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

The political price of superblocks. Electoral outcomes of sustainable transport interventions in Barcelona

Urban and transportation policies are increasingly recognized for their potential to mitigate climate change impacts and address transport externalities. Amidst efforts to shift modal preferences and reduce transport emissions, cities are turning to spatialbased policies, such as Superblocks, to reshape urban mobility. This research examines the electoral outcomes associated with the implementation of Superblocks in Barcelona, focusing on their impact on political support for Barcelona en Comú (BEC) during the local elections of 2015 and 2023. Utilizing a combination of adjusted difference-in-differences and propensity score matching methods, we assessed the public's electoral response to the Superblock initiative amidst a backdrop of declining city-wide support for BEC. Our findings reveal that Superblock areas demonstrated significantly stronger support for BEC, suggesting a political premium for the party responsible for these urban interventions. Specifically, electoral support in Superblock districts saw an increase of 10-14% compared to the rest of the city. This result highlights the potential of urban transformation policies to influence political preferences locally and potentially validate the use of local electoral data as a tool for evaluating public response to highly contested urban policies.

The Superblock model: A review of an innovative urban model for sustainability, liveability, health and well-being

INTRODUCTION

Current urban and transport planning practices have significant negative health, environmental, social and economic impacts in most cities. New urban development models and policies are needed to reduce these negative impacts. The Superblock model is one such innovative urban model that can significantly reduce these negative impacts through reshaping public spaces into more diverse uses such as increase in green space, infrastructure supporting social contacts and physical activity, and through prioritization of active mobility and public transport, thereby reducing air pollution, noise and urban heat island effects. This paper reviews key aspects of the Superblock model, its implementation and initial evaluations in Barcelona and the potential international uptake of the model in Europe and globally, focusing on environmental, climate, lifestyle, liveability and health aspects.

METHODS

We used a narrative meta-review approach and PubMed and Google scholar databases were searched using specific terms.

RESULTS

The implementation of the Super block model in Barcelona is slow, but with initial improvement in, for example, environmental, lifestyle, liveability and health indicators, although not so consistently. When applied on a large scale, the implementation of the Superblock model is not only likely to result in better environmental conditions, health and wellbeing, but can also contribute to the fight against the climate crisis. There is a need for further expansion of the program and further evaluation of its impacts and answers to related concerns, such as environmental equity and gentrification, traffic and related environmental exposure displacement. The implementation of the Superblock model gained a growing international reputation and variations of it are being planned or implemented in cities worldwide. Initial modelling exercises showed that it could be implemented in large parts of many cities.

CONCLUSION

The Superblock model is an innovative urban model that addresses environmental, climate, liveability and health concerns in cities. Adapted versions of the Barcelona Superblock model are being implemented in cities around Europe and further implementation, monitoring and evaluation are encouraged. The Superblock model can be considered an important public health intervention that will reduce mortality and morbidity and generate cost savings for health and other sectors.

Quantitative evaluation of urban green exposure and its impact on human health: A case study on the 3-30-300 green space rule

BACKGROUND AND AIMS

Urban green spaces offer various health benefits, yet the impact of comprehensive green exposure criteria on multidimensional health remains unclear. The 3-30-300 green space rule represents the green exposure indicators with specific thresholds. This study aims to quantitatively evaluate urban green exposure in cities and can support investigation of its relationship with human health.

METHODS

We conducted a cross-sectional study based on 902 investigated individuals in 261 residential locations aged 11-95 years from Xiamen City, China. 3-30-300 green exposure was calculated using field surveys, GIS, and Baidu Maps Application Programming Interface (API). Physical health data was based on Occupational Stress Indicator (OSI)-2. Mental health was from the 12-item General Health Questionnaire (GHQ-12). Social health was from a self-constructed evaluation questionnaire. Statistical analyses were conducted using Geographically Weighted Regression and Geographically Weighted Logistic Regression for global and local effects on green exposure and multidimensional health.

RESULT

Among the investigated individuals, only 3.55 % (32/902) fully meet the 3-30-300 rule in Xiamen. Global results show that individuals achieved at least 30 % vegetation coverage (Yes) is associated with better physical (β: 0.76, p < 0.01) and social (β: 0.5, p < 0.01) health. GWLR global results indicate that individuals can "see at least 3 trees from home" meeting one (OR = 0.46, 95%CI: 0.25-0.86, p < 0.05) or two (OR = 0.41, 95%CI: 0.22,0.78, p < 0.01; OR = 0.24, 95%CI: 0.07-0.77, p < 0.05) 3-30-300 rule components are significantly associated with reduced medical visits and hospitalizations refer to not met these criterias. In the GWR local analysis, achieved 30 % vegetation cover is significantly related to improved social health at all locations. Meeting any two indicators also contribute to improved social health (n = 511, β: 0.46-0.51, P < 0.05).

