Changing the urban design of cities for health: The superblock model

Density or Connectivity: What Are the Main Causes of the Spatial Proliferation of COVID-19 in Korea?

COVID-19 has sparked a debate on the vulnerability of densely populated cities. Some studies argue that high-density urban centers are more vulnerable to infectious diseases due to a higher chance of infection in crowded urban environments. Other studies, however, argue that connectivity rather than population density plays a more significant role in the spread of COVID-19. While several studies have examined the role of urban density and connectivity in Europe and the U.S., few studies have been conducted in Asian countries. This study aims to investigate the role of urban spatial structure on COVID-19 by comparing different measures of urban density and connectivity during the first eight months of the outbreak in Korea. Two measures of density were derived from the Korean census, and four measures of connectivity were computed using social network analysis of the Origin-Destination data from the 2020 Korea Transport Database. We fitted both OLS and negative binomial models to the number of confirmed COVID-19 patients and its infection rates at the county level, collected individually from regional government websites in Korea. Results show that both density and connectivity play an important role in the proliferation of the COVID-19 outbreak in Korea. However, we found that the connectivity measure, particularly a measure of network centrality, was a better indicator of COVID-19 proliferation than the density measures. Our findings imply that policies that take into account different types of connectivity between cities might be necessary to contain the outbreak in the early phase.

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

BACKGROUND

The population living in urban areas is growing rapidly. The level of exposure to adverse environmental factors is detrimental to human health and is directly related to urban and transport planning practices.

OBJECTIVE

To estimate the premature mortality burden of non-compliance with international exposure guidelines for air pollution, noise, access to green space and heat for Barcelona and Madrid (Spain), and its distribution among the population by the socioeconomic status (SES).

METHODS

The Urban and TranspOrt planning Health Impact Assessment (UTOPHIA) tool was applied and the attributable premature mortality due to non-compliance with recommended exposure levels was estimated. The distribution of the attributable mortality burden among the population by SES was investigated through Generalized Additive Models (GAMs) adjusting for spatial autocorrelation and a cluster analysis was performed to identify attributable mortality hot spots.

RESULTS

Annually, 7.1% and 3.4% of premature mortality in Barcelona and Madrid, respectively, could be attributed to non-compliance with the international exposure recommendations for air pollution, noise, heat and access to green space. In addition, analysis by SES showed that in Barcelona lower SES areas had an overall greater attributable mortality rate, while in Madrid, the distribution of the attributable mortality burden by SES varied by exposure.

CONCLUSION

This study shows the impact of environmental exposures on mortality and highlights the importance of taking integrated actions when designing cities considering the health impacts, but also the specificities of each city such as the socio-demographic context. Moreover, the high precision scale of the analysis enables the identification of environmental hazards and mortality hot spots providing a powerful tool to support priority-setting and guide policymakers towards a healthy, sustainable and just city for all of their residents.

Towards Sustainable Urbanization. Learning from What’s Out There

The incremental recognition of the importance of land as a finite resource has led to the adoption and implementation of an increasing number of sustainable land use practices in European cities and regions. This paper reflects on these experiences, building on the evidence collected in the framework of the ESPON SUPER pan-European research project. In particular, the authors look at the project’s database, which includes 235 examples of sustainable urbanization interventions gathered from all around Europe. In doing so, they reflect on the outcomes of these interventions, focusing on both their scope and objectives and the types of instruments that were adopted in their implementation. The objective of this contribution is to critically analyze the rich set of practices collected throughout the project and to provide guidance for decision and policy makers aiming at promoting a more sustainable use of land. In this light, it suggests a number of recommendations and warnings, bearing in mind that no “right instruments” or “right targets” exist that could prove successful for all European cities and regions.

