortality. We aimed to evaluate this evidence with a meta-analysis, to determine exposure-response functions for future quantitative health impact assessments.

METHODS

We did a systematic review and meta-analysis of cohort studies on green spaces and all-cause mortality. We searched for studies published and indexed in MEDLINE before Aug 20, 2019, which we complemented with an additional search of cited literature. We included studies if their design was longitudinal; the exposure of interest was measured green space; the endpoint of interest was all-cause mortality; they provided a risk estimate (ie, a hazard ratio [HR]) and the corresponding 95% CI for the association between green space exposure and all-cause mortality; and they used normalised difference vegetation index (NDVI) as their green space exposure definition. Two investigators (DR-R and DP-L) independently screened the full-text articles for inclusion. We used a random-effects model to obtain pooled HRs. This study is registered with PROSPERO, CRD42018090315.

FINDINGS

We identified 9298 studies in MEDLINE and 13 studies that were reported in the literature but not indexed in MEDLINE, of which 9234 (99%) studies were excluded after screening the titles and abstracts and 68 (88%) of 77 remaining studies were excluded after assessment of the full texts. We included nine (12%) studies in our quantitative evaluation, which comprised 8 324 652 individuals from seven countries. Seven (78%) of the nine studies found a significant inverse relationship between an increase in surrounding greenness per 0·1 NDVI in a buffer zone of 500 m or less and the risk of all-cause mortality, but two studies found no association. The pooled HR for all-cause mortality per increment of 0·1 NDVI within a buffer of 500 m or less of a participant's residence was 0·96 (95% CI 0·94-0·97; I², 95%).

INTERPRETATION

We found evidence of an inverse association between surrounding greenness and all-cause mortality. Interventions to increase and manage green spaces should therefore be considered as a strategic public health intervention.

FUNDING

World Health Organization.

Interactions between Ambient Air Particles and Greenness on Cause-specific Mortality in Seven Korean Metropolitan Cities, 2008-2016

This study aims to investigate the association of particulate matter with an aerodynamic diameter smaller than 10 μm (PM₁₀) and greenness with cause-specific mortality and their interactions in seven Korean metropolitan cities. We obtained the annual standardized cause-specific mortality rates, annual mean concentration of PM₁₀, and annual Normalized Difference Vegetation Index (NDVI) for 73 districts for the period 2008-2016. We used negative binomial regression with city-specific random effects to estimate the association of PM₁₀ and greenness with mortality. The models were adjusted for potential confounders and spatial autocorrelation. We also conducted stratified analyses to investigate whether the association between PM₁₀ and mortality differs by the level of greenness. Our findings suggest an increased risk of all causes examined, except respiratory disease mortality, with high levels of PM₁₀ and decreased risk of cardiovascular-related mortality with a high level of greenness. In the stratified analyses, we found interactions between PM₁₀ and greenness, but these interactions in the opposite direction depend on the cause of death. The effects of PM₁₀ on cardiovascular-related mortality were attenuated in greener areas, whereas the effects of PM₁₀ on non-accidental mortality were attenuated in less green areas. Further studies are needed to explore the underlying mechanisms.

[Green environments and forests in cities: Benefits and risks for human health according to the "one health" approach]

The new One Health approach proposes to view the human-animal-ecosystems relations as a continuum. This systemic approach proves very valuable when examining the links between wooded green spaces in urban areas and the health of city dwellers (more than half of the world population). These links and their diversity and complexity are now beginning to be adequately documented by the scientific literature. Some benefits and risks for human health can now be better analysed enabling areas for useful action in the future to be identified.

Greenspace and Atopic Sensitization in Children and Adolescents-A Systematic Review

In the last decade, studies investigating greenspace have highlighted several benefits to human health. However, the effect of greenspace on allergies and atopic sensitization in children was not clear. While several studies have investigated this link, the evidence has not been systematically synthesized. We conducted a systematic search of eight databases. Study characteristics and findings were extracted from five articles covering 11 cohorts published between 2012 and 2016, and study quality assessments were performed. Due to significant heterogeneity, meta-analysis was not conducted. Findings were not consistent, possibly due to variations in exposure measurements, study populations and location, the specific allergens tested, and inclusion of confounders. Protective effects from greenspace were reported in four cohorts, while two cohorts showed an increase in sensitization related to greenspace. The other five cohorts found no significant effect of greenspace on atopic sensitization. There is limited understanding of the contributions of greenspace to specific allergens. Future research should consider amount and type of greenspace, as well as the specific allergens tested.

Biodiversity and human health: mechanisms and evidence of the positive health effects of diversity in nature and green spaces

INTRODUCTION

Natural environments and green spaces provide ecosystem services that enhance human health and well-being. They improve mental health, mitigate allergies and reduce all-cause, respiratory, cardiovascular and cancer mortality. The presence, accessibility, proximity and greenness of green spaces determine the magnitude of their positive health effects, but the role of biodiversity (including species and ecosystem diversity) within green spaces remains underexplored. This review describes mechanisms and evidence of effects of biodiversity in nature and green spaces on human health.

SOURCES OF DATA

We identified studies listed in PubMed and Web of Science using combinations of keywords including 'biodiversity', 'diversity', 'species richness', 'human health', 'mental health' and 'well-being' with no restrictions on the year of publication. Papers were considered for detailed evaluation if they were written in English and reported data on levels of biodiversity and health outcomes.

AREAS OF AGREEMENT

There is evidence for positive associations between species diversity and well-being (psychological and physical) and between ecosystem diversity and immune system regulation.

AREAS OF CONCERN

There is a very limited number of studies that relate measured biodiversity to human health. There is more evidence for self-reported psychological well-being than for well-defined clinical outcomes. High species diversity has been associated with both reduced and increased vector-borne disease risk.

GROWING POINTS

Biodiversity supports ecosystem services mitigating heat, noise and air pollution, which all mediate the positive health effects of green spaces, but direct and long-term health outcomes of species diversity have been insufficiently studied so far.

AREAS TIMELY FOR RESEARCH

Additional research and newly developed methods are needed to quantify short- and long-term health effects of exposure to perceived and objectively measured species diversity, including health effects of nature-based solutions and exposure to microbiota.

The importance of green spaces to public health: a multi-continental analysis

As green spaces are a common feature of liveable cities, a detailed understanding of the benefits provided by these areas is essential. Although green spaces are regarded as a major contribution to the human well-being in urbanized areas, current research has largely focused on the cities in developed countries and their global importance in terms of public health benefits remains unclear. In this study, we performed a multiple linear regression using 34 cities in different regions across the globe to investigate the relationship between green spaces and public health. Our analysis suggested that for richer cities, green spaces were associated with better public health; whereas a greater area of green spaces was associated with reduced public health in the poorest cities. In contrast to previous studies, which typically found positive relationships between green spaces and health benefits, we demonstrate that health benefits of green spaces could be context dependent.