CONCLUSION

Green exposure indicators based on the 3-30-300 rule guiding healthy urban green space development. We observed multidimensional health benefits when 1/3 or 2/3 of the indicators were met.

Human health and the health of Planet Earth go together

The emergence of the planetary health approach was highlighted by the report of The Rockefeller Foundation-Lancet Commission on Planetary Health in 2015 and changed how we comprehend human well-being. The report advocates integrating the health of other living beings and Earth's natural systems as intrinsic components of human health. Drawing on over three decades of experience in respiratory epidemiology and environmental health, this article outlines how my perspective on human health underwent a transformative shift upon reading the abovementioned report. The planetary health approach offers a lens through which human health issues and potential solutions can be understood within the context of the Anthropocene. It addresses the pressing existential challenges arising from humanity's transgression of planetary limits. Embracing the planetary health paradigm within the field of health sciences can catalyze transformative changes essential for cultivating a sustainable and equitable future.

The Urban Environment and Cardiometabolic Health

Urban environments contribute substantially to the rising burden of cardiometabolic diseases worldwide. Cities are complex adaptive systems that continually exchange resources, shaping exposures relevant to human health such as air pollution, noise, and chemical exposures. In addition, urban infrastructure and provisioning systems influence multiple domains of health risk, including behaviors, psychological stress, pollution, and nutrition through various pathways (eg, physical inactivity, air pollution, noise, heat stress, food systems, the availability of green space, and contaminant exposures). Beyond cardiometabolic health, city design may also affect climate change through energy and material consumption that share many of the same drivers with cardiometabolic diseases. Integrated spatial planning focusing on developing sustainable compact cities could simultaneously create heart-healthy and environmentally healthy city designs. This article reviews current evidence on the associations between the urban exposome (totality of exposures a person experiences, including environmental, occupational, lifestyle, social, and psychological factors) and cardiometabolic diseases within a systems science framework, and examines urban planning principles (eg, connectivity, density, diversity of land use, destination accessibility, and distance to transit). We highlight critical knowledge gaps regarding built-environment feature thresholds for optimizing cardiometabolic health outcomes. Last, we discuss emerging models and metrics to align urban development with the dual goals of mitigating cardiometabolic diseases while reducing climate change through cross-sector collaboration, governance, and community engagement. This review demonstrates that cities represent crucial settings for implementing policies and interventions to simultaneously tackle the global epidemics of cardiovascular disease and climate change.

Urban green spaces and behavioral and cognitive development in children: A health impact assessment of the Barcelona "Eixos Verds" Plan (Green Axis Plan)

BACKGROUND

Urban environments lack natural features, while nature exposure in cities has been associated with health benefits, including children's neurodevelopment. Through extensive street greening, Barcelona's Eixos Verds (Green Axis) Plan enhances safety, environment, and climate resilience. We aimed to assess the Eixos Verds Plan's potential impact on children's behavioral and cognitive development due to the increased green space expected under the Eixos Verds implementation.

METHODS

We performed a quantitative health impact assessment for Barcelona children at census-tract level (n = 1068). We assessed the Eixos Verds Plan's impact by comparing baseline green space distribution with the proposed plan, translating it into percentage green area (%GA) and Normalized Difference Vegetation Index (NDVI). By combining these exposure metrics with child-specific risk estimates and population data, we estimated potential improvements in children's behavioral and cognitive development due to full Eixos Verds implementation.

RESULTS

With the full Eixos Verds implementation, citywide, %GA increased by 6.9% (IQR: 6.4%; range: 0-23.1%) and NDVI by 0.065 (IQR: 0.083; range: 0.000-0.194). Child behavioral and cognitive development outcomes are expected to improve compared to the baseline. Based on NDVI increases, children's Total Difficulties and Hyperactivity/Inattention scores, based on the Strengths and Difficulties Questionnaire (SDQ), are projected to decrease by 5% (95% CI: 0-15%) and 6% (95% CI: 0-17%). Working Memory and Superior Working Memory scores are expected to increase by 4% and 5%, respectively, based on the computerized n-back test, while the Inattentiveness score could be reduced by 1%, based on the computerized attentional test (ANT).

INTERPRETATION

Urban greening as planning tool can improve behavioral and cognitive development in city children. Methods and results of our study are applicable to many cities worldwide, and similar results for children of real-life urban greening interventions can be expected.

The impact of traffic noise on the capitalization of public walking area: A hedonic analysis of Vienna, Austria

Traffic noise is a burden at home and outdoors. Economic literature confirms mostly negative effects of traffic noise on house prices, often based on distance between high noise and house location. We extend this literature using rich micro data to examine not only the impact of traffic noise at the house but also provide new results on the impact of traffic noise in public areas surrounding a home. Using Hedonic regression in Vienna, Austria, we confirm that very loud traffic noise (≥65 dB) experienced at the house reduces housing prices and further show that the value of public walking areas near a home, while positive overall, are substantially reduced when exposed to noise. Our findings help to establish spatial patterns in noise capitalization reflecting household exposure and the impact on the capitalized values of public areas in a context where active transportation (e.g. walking, biking) is an important mode of transportation. For policymakers, our findings help quantify and raise important questions as how to address and link the public bad nature of noise pollution to nearby residents.