The Challenge of the Urban Compact Form: Three-Dimensional Index Construction and Urban Land Surface Temperature Impacts

Cities are growing higher and denser, and understanding and constructing the compact city form is of great importance to optimize sustainable urbanization. The two-dimensional (2D) urban compact form has been widely studied by previous researchers, while the driving mechanism of three-dimensional (3D) compact morphology, which reflects the reality of the urban environment has seldom been developed. In this study, land surface temperature (LST) was retrieved by using the mono-window algorithm method based on Landsat 8 images of Xiamen in South China, which were acquired respectively on 14 April, 15 August, 2 October, and 21 December in 2017, and 11 March in 2018. We then aimed to explore the driving mechanism of the 3D compact form on the urban heat environment (UHE) based on our developed 3D Compactness Index (VCI) and remote sensing, as well as Geo-Detector techniques. The results show that the 3D compact form can positively effect UHE better than individual urban form construction elements, as can the combination of the 2D compact form with building height. Individually, building density had a greater effect on UHE than that of building height. At the same time, an integration of building density and height showed an enhanced inter-effect on UHE. Moreover, we explore the temporal and spatial UHE heterogeneity with regards to 3D compact form across different seasons. We also investigate the UHE impacts discrepancy caused by different 3D compactness categories. This shows that increasing the 3D compactness of an urban community from 0.016 to 0.323 would increase the heat accumulation, which was, in terms of satellite derived LST, by 1.35 °C, suggesting that higher compact forms strengthen UHE. This study highlights the challenge of the urban 3D compact form in respect of its UHE impact. The related evaluation in this study would help shed light on urban form optimization.

Assessing the Distribution of Air Pollution Health Risks within Cities: A Neighborhood-Scale Analysis Leveraging High-Resolution Data Sets in the Bay Area, California

BACKGROUND

Air pollution-attributable disease burdens reported at global, country, state, or county levels mask potential smaller-scale geographic heterogeneity driven by variation in pollution levels and disease rates. Capturing within-city variation in air pollution health impacts is now possible with high-resolution pollutant concentrations.

OBJECTIVES

We quantified neighborhood-level variation in air pollution health risks, comparing results from highly spatially resolved pollutant and disease rate data sets available for the Bay Area, California.

METHODS

We estimated mortality and morbidity attributable to nitrogen dioxide (NO2), black carbon (BC), and fine particulate matter [PM ≤2.5μm in aerodynamic diameter (PM2.5)] using epidemiologically derived health impact functions. We compared geographic distributions of pollution-attributable risk estimates using concentrations from a) mobile monitoring of NO2 and BC; and b) models predicting annual NO2, BC and PM2.5 concentrations from land-use variables and satellite observations. We also compared results using county vs. census block group (CBG) disease rates.

RESULTS

Estimated pollution-attributable deaths per 100,000 people at the 100-m grid-cell level ranged across the Bay Area by a factor of 38, 4, and 5 for NO2 [mean=30 (95% CI: 9, 50)], BC [mean=2 (95% CI: 1, 2)], and PM2.5, [mean=49 (95% CI: 33, 64)]. Applying concentrations from mobile monitoring and land-use regression (LUR) models in Oakland neighborhoods yielded similar spatial patterns of estimated grid-cell-level NO2-attributable mortality rates. Mobile monitoring concentrations captured more heterogeneity [mobile monitoring mean=64 (95% CI: 19, 107) deaths per 100,000 people; LUR mean=101 (95% CI: 30, 167)]. Using CBG-level disease rates instead of county-level disease rates resulted in 15% larger attributable mortality rates for both NO2 and PM2.5, with more spatial heterogeneity at the grid-cell-level [NO2 CBG mean=41 deaths per 100,000 people (95% CI: 12, 68); NO2 county mean=38 (95% CI: 11, 64); PM2.5 CBG mean=59 (95% CI: 40, 77); and PM2.5 county mean=55 (95% CI: 37, 71)].

DISCUSSION

Air pollutant-attributable health burdens varied substantially between neighborhoods, driven by spatial variation in pollutant concentrations and disease rates. https://doi.org/10.1289/EHP7679.

Premature mortality due to air pollution in European cities: a health impact assessment

BACKGROUND

Ambient air pollution is a major environmental cause of morbidity and mortality worldwide. Cities are generally hotspots for air pollution and disease. However, the exact extent of the health effects of air pollution at the city level is still largely unknown. We aimed to estimate the proportion of annual preventable deaths due to air pollution in almost 1000 cities in Europe.

