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

Iungman, Tamara; Khomenko, Sasha; Nieuwenhuijsen, Mark; Barboza, Evelise Pereira; Ambrós, Albert; Padilla, Cindy; Mueller, Natalie

doi:10.1016/j.envres.2021.110988

Cited by 19 publications

(18 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

Section: Discussionsupporting

confidence: 83%

“…Results of other studies using a similar health impact assessment methodology are comparable to our estimates for the %GA proxy and were conducted in the European cities of Vienna, 23 Barcelona, 22,24 Bradford, 25 and Madrid. 24 Moreover, Mitsakou and colleagues 39 reported preventable mortality rates slightly higher than ours for Athens, Barcelona, and Lisbon, while slightly lower for London, Stockholm, and Turin. The differences in the values by Mitsakou and colleagues and ours might partially be due to the difference in the spatial unit, from a fine scale (ie, grid cell in our study) to a medium scale (ie, city or district level in their study).…”

Section: Discussionsupporting

confidence: 83%

“…For NDVI, we estimated that 62% of the population (city range 15-97%) had residences in areas where the NDVI level was below the city-target NDVI. An increase in NDVI could prevent 42 968 (95% CI 32 296-64 177) deaths annually (ie, 20% [95% CI [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][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 (table 1). For %GA, we estimated that 65% of the population (city range of 4% to 100%) had not enough access to green spaces within 300 m linear distance from their residences.…”

Section: Resultsmentioning

confidence: 99%

“…Despite not accounting for within-city variability in mortality and age, the analysis at the 250 m scale allowed us to consider the variability in residential green space exposure within-city, and results were comparable to those from previous studies. [22][23][24][25] Additionally, more in-depth geographical health impact assessment analyses could be performed when withincity mortality and age-structure data become available.…”

Section: Discussionmentioning

confidence: 99%

“…We performed the analysis by city and greater city. We followed the Urban and Transport Planning Health Impact Assessment methodology, [21][22][23][24][25][26] based on the comparative risk assessment approach in relation to a counterfactual scenario. 27 We defined our counterfactual scenario as compliance with the WHO recommendation of universal residential access to green space, because it is the only internationally recognised recommendation, and retrieved exposureresponse functions from the literature, quantifying the strength of association between exposure to green space and mortality.…”

Section: Quantitative Health Impact Assessmentmentioning

confidence: 99%

See 4 more Smart Citations

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

Barboza

Cirach

Khomenko

et al. 2021

The Lancet Planetary Health

Self Cite

164

View full text Add to dashboard Cite

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. MethodsIn 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 agestructures 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.

show abstract