Surrounding greenness is associated with lower risk and burden of low birth weight in Iran

The nexus between prenatal greenspace exposure and low birth weight (LBW) remains largely unstudied in low- and middle-income countries (LMICs). We investigated a nationwide retrospective cohort of 4,021,741 live births (263,728 LBW births) across 31 provinces in Iran during 2013-2018. Greenness exposure during pregnancy was assessed using satellite-based normalized difference vegetation index (NDVI) and enhanced vegetation index (EVI). We estimated greenness-LBW associations using multiple logistic models, and quantified avoidable LBW cases under scenarios of improved greenspace through counterfactual analyses. Association analyses provide consistent evidence for approximately L-shaped exposure-response functions, linking 7.0-11.5% declines in the odds of LBW to each 0.1-unit rise in NDVI/EVI with multiple buffers. Assuming causality, 3931-5099 LBW births can be avoided by achieving greenness targets of mean NDVI/EVI, amounting to 4.4-5.6% of total LBW births in 2015. Our findings suggest potential health benefits of improved greenspace in lowering LBW risk and burden in LMICs.

Assessing physical activity promotion in different settings and how its associated with public participation during COVID-19 epidemic: evidence from national policy evaluation

BACKGROUND

Various interventions, programs and policies have been implemented to improve physical activity (PA) levels worldwide. However, countries continue to face barriers and challenges in achieving their targets. To date, there is a lack of study on the evaluation of physical activity (PA) promotion and how it's associated with public participation.

METHODS

This study assessed PA promotion in eight different settings in terms of policy availability, policy implementation, and public participation in PA programs. Policy availability was assessed by reviewing 384 policy and strategy documents, rules, regulations, legislation, and guidelines on PA. We scored the documents by using the Comprehensive Analysis of Policy on Physical Activity (CAPPA) framework. Data to assess policy implementation and public participation were taken from the Thailand Report Card Survey 2021 (TRC2021), and the Thailand Surveillance on Physical Activity (SPA) 2021. Both surveys comprised over 5,000 nationally-representative samples from on-screen, face-to-face interviews, and an online self-administered survey. We scored the policy implementation and public participation based on respondents' response towards policy implementation and participation indicators. A grading scheme was applied to indicate how successful an investment has been made.

RESULTS

Public education and mass media received the highest average score in policy availability, implementation and public participation in PA program (67.9%, grade B), followed by active urban design (66.1%, grade B-) and active transport (63.7%, grade B-). Workplace, whole-of-school, and community-wide initiatives were the investments with the lowest scores, implying low availability, limited implementation, and less accessibility to public. Females were less likely to participate in active transport, active urban design, sports/recreation for all, workplace activity, and community-wide initiatives. Age and educational attainment were consistent predictors of utilization in all investments.

CONCLUSIONS

With varying degrees of policy availability and accessibility, public participation in PA investments is likely to be constrained by biological and socioeconomic inequality. Future investments should aim at providing generalized or tailored interventions to ensure equal access and participation for all segments of the population.

15-min Cities: the Potential of a Medium-Sized Polycentric Latin American City

Urban sustainability and sustainable mobility have become the central focus of sustainable development initiatives. The city of 15 models seeks to ensure that urban development is sustainable. This paper evaluates the current state of mobility and the use of sustainable transport in the specific context of the city of Antofagasta, which, due to its characteristics of urban expansion and its mining activity, has been considered an international reference case. In particular, we study how the current urban structure shapes the city's travel patterns and identify opportunities for public policy actions to focus their investment and urban intervention efforts on the essential aspects that make it possible to achieve 15- or 20-min territories. The results reveal the need for urban development initiatives to focus on improving the supply of goods and services in areas with low installed capacity, promoting the culture of micro-neighbourhoods, and encouraging cycling. In particular, only 10% of trips, for all purposes and all modes of transport, are completed in less than 15 min. And about 58% of trips, for all purposes and all modes, are completed in less than 30 min. In the marginal effects of the multinomial logit model, a one-unit increase in travel time increases the probability of choosing to travel by public transport by 63% and decreases the probability of walking by 41%.

The effect of sustainable mobility transition policies on cumulative urban transport emissions and energy demand

The growing urban transport sector presents towns and cities with an escalating challenge in the reduction of their greenhouse gas emissions. Here we assess the effectiveness of several widely considered policy options (electrification, light-weighting, retrofitting, scrapping, regulated manufacturing standards and modal shift) in achieving the transition to sustainable urban mobility in terms of their emissions and energy impact until 2050. Our analysis investigates the severity of actions needed to comply with Paris compliant regional sub-sectoral carbon budgets. We introduce the Urban Transport Policy Model (UTPM) for passenger car fleets and use London as an urban case study to show that current policies are insufficient to meet climate targets. We conclude that, as well as implementation of emission-reducing changes in vehicle design, a rapid and large-scale reduction in car use is necessary to meet stringent carbon budgets and avoid high energy demand. Yet, without increased consensus in sub-national and sectoral carbon budgets, the scale of reduction necessary stays uncertain. Nevertheless, it is certain we need to act urgently and intensively across all policy mechanisms available as well as developing new policy options.