METHODS

We did a quantitative health impact assessment for the year 2015 to estimate the effect of air pollution exposure (PM_2·5 and NO₂) on natural-cause mortality for adult residents (aged ≥20 years) in 969 cities and 47 greater cities in Europe. We retrieved the cities and greater cities from the Urban Audit 2018 dataset and did the analysis at a 250 m grid cell level for 2015 data based on the global human settlement layer residential population. We estimated the annual premature mortality burden preventable if the WHO recommended values (ie, 10 μg/m³ for PM_2·5 and 40 μg/m³ for NO₂) were achieved and if air pollution concentrations were reduced to the lowest values measured in 2015 in European cities (ie, 3·7 μg/m³ for PM_2·5 and 3·5 μg/m³ for NO₂). We clustered and ranked the cities on the basis of population and age-standardised mortality burden associated with air pollution exposure. In addition, we did several uncertainty and sensitivity analyses to test the robustness of our estimates.

FINDINGS

Compliance with WHO air pollution guidelines could prevent 51 213 (95% CI 34 036-68 682) deaths per year for PM_2·5 exposure and 900 (0-2476) deaths per year for NO₂ exposure. The reduction of air pollution to the lowest measured concentrations could prevent 124 729 (83 332-166 535) deaths per year for PM_2·5 exposure and 79 435 (0-215 165) deaths per year for NO₂ exposure. A great variability in the preventable mortality burden was observed by city, ranging from 0 to 202 deaths per 100 000 population for PM_2·5 and from 0 to 73 deaths for NO₂ per 100 000 population when the lowest measured concentrations were considered. The highest PM_2·5 mortality burden was estimated for cities in the Po Valley (northern Italy), Poland, and Czech Republic. The highest NO₂ mortality burden was estimated for large cities and capital cities in western and southern Europe. Sensitivity analyses showed that the results were particularly sensitive to the choice of the exposure response function, but less so to the choice of baseline mortality values and exposure assessment method.

INTERPRETATION

A considerable proportion of premature deaths in European cities could be avoided annually by lowering air pollution concentrations, particularly below WHO guidelines. The mortality burden varied considerably between European cities, indicating where policy actions are more urgently needed to reduce air pollution and achieve sustainable, liveable, and healthy communities. Current guidelines should be revised and air pollution concentrations should be reduced further to achieve greater protection of health in cities.

FUNDING

Spanish Ministry of Science and Innovation, Internal ISGlobal fund.

A Methodological Approach on Disused Public Properties in the 15-Minute City Perspective

Accessibility and Walkability represent, today, some of the most striking challenges contemporary cities are facing, particularly in light of the goals from UN Agenda 2030, aimed at a sustainable city, and particularly in terms of a livable, healthy and inclusive city. This can be also performed thanks to a set of high quality public services and a set of important and central services and infrastructures. These principles, however, are constrained by an overall, general fragmentation affecting many urban areas, particularly as an outcome of the vehicular accessibility needs. Scholars have debated through the years on the nature of cities and on the preference for centrality of services compared to the distribution of services towards dispersed neighborhood units. Recently, a need for a wider, minimum set of services that is easily reachable to most citizens is filling the scholars and city mayors’ agendas in order to improve urban performances. This is also coupled with a huge surge in the heritage of abandoned urban items coming from previous periods of time and alternative uses. The aim of this research is to evaluate the role of abandoned urban assets—particularly big-size buildings and compounds and their areas—to facilitate the implementation of the concept of a 15-minute city, a city that is capable of granting a wider social equality and access to main urban services to citizens and city users. To do this, we developed a set of indexes, capable of detecting porosity, crossing and attractiveness. This latter index in particular represents a combined index that can be used to improve the accessibility of pedestrians in urban central locations. In the present research, we decided to limit the analysis to a subset of disused public buildings in the historic center of a sample city, as Cagliari (Sardinia, Italy). This was done in order to understand if and in which terms they can contribute, after their redevelopment, to the development of the 15-minute city, as well as reducing the “enclave–effect: they are, at present, playing in the historic urban fabric.

