Which urban land covers/uses are associated with residents’ mortality? A cross-sectional, ecological, pan-European study of 233 cities

Abstract

​ObjectivesThe study aim was to determine whether the range and distribution of all, and proportions of specific, land covers/uses within European cities are associated with city-specific mortality rates.​Setting233 European cities within 24 countries.​ParticipantsAggregated city-level all-cause and age-group standardised mortality ratio for males and females separately and Western or Eastern European Region.​ResultsThe proportion of specific land covers/uses within a city was related to mortality, displaying differences by macroregion and sex. The land covers/uses associated with lower standardised mortality ratio (SMR) for both Western and Eastern European cities were those characterised by ‘natural’ green space, such as forests and semi-natural areas (Western Female coefficient: −18.3, 95% CI −29.8 to −6.9). Dense housing was related to a higher SMR, most prominently in Western European cities (Western Female coefficient: 17.4, 95% CI 9.6 to 25.2).​ConclusionsThere is pressure to build on urban natural spaces, both for economic gain and because compact cities are regarded as more sustainable, yet here we offer evidence that doing so may detract from residents’ health. Our study suggests that urban planners and developers need to regard retaining more wild and unstructured green space as important for healthy city systems.

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

“…26 In Spain, Mueller and colleagues 21 estimated that around 60 deaths annually could be prevented in one neighbourhood of Barcelona by implementing the Superblocks Program and increasing the percentage of green space from 6•5% to 19•6% GA. 21 Furthermore, a large study examined the impact of land use or cover and mortality in 233 cities from 24 European countries and found a reduction in mortality in areas with more green spaces (ie, in cities in eastern and western Europe). 40 Open and public green spaces in cities (best represented by the %GA proxy) have been associated with increased physical activity levels, social interaction and social cohesion, psychological restoration (ie, stress reduction and attention restoration), and better general health and wellbeing. 1 Additionally, parks and larger green spaces provide ecosystem services by mitigating detrimental exposures, such as air pollution, noise, and the urban heat island effect.…”

Not all types of nature have an equal effect on urban residents’ well-being: A structural equation model approach

“…Past research on the potential influence of nature near citizens' residences on well-being has mainly investigated the association between nature and specific dimensions of well-being, such as its psychological (e.g., Mitchell, 2013;Pope et al, 2015;van den Berg et al, 2010;White et al, 2017;Wood et al, 2017) or physical (Olsen et al, 2019b;Richardson and Mitchell, 2010) aspects, or between nature and quality of life (Olsen et al, 2019a). To our knowledge, the potential effects of nature on well-being as a comprehensive concept have not been investigated.…”

“…Second, the study deepens our understanding of the association between the "nature of nature" and well-being. The recent research conducted by Olsen et al (2019b) outlines differing associations between various urban land types and uses and mortality rates in European cities.…”

“…While past research has contributed to demonstrating empirically the association between urban green spaces or nature and urban residents' well-being, and provided theoretical explanations for it, such studies rarely consider the various types of nature and vegetation that urban spaces may host. With a few recent exceptions (e.g., Weber and Schneider, 2021 on green alleys; de Bell et al, 2020 on private gardens;Olsen et al, 2019b on different types of land cover; or Dzhambov et al, 2021 on indoor and outdoor greenery), empirical research conducted on the effects of urban nature has focused on green spaces. Although such areas may include spaces of various sizes and types (e.g., recreational, sports or nature parks, see Wood et al, 2017) and greatly contribute to urban residents' well-being and health, especially during crisis periods (see Poortinga et al, 2021), they do not represent all types of nature from which urban residents may benefit.…”

Going Green and Going Dense: A Systematic Review of Compatibilities and Conflicts in Urban Research

“…Some studies, mostly focused on physical health outcomes, suggest close associations between dense urban environments with a lack of green spaces and poor health outcomes. For instance, two large-scale studies in multiple European and Chinese cities evaluated the association between urban form elements such as land covers and mortality ratios, finding that dense urban environments with a lack of green land covers were associated with a higher mortality [75,76]. Additionally, a study conducted by Xie, et al [77] in Wuhan, China, found that population density and building density were positively associated with stroke risk and, in contrast, a negative correlation between abundance of public parks and stroke risk, regardless of urban density.…”