Urbanization and the Future of Population Health

Policy Points Cities, which are where the majority of the world's population lives today, directly and indirectly shape human health and well-being. Urban health research, policy, and practice are increasingly using a systems science approach to address the upstream and downstream drivers of health in cities, which include social and environmental factors, features of the built environment, conditions of living, and health care resources. To guide future scholarship and policy, we propose an urban health agenda for 2050 focused on revitalizing the sanitation movement, integrating data, scaling best practices, adopting the Health in All Policies approach, and addressing intraurban health inequities.

Health impact assessment of road traffic noise exposure based on different densification scenarios in Malmö, Sweden

While urbanization provides many opportunities to those arriving in thriving urban areas, a greater number of residents necessitates the expansion of housing and infrastructure. This is often achieved through densification, which can lead to increased noise, particularly through increased road traffic. A key challenge of promoting healthy urban planning is to understand potential health effects, especially on the local level. The aim of the present study is, therefore, to estimate and compare the health impacts of road traffic noise exposure for various urban densification scenarios within a neighborhood (Lorensborg) in Malmö, Sweden. The three scenarios include 1) Present-day, representing the study area as it is presently organized; 2) Planned municipal strategy (the city of Malmö's own densification plans) and 3) Health-centred, which involves major structural alterations and reflects an effort prioritize a health-centred approach. Noise was modelled using the Nordic prediction method for road traffic. Health outcomes included noise annoyance, adverse sleep disturbance, ischemic heart disease (IHD) incidence and mortality. Within all scenarios, a large proportion of the study population was exposed above the WHO's health-based guideline value (L_den 53 dB): >80% for Present-day and Planned municipal strategy scenarios, and almost 50% in the Health-centred scenario. Still, densifying Lorensborg (population ≈9,600) according to the Health-centred scenario could prevent 549 cases of highly annoyed, 193 cases of adverse sleep disturbance, 4.7 new cases of IHD (8.9% of total cases), and 1.5 deaths due to IHD (17.8% of IHD mortality) annually. The results demonstrated that it is possible to considerably lower the health impact with a more health-centred densification strategy. Important co-benefits for public and environmental health include air pollution reduction and green space creation, although their health effects were not quantified in the present study. Urban planning initiatives must be more ambitious in order to create healthy, sustainable cities.

An urban green space intervention with benefits for mental health: A health impact assessment of the Barcelona "Eixos Verds" Plan

BACKGROUND

Mental health disorders account for over 30% of the global burden of disease. There is a positive association between green space exposure and better mental health, and therefore urban greening can be an effective public health tool. Barcelona is a compact city with one of the highest population and traffic densities in Europe, with limited green spaces. Under the umbrella of the Superblock model, the Barcelona City council is implementing the Eixos Verds Plan for extensive street greening. We estimated the potential mental health benefits of this plan.

METHODS

We performed a quantitative health impact assessment at the Barcelona grid-cell level (n = 1,096). We compared the baseline green space situation (2015) with the proposed plan and translated the increase in green space into a) percentage of green area (%GA) and b) NDVI. We combined exposure data with Barcelona-specific mental health risk estimates, adult population (n = 1,235,375), and mental health data, and calculated preventable cases.

FINDINGS

Under the Eixos Verds Plan, we estimated an average increase of 5·67 %GA (range: 0·00% - 15·77%) and 0·059 NDVI (range: 0·000 - 0·312). We estimated that with the Eixos Verds Plan implementation, 31,353 (95%CI: 18,126-42,882) cases of self-perceived poor mental health (14·03% of total), 16,800 (95%CI: 6828-25,700) visits to mental health specialists (13·37% of total), 13,375 (95%CI: 6107-19,184) cases of antidepressant use (13·37% of total), and 9476 (95%CI: 802-16,391) cases of tranquilliser/ sedative use (8·11% of total) could be prevented annually, along corresponding to over 45 M € annual savings in mental health costs annually.

INTERPRETATION

Our results highlight the importance of urban greening as a public health tool to improve mental health in cities. Similar results for green interventions in other cities could be expected.

Walkability and urban built environments-a systematic review of health impact assessments (HIA)

BACKGROUND

Urban environments are important determinants of human health. The term walkability summarizes features of the urban built environment that promote walking and other types of physical activity. While the beneficial effects of active and public transport have been well established, the health impact of other features of walkability are less well documented.