Defining pathways to healthy sustainable urban development

Goals and pathways to achieve sustainable urban development have multiple interlinkages with human health and wellbeing. However, these interlinkages have not been examined in depth in recent discussions on urban sustainability and global urban science. This paper fills that gap by elaborating in detail the multiple links between urban sustainability and human health and by mapping research gaps at the interface of health and urban sustainability sciences. As researchers from a broad range of disciplines, we aimed to: 1) define the process of urbanization, highlighting distinctions from related concepts to support improved conceptual rigour in health research; 2) review the evidence linking health with urbanization, urbanicity, and cities and identify cross-cutting issues; and 3) highlight new research approaches needed to study complex urban systems and their links with health. This novel, comprehensive knowledge synthesis addresses issue of interest across multiple disciplines. Our review of concepts of urban development should be of particular value to researchers and practitioners in the health sciences, while our review of the links between urban environments and health should be of particular interest to those outside of public health. We identify specific actions to promote health through sustainable urban development that leaves no one behind, including: integrated planning; evidence-informed policy-making; and monitoring the implementation of policies. We also highlight the critical role of effective governance and equity-driven planning in progress towards sustainable, healthy, and just urban development.

Could smart research ensure healthy people in disrupted cities?

BACKGROUND

Since the late 19th century, city planners have struggled to cope with new types of urban transport and mobility that threatened the existing system, or even rendered it obsolete.

PURPOSE

As city planners confront the range of disruptive urban mobilities currently on the horizon, this paper explores how we can draw on a vast body of evidence to anticipate and avoid unintended consequences to people's health and wellbeing.

METHODS

This commentary involved a rapid review of the literature on transport disruption.

RESULTS

We found that to avoid the unintended consequences of disruption, research, policy and practice must think beyond single issues (such as the risk of chronic disease, injury, or traffic management) and consider the broader consequences of interventions. For example, although autonomous vehicles will probably reduce road trauma, what will be the negative consequences for physical inactivity, sedentary behavior, chronic disease, land use, traffic congestion and commuting patterns? Research is needed that considers and informs how to mitigate the range of potential harms caused by disruptive mobilities.

CONCLUSION

In the face of new disruptive mobilities, we must: (a) draw on existing evidence to shape new regulations that address the 'who, when and where' rules of introducing new mobilities (such as electric assisted bicycles (e-bikes) and scooters (e-scooters)) of which the health repercussions can be easily anticipated; (b) monitor and evaluate the implementation of any interventions through natural experiment studies; and (c) use innovative research methods (such as agent-based simulation and health-impact-assessment modelling) to assess the likely effects of emerging disruptive mobilities (e.g., autonomous vehicles) on health and wellbeing and on the environment.

Sustainable Development of the Historic Centre of Naples: The Impact of Vehicular Traffic and Food Service Business on Air Quality

Monitoring campaigns were carried out to assess the impact of vehicular traffic and food service business on the air quality in the historic centre of Naples. These campaigns monitored fine particles (FPs) from 20 to 1000 nm, using a condensation particle counter (CPC) in four connected streets, during a period of four weeks, from 7 November to 7 December 2019. Two streets were pedestrian only, while the others had average traffic. The following variables were considered while analysing the data—street geometry, and traffic and food service business emissions. The results showed prevalent air contamination, with some critical situations. The FP concentration values in the pedestrian streets were similar to the average values measured at the roadside of other European cities. However, the FP concentration values measured on the streets with average traffic, were twice that of their European counterparts. Spatial maps of FP concentration were produced to assess the impact of food service business emissions at the street level. The maps showed an insignificant contribution to FP pollution. However, it must be noted that emissions of the food service businesses were not measured at the roof top level in this study. The aspect ratio (H/W) played a relevant role on FP concentration, as an increase in aspect ratio correlated to an increase in FP concentration. These findings showed critical preliminary information for the sustainable development of the historic centre of Naples, which should be confirmed through a long-term monitoring campaign.