METHODS

We conducted a systematic review of health impact assessments (HIAs) of walkability. Studies were identified through PUBMED and Science Direct, from two German websites related to urban health and reference tracking. Finally, 40 studies were included in the present review. We applied qualitative thematic analysis to summarize the major results from these studies.

RESULTS

Most of the HIAs (n = 31) reported the improvement of health or health behaviour resulting from an investigated project or policy. However, three HIAs reported a lack of improvement or even a decrease of health status. In parallel, 13 HIAs reported a gain in economic value, whereas one reported a lack or loss of economic effects. Moreover, three HIAs reported on social effects and six HIAs gave additional recommendations for policies or the implementation of projects or HIAs.

CONCLUSIONS

Most HIAs investigate the impact of increasing active or public transport. Other features of walkability are less well studied. With few exceptions, HIAs document beneficial impacts of improving walkability on a variety of health outcomes, including reductions of mortality and non-communicable diseases.

Model Choice for Quantitative Health Impact Assessment and Modelling: An Expert Consultation and Narrative Literature Review

BACKGROUND

Health impact assessment (HIA) is a widely used process that aims to identify the health impacts, positive or negative, of a policy or intervention that is not necessarily placed in the health sector. Most HIAs are done prospectively and aim to forecast expected health impacts under assumed policy implementation. HIAs may quantitatively and/ or qualitatively assess health impacts, with this study focusing on the former. A variety of quantitative modelling methods exist that are used for forecasting health impacts, however, they differ in application area, data requirements, assumptions, risk modelling, complexities, limitations, strengths, and comprehensibility. We reviewed relevant models, so as to provide public health researchers with considerations for HIA model choice.

METHODS

Based on an HIA expert consultation, combined with a narrative literature review, we identified the most relevant models that can be used for health impact forecasting. We narratively and comparatively reviewed the models, according to their fields of application, their configuration and purposes, counterfactual scenarios, underlying assumptions, health risk modelling, limitations and strengths.

RESULTS

Seven relevant models for health impacts forecasting were identified, consisting of (i) comparative risk assessment (CRA), (ii) time series analysis (TSA), (iii) compartmental models (CMs), (iv) structural models (SMs), (v) agent-based models (ABMs), (vi) microsimulations (MS), and (vii) artificial intelligence (AI)/machine learning (ML). These models represent a variety in approaches and vary in the fields of HIA application, complexity and comprehensibility. We provide a set of criteria for HIA model choice. Researchers must consider that model input assumptions match the available data and parameter structures, the available resources, and that model outputs match the research question, meet expectations and are comprehensible to end-users.

CONCLUSION

The reviewed models have specific characteristics, related to available data and parameter structures, computational implementation, interpretation and comprehensibility, which the researcher should critically consider before HIA model choice.

Effectiveness of Mobility and Urban Sustainability Measures in Improving Citizen Health: A Scoping Review

BACKGROUND

The relationship between mobility and health has multiple dimensions, and the mobility model can be considered a public health intervention. Increasingly, mobility in cities is oriented towards incorporating sustainability criteria; however, there are many very diverse measures that cities carry out in terms of mobility and urban sustainability, and in many cases, these do not receive subsequent evaluation and/or study to analyse their effectiveness or impact. Currently, the literature does not offer any updated review of the measures applied in the different communities and countries.

AIM

To carry out a panoramic review of the measures implemented in the last 5 years to analyse which ones report a greater effectiveness and efficiency in health.

RESULTS

After applying the exclusion criteria of the study, a total of 16 articles were obtained for evaluation. The measures applied in terms of sustainability are grouped into four subgroups and their subsequent evaluation and possible impact on public health is analysed.

CONCLUSIONS

The present study found a large heterogeneous variety of sustainability measures in local settings around the world, which seem to reflect positive impacts on population health. However, subsequent evaluation of these measures is inconclusive in most cases. Further research and sharing across macro-communities are needed to establish universal criteria.

Use of the Superblock model for promoting physical activity in Barcelona: a one-year observational comparative study

BACKGROUND

The Barcelona Superblock model transforms urban public spaces into active-friendly spaces, a key issue for public health. This study assessed the extent to which a newly developed Superblock in St. Antoni Market Square was used by citizens to perform physical activities and for sedentary behaviour during the first year of implementation. It then compared this citizens' use of the Superblock for physical activities and sedentary behaviour with a comparison site at one-year follow-up, when the Superblock was fully integrated into citizens' daily life.

METHODS

This observational comparative study (May 2018-May 2019) used the System for Observing Play and Recreation in Communities (SOPARC). SOPARC assessed citizens' sitting, standing, walking, practice of vigorous activities and use of electric scooter by gender, age group and time of the day. At the Superblock site, two observers completed five weekly observations: the opening week, and at three, five, eight and twelve months. At the comparison site, observers completed one weekly observation at twelve months after the implementation of the Superblock. Observations included 4 days/week (including weekends) and, 4 h/day (morning, midday, afternoon, evening).

RESULTS

At baseline, an average of 2,340 citizens/hour were observed using the Superblock but visits reduced by 12% in the next three observation weeks and 17.6% after one-year (mainly elderly and teenagers). At baseline, 92.9% walked in the Superblock, while 3.1% engaged in vigorous physical activity. After one year, citizens' walking decreased by 18.2%, from 2,170 citizens/hour at baseline to 1,930 citizens/hour. Citizens' engagement in vigorous activities also declined by 11%, from 73 citizens/hour at baseline to 65 citizens/hour at one-year follow up. In the comparison site, citizens' usage for walking and vigorous physical activity was similar to the Superblock.

CONCLUSIONS

This is the first study to assess the extent to which citizens made use of the Barcelona Superblock model to perform physical activities, an urban built-environment intervention that is both novel and health-enhancing. The Superblock model would benefit from strategies maximizing effectiveness for promoting superblock-based physical activity, with special focus on seniors and teenagers.

Estimating the social value of nature-based solutions in European cities

By implementing nature-based solutions (NBS), cities generate value for their residents, such as health and wellbeing. We estimate the aggregate social value to urban residents of 85 NBS projects implemented across Europe and find that the majority yield attractive social returns on investment. We offer a new metric to support investments for NBS by public and private actors for whom social value creation to residents is a core objective.

Agent-based modeling of urban exposome interventions: prospects, model architectures, and methodological challenges

With ever more people living in cities worldwide, it becomes increasingly important to understand and improve the impact of the urban habitat on livability, health behaviors, and health outcomes. However, implementing interventions that tackle the exposome in complex urban systems can be costly and have long-term, sometimes unforeseen, impacts. Hence, it is crucial to assess the health impact, cost-effectiveness, and social distributional impacts of possible urban exposome interventions (UEIs) before implementing them. Spatial agent-based modeling (ABM) can capture complex behavior-environment interactions, exposure dynamics, and social outcomes in a spatial context. This article discusses model architectures and methodological challenges for successfully modeling UEIs using spatial ABM. We review the potential and limitations of the method; model components required to capture active and passive exposure and intervention effects; human-environment interactions and their integration into the macro-level health impact assessment and social costs benefit analysis; and strategies for model calibration. Major challenges for a successful application of ABM to UEI assessment are (1) the design of realistic behavioral models that can capture different types of exposure and that respond to urban interventions, (2) the mismatch between the possible granularity of exposure estimates and the evidence for corresponding exposure-response functions, (3) the scalability issues that emerge when aiming to estimate long-term effects such as health and social impacts based on high-resolution models of human-environment interactions, (4) as well as the data- and computational complexity of calibrating the resulting agent-based model. Although challenges exist, strategies are proposed to improve the implementation of ABM in exposome research.

Evaluating the Coordinated Development between Urban Greening and Economic Growth in Chinese Cities during 2005 to 2019

Balancing economic growth with environmental protection is vital for the sustainable development of cities and regions. However, urban greening has rarely been considered in extensive studies. This study incorporates urban greening into a coupling coordination degree (CCD) model, in order to evaluate its coordination with economic performance. A total of 286 cities in China between 2005 and 2019 were selected as specific study subjects. Meanwhile, clustering method was used to classify different clusters based on CCD values, the Gini coefficient analysis was applied to discover the CCD values inequality characteristics and the exploratory spatial data analysis (ESDA) method was employed to study the CCD values spatial aggregation features. The results indicate that the CCD values presented significant spatial heterogeneity. Spatially, the CCD values were divided into eight clusters, with those in the eastern region generally being higher than in the central and western regions. Temporally, the CCD in all cities showed an increasing trend, but more than 60% of cities were still in the uncoordinated or low-level coordination stage. In addition, inequality and spatial aggregation characteristics were observed in CCD values, both of which presented decreasing trends. Greening has a stronger influence on the linked and coordinated growth of the two systems; therefore, we propose policy recommendations for pursuing the development of environmentally friendly cities from different aspects. In summary, this research allows for a better understanding of economic and environmental relationships, thus contributing to the objective of creating sustainable cities and communities.

The potential of implementing superblocks for multifunctional street use in cities

The Barcelona superblock has been proposed as a sustainable urban neighbourhood transformation strategy in cities. Superblock design reduces space assigned to cars to enable alternative uses for improving liveability and sustainability. Here, the potential for superblock transformation is systematically quantified and evaluated for cities with varying urban forms and densities. A superblock consists of nine (3×3) urban city blocks including interior and exterior streets. Miniblocks, consisting of four (2×2) blocks, are proposed as a less disruptive strategy to initiate urban transformation on which superblocks can build upon. A geospatial network-based approach is developed to find locations for introducing multifunctional streets. For possible site prioritization, the identified locations are evaluated concerning the potential disruption to traffic. The analysis reveals that the potential for super- and miniblocks, as well as their disruption effect, varies considerably across cities and is affected by the urban layout. For some cities, over 40% of the street network is potentially suitable for integrating super- or miniblock design, providing opportunities for city-scale transition towards more sustainable and liveable cities. A grid-like layout in cities is not a sufficient condition for high superblock potential and cities with irregular street layouts can show high transformation potential as well.