[Designing healthy mobility in cities: how urban planning can promote walking and cycling]

Mobility is a prerequisite for satisfying essential human needs. Work, education, social participation: all these activities generate regular journeys. Particularly in cities, however, the "side effects" of mobility such as traffic jams, traffic accidents, air pollution, noise and the resulting health effects are also evident.The planning of settlement structures, the necessary infrastructures, and the design of urban spaces are tasks of urban planning. Urban planning can have a decisive influence on the means of transport people choose, the distances they travel, and the environmental and health effects associated with these choices.This article examines how urban planning can promote alternatives to motorized individual travel. It focuses in particular on active mobility, such as cycling and walking. The paper begins by presenting the fundamental effects of everyday mobility and the resulting traffic on health. It then gives an overview of the potential for promoting active mobility in Germany and how urban planning and the factors it regulates, such as settlement density or mix of uses, influence mobility decisions. An overview of current initiatives and an in-depth presentation of planning strategies in the cities of Barcelona and Bogotá will be used to show which instruments and measures are being used.The article emphasizes that urban planning and the built environment it creates can promote walking and cycling. The examples show, however, that promising initiatives are not realised through spatial planning and the creation of infrastructure alone. Rather, they are cross-sectoral measures aimed at changing the mobility culture in cities.

Study of Urban Greenery Models to Prevent Overheating of Parked Vehicles in P + R Facilities in Ljubljana, Slovenia

Parking in park-and-ride (P + R) facilities on the outskirts of a city reduces the traffic inside the cities and follows the principles of sustainable mobility. However, large paved (asphalt) surfaces create urban heat islands (UHI). This causes the temperature to rise in vehicles during full-day parking, which has a negative effect on comfort level and driving performance. This study was conceptualized as two-stage research. The first (preliminary) stage dealt with the measurement and analysis of temperature data at two nearby open parking lots in the city of Ljubljana, one of which was the main research spatial area, P + R Barje (L1), and Trnovo parking (L2), which was used for comparison in the first-stage research. In the preliminary research, we underlined the problem of long-term parking in parking areas exposed to heatwaves (HW). The second stage involved the studying of greening schemes in P + R facilities, which would allow for optimal shading during parking. Advanced 3D and 4D models using ENVI-met and LEONARDO software were developed, which assessed the parking surfaces and the areas of optimum outdoor comfort. Shading by greenery was adopted in this paper, as the strategy aimed at improving the conditions by modelling different variants of greening the parking lot L1.

Mobility Infrastructures in Cities and Climate Change: An Analysis Through the Superblocks in Barcelona

Cities are key actors in the fight against climate change since they are major sources of greenhouse gas (GHG) emissions while at the same time they experience the negative impact of this phenomenon. Mitigating and adapting to climate change requires fundamental changes in urbanism and city automobile traffic. Superblocks, a grid of blocks and basic roads forming a polygon, approximately 400 by 400 m, are one of the instruments for such changes. These type of city Superblocks represent a new model of mobility that restructures the typical urban road network, thereby substantially reducing automobile traffic, and accordingly GHG emissions, while increasing green space in the city and improving the health and quality of life of its inhabitants. Furthermore, the Superblocks do not require investment in hard infrastructures, nor do they involve demolishing buildings or undertaking massive development; they are in fact very low-tech urbanism. The city of Barcelona has been implementing Superblocks as one of the measures to combat climate change with very positive results. The paper analyzes the concept of the Superblock and its relation with climate change in cities. Along these lines, it analyzes the pioneer experience of Barcelona in the development and implementation of the Superblocks, as a radical plan aimed at taking back the streets from cars. The role of political power and institutional leadership has been key in societal acceptance and the achievement of tangible results. But there are also obstacles and drawbacks in the development of these types of Superblocks, such as the necessity to redesign the collective transport network so that car traffic can truly be reduced in cities, the possible negative influence on traffic going in and out of the city, the lack of visible advantages if they are not implemented in the entire city, the risk of gentrification in the areas with Superblocks, public opposition, and opposition from certain sectors of the business community.

Is a liveable city a healthy city? Health impacts of urban and transport planning in Vienna, Austria

Each year, The Economist Intelligence Unit (EIU) computes the Global Liveability Index and determines the most liveable cities around the world. Vienna, Austria, was ranked by the EIU as the most liveable city worldwide in 2018 and 2019. However, the relationship between a liveable as well as healthy and environmentally-just city has not been previously explored. To explore whether the most liveable city is also a healthy and environmentally-just one, we estimated the premature mortality burden related to non-compliance with international exposure level recommendations for physical activity (PA), air pollution (PM_2.5 and NO₂), road traffic noise, green space and heat for Vienna, as well as its distribution by socioeconomic status (SES). We applied the Urban and TranspOrt Planning Health Impact Assessment (UTOPHIA) methodology and estimated the annual mortality, life expectancy (LE) and economic impact of non-compliance with exposure guidelines for the Viennese adult population ≥ 20 years. We compared current with recommended exposure levels, quantified the association between exposures and mortality and calculated attributable health impact fractions. Eight percent of premature mortality (i.e. 1239 deaths, 95% CI: 679-1784) was estimated to be attributable to non-compliance with the recommended exposure levels. Seventy-six percent of the attributable premature mortality was due to PM_2.5 exposure and insufficient PA. Non-compliance also resulted in an average of 199 days of LE lost for the adult population (95% CI: 111-280) and an economic impact of 4.6 (95% CI: 2.5-6.7) billion 2015€ annually. Overall, residents of lower SES neighbourhoods faced higher risk of premature mortality due to higher exposure to NO₂, road traffic noise, heat and less green space. Despite high liveability standards according to EIU definition, a considerable premature mortality burden was attributable to non-compliance with exposure recommendations, and socioeconomic inequalities were estimated. Although the exposure attributable mortality burden was lower than in other European cities and local Viennese policies favour the reduction of motorized traffic, alongside the promotion of active and public transport and urban greening, there is room for further alignment of liveability, environmental health and justice objectives.

The Role of Urban Morphology Design on Enhancing Physical Activity and Public Health

Along with environmental pollution, urban planning has been connected to public health. The research indicates that the quality of built environments plays an important role in reducing mental disorders and overall health. The structure and shape of the city are considered as one of the factors influencing happiness and health in urban communities and the type of the daily activities of citizens. The aim of this study was to promote physical activity in the main structure of the city via urban design in a way that the main form and morphology of the city can encourage citizens to move around and have physical activity within the city. Functional, physical, cultural-social, and perceptual-visual features are regarded as the most important and effective criteria in increasing physical activities in urban spaces, based on literature review. The environmental quality of urban spaces and their role in the physical activities of citizens in urban spaces were assessed by using the questionnaire tool and analytical network process (ANP) of structural equation modeling. Further, the space syntax method was utilized to evaluate the role of the spatial integration of urban spaces on improving physical activities. Based on the results, consideration of functional diversity, spatial flexibility and integration, security, and the aesthetic and visual quality of urban spaces plays an important role in improving the physical health of citizens in urban spaces. Further, more physical activities, including motivation for walking and the sense of public health and happiness, were observed in the streets having higher linkage and space syntax indexes with their surrounding texture.

Short-Term Impact of Traffic-Related Particulate Matter and Noise Exposure on Cardiac Function

Exposure to traffic-related air pollution and noise exposure contributes to detrimental effects on cardiac function, but the underlying short-term effects related to their simultaneous personal exposure remain uncertain. The aim is to assess the impact of total inhaled dose of particulate matter and total noise exposure on the variations of electrocardiogram (ECG) parameters between pre-cycling and post-cycling periods. Mid-June 2019, we collected four participants' personal exposure data related to traffic-related noise and particulate matter (PM_2.5 and PM₁₀) as well as ECG parameters. Several Bayesian linear models were built to examine a potential association between air pollutants and noise exposure and ECG parameters: heart rate (HR), standard deviation of the normal-to-normal intervals (SDNN), percentage of successive RR intervals that differ by more than 50 ms (pNN50), root mean square of successive RR interval differences (rMSSD), low-frequency power (LF), high-frequency power (HF), and ratio of low- to high-frequency power (LF/HF). We analyzed in total 255 5-min segments of RR intervals. We observed that per 1 µg increase in cumulative inhaled dose of PM_2.5 was associated with 0.48 (95% CI: 0.22; 15.61) increase in variation of the heart rate, while one percent of total noise dose was associated with 0.49 (95% CI: 0.17; 0.83) increase in variation of heart rate between corresponding periods. Personal noise exposure was no longer significant once the PM_2.5 was introduced in the whole model, whilst coefficients of the latter that were significant previously remained unchanged. Short-term exposure to traffic-related air and noise pollution did not, however, have an impact on heart rate variability.