Barriers and Enablers for Integrating Public Health Cobenefits in Urban Climate Policy

Urban climate policy offers a significant opportunity to promote improved public health. The evidence around climate and health cobenefits is growing but has yet to translate into widespread integrated policies. This article presents two systematic reviews: first, looking at quantified cobenefits of urban climate policies, where transportation, land use, and buildings emerge as the most studied sectors; and second, looking at review papers exploring the barriers and enablers for integrating these health cobenefits into urban policies. The latter reveals wide agreement concerning the need to improve the evidence base for cobenefits and consensus about the need for greater political will and leadership on this issue. Systems thinking may offer a way forward to help embrace complexity and integrate health cobenefits into decision making. Knowledge coproduction to bring stakeholders together and advance policy-relevant research for urban health will also be required. Action is needed to bring these two important policy agendas together.

Study of Pedestrian Zone According to Superblock Criteria in the Casco Antiguo of Panama

The Casco Viejo of Panama is an area with great potential to develop a pedestrian zone, as it is an attractive area for travelers to visit. For this development to be carried out safely, it is recommended that the site is analyzed based on superblock criteria to ensure pedestrians can move through the streets in a free and accessible way regardless of their physical condition. Hence, it is necessary to evaluate the current state of the road infrastructure, as we did in this research. The methodology consisted of field visits where information was gathered on the distribution of space so that ideal routes for pedestrian tourists could be ensured. We surveyed the state of the sidewalks, their physical condition, minimum widths, heights, their accessibility, and the presence of obstacles that block movement from one point to another. We also assessed the characteristics of the roads, safe crossings and signs, the current management of parking in illegal areas, and the system of public transport routes. The results describe the current problems, which are, firstly, the issue of poor pedestrian and cyclist mobility due to the lack of space available on public roads as a result of poorly parked cars and the placement of bollards. Secondly, free movement is impossible for the disabled due to the absence of ramps and railings, which prevents the integration of this group in the area.

Understanding Urban Complexity via the Spatial Diversity of Activities: An Application to Barcelona (Spain)

Urban complexity can be measured by the numerical and spatial diversity of activities in a territory. Just as biodiversity can be measured in a natural ecosystem, diversity indices can be applied to urban settings. Urban diversity presents higher values in areas where there is a greater number of (economic, institutional, and social) activities with a high degree of differentiation between them. This study seeks to investigate the potential of applying an urban diversity index in a specific case study: namely, the city of Barcelona (Spain), known for the orthogonal grid plan of its Eixample district. Results show that the municipal territory of Barcelona as a whole is characterized by highly differentiated spaces according to their urban diversity values. Specifically, it is the Eixample district that presents the highest values of urban diversity, reflecting the densification of its morphology and its urban commercial policies.

Study protocol of the European Urban Burden of Disease Project: a health impact assessment study

INTRODUCTION

Cities have long been known to be society's predominant engine of innovation and wealth creation, yet they are also hotspots of pollution and disease partly due to current urban and transport practices. The aim of the European Urban Burden of Disease project is to evaluate the health burden and its determinants related to current and future potential urban and transport planning practices and related exposures in European cities and make this evidence available for policy and decision making for healthy and sustainable futures.

METHODS AND ANALYSIS

Drawing on an established comparative risk assessment methodology (ie, Urban and Transport Planning Health Impact Assessment) tool), in nearly 1000 European cities we will (1) quantify the health impacts of current urban and transport planning related exposures (eg, air pollution, noise, excess heat, lack of green space) (2) and evaluate the relationship between current levels of exposure, health impacts and city characteristics (eg, size, density, design, mobility) (3) rank and compare the cities based on exposure levels and the health impacts, (4) in a number of selected cities assess in-depth the linkages between urban and transport planning, environment, physical activity and health, and model the health impacts of alternative and realistic urban and transport planning scenarios, and, finally, (5) construct a healthy city index and set up an effective knowledge translation hub to generate impact in society and policy.

ETHICS AND DISSEMINATION

All data to be used in the project are publicly available data and do not need ethics approval. We will request consent for personal data on opinions and views and create data agreements for those providing information on current and future urban and transport planning scenarios.For dissemination and to generate impact, we will create a knowledge translation hub with information tailored to various stakeholders.