Urban health: an example of a "health in all policies" approach in the context of SDGs implementation

BACKGROUND

Cities are an important driving force to implement the Sustainable Development Goals (SDGs) and the New Urban Agenda. The SDGs provide an operational framework to consider urbanization globally, while providing local mechanisms for action and careful attention to closing the gaps in the distribution of health gains. While health and well-being are explicitly addressed in SDG 3, health is also present as a pre condition of SDG 11, that aims at inclusive, safe, resilient and sustainable cities. Health in All Policies (HiAP) is an approach to public policy across sectors that systematically takes into account the health implications of decisions, seeks synergies, and avoids harmful health impacts in order to improve population health and health equity. HiAP is key for local decision-making processes in the context of urban policies to promote public health interventions aimed at achieving SDG targets. HiAPs relies heavily on the use of scientific evidence and evaluation tools, such as health impact assessments (HIAs). HIAs may include city-level quantitative burden of disease, health economic assessments, and citizen and other stakeholders' involvement to inform the integration of health recommendations in urban policies. The Barcelona Institute for Global Health (ISGlobal)'s Urban Planning, Environment and Health Initiative provides an example of a successful model of translating scientific evidence into policy and practice with regards to sustainable and healthy urban development. The experiences collected through ISGlobal's participation implementing HIAs in several cities worldwide as a way to promote HiAP are the basis for this analysis.

AIM

The aim of this article is threefold: to understand the links between social determinants of health, environmental exposures, behaviour, health outcomes and urban policies within the SDGs, following a HiAP rationale; to review and analyze the key elements of a HiAP approach as an accelerator of the SDGs in the context of urban and transport planning; and to describe lessons learnt from practical implementation of HIAs in cities across Europe, Africa and Latin-America.

METHODS

We create a comprehensive, urban health related SDGs conceptual framework, by linking already described urban health dimensions to existing SDGs, targets and indicators. We discuss, taking into account the necessary conditions and steps to conduct HiAP, the main barriers and opportunities within the SDGs framework. We conclude by reviewing HIAs in a number of cities worldwide (based on the experiences collected by co-authors of this publication), including city-level quantitative burden of disease and health economic assessments, as practical tools to inform the integration of health recommendations in urban policies.

RESULTS

A conceptual framework linking SDGs and urban and transportplanning, environmental exposures, behaviour and health outcomes, following a HiAP rationale, is designed. We found at least 38 SDG targets relevant to urban health, corresponding to 15 SDGs, while 4 important aspects contained in our proposed framework were not present in the SDGs (physical activity, noise, quality of life or social capital). Thus, a more comprehensive HiAP vision within the SDGs could be beneficial. Our analysis confirmed that the SDGs framework provides an opportunity to formulate and implement policies with a HiAP approach. Three important aspects are highlighted: 1) the importance of the intersectoral work and health equity as a cross-cutting issue in sustainable development endeavors; 2) policy coherence, health governance, and stakeholders' participation as key issues; and 3) the need for high quality data. HIAs are a practical tool to implement HiAP. Opportunities and barriers related to the political, legal and health governance context, the capacity to inform policies in other sectors, the involvement of different stakeholders, and the availability of quality data are discussed based on our experience. Quantitative assessments can provide powerful data such as: estimates of annual preventable morbidity and disability-adjusted life-years (DALYs) under compliance with international exposure recommendations for physical activity, exposure to air pollution, noise, heat, and access to green spaces; the associated economic impacts in health care costs per year; and the number of preventable premature deaths when improvements in urban and transport planning are implemented. This information has been used to support the design of policies that promote cycling, walking, public, zero and low-emitting modes of transport, and the provision of urban greening or healthy public open spaces in Barcelona (e.g. Urban Mobility, Green Infrastructure and Biodiversity Plans, or the Superblocks's model), the Bus Rapid Transit and Open Streets initiatives in several Latin American cities or targeted SDGs assessments in Morocco.

CONCLUSIONS

By applying tools such as HIA, HiAP can be implemented to inform and improve transport and urban planning to achieve the 2030 SDG Agenda. Such a framework could be potentially used in cities worldwide, including those of less developed regions or countries. Data availability, taking into account equity issues, strenghtening the communication between experts, decision makers and citizens, and the involvement of all major stakeholders are crucial elements for the HiAP approach to translate knowledge into SDG implementation.