Spatial Responses of Ecosystem Service Value during the Development of Urban Agglomerations

This study analyzed data from 1995, 2005, and 2015 using mathematical calculations, spatial analysis, and a geographically weighted regression model. The results showed that from 1995 to 2015, the comprehensive regional development degree (RDD) of urban agglomeration in the middle of Jilin Province increased overall, with the average RDD increasing from 0.250 in 1995 to 0.323 in 2015. Especially in Changchun, a sub-provincial city, the RDD increased by nearly one-third, and the gap between this and other cities has been increasing. However, the ecosystem service value (ESV) decreased overall, with the average ESV decreasing from 108.3 in 1995 to 105.4 in 2015, and showed a strong spatial correlation. The maximum quantile in southeast–northwest direction was 1.712, with good homogeneity. The spatial influence coefficient of the RDD on the ESV showed a trend from positive to negative in the northwest–southeast direction. This value decreased continuously while the negative agglomeration area was gradually expanding, corresponding to the stressful effects of the RDD on ESV. The results of this study can provide a reference for urban planning and development as well as encourage reasonable regional spatial planning to ensure the sustainable development of urban agglomerations.

Accelerating the Nature Deficit or Enhancing the Nature-Based Human Health during the Pandemic Era: An International Study in Cambodia, Indonesia, Japan, South Korea, and Myanmar, following the Start of the COVID-19 Pandemic

In modern society, the opportunity to experience nature is separate from everyday life, requiring time and effort. Since the start of the COVID-19 pandemic, restrictions on freedom of activity and communication around the world have become a crisis, causing a nature deficit by accelerating the process of separation from nature. At the same time, the pandemic has increased people’s motivation to return to nature, providing an opportunity to seek experiences and health recovery in nature. The authors conducted an international cross-sectional study in five Asian countries, investigating changes in the perception of recreational activities and health restoration in the natural environment, one of the many effects of the COVID-19 pandemic on human society. An online survey, completed by 524 respondents, has confirmed the efficacy of the SEM model, which includes COVID-19 stress, increased indoor activity, a preference for the natural environment, and the perception of health recovery. Although the five countries had different response values for each theme, the stress caused by restricted activities and communication during the pandemic was linked to a preference for natural experiences and the motivation to visit natural environments in all five countries, ultimately affecting perceptions of health recovery in nature. This study has shown that the COVID-19 pandemic, a disaster afflicting all human civilization, has changed people’s perceptions by enhancing their preference for natural recreational activities and health. It has accelerated people’s return to nature and fostered a positive perception of nature’s ability to promote good health.

Methods for Evaluating Environmental Health Impacts at Different Stages of the Policy Process in Cities

PURPOSE OF REVIEW

Evaluating the environmental health impacts of urban policies is critical for developing and implementing policies that lead to more healthy and equitable cities. This article aims to (1) identify research questions commonly used when evaluating the health impacts of urban policies at different stages of the policy process, (2) describe commonly used methods, and (3) discuss challenges, opportunities, and future directions.

RECENT FINDINGS

In the diagnosis and design stages of the policy process, research questions aim to characterize environmental problems affecting human health and to estimate the potential impacts of new policies. Simulation methods using existing exposure-response information to estimate health impacts predominate at these stages of the policy process. In subsequent stages, e.g., during implementation, research questions aim to understand the actual policy impacts. Simulation methods or observational methods, which rely on experimental data gathered in the study area to assess the effectiveness of the policy, can be applied at these stages. Increasingly, novel techniques fuse both simulation and observational methods to enhance the robustness of impact evaluations assessing implemented policies. The policy process consists of interdependent stages, from inception to end, but most reviewed studies focus on single stages, neglecting the continuity of the policy life cycle. Studies assessing the health impacts of policies using a multi-stage approach are lacking. Most studies investigate intended impacts of policies; focusing also on unintended impacts may provide a more comprehensive evaluation of policies.

A Heat Vulnerability Index: Spatial Patterns of Exposure, Sensitivity and Adaptive Capacity for Urbanites of Four Cities of India

Extreme heat and heat waves have been established as disasters which can lead to a great loss of life. Several studies over the years, both within and outside of India, have shown how extreme heat events lead to an overall increase in mortality. However, the impact of extreme heat, similar to other disasters, depends upon the vulnerability of the population. This study aims to assess the extreme heat vulnerability of the population of four cities with different characteristics across India. This cross-sectional study included 500 households from each city across the urban localities (both slum and non-slum) of Ongole in Andhra Pradesh, Karimnagar in Telangana, Kolkata in West Bengal and Angul in Odisha. Twenty-one indicators were used to construct a household vulnerability index to understand the vulnerability of the cities. The results have shown that the majority of the households fell under moderate to high vulnerability level across all the cities. Angul and Kolkata were found to be more highly vulnerable as compared to Ongole and Karimnagar. Further analysis also revealed that household vulnerability is more significantly related to adaptive capacity than sensitivity and exposure. Heat Vulnerability Index can help in identifying the vulnerable population and scaling up adaptive practices.

New urban models for more sustainable, liveable and healthier cities post covid19; reducing air pollution, noise and heat island effects and increasing green space and physical activity

Cities are centres of innovation and wealth creation, but also hotspots of air pollution and noise, heat island effects and lack of green space, which are all detrimental to human health. They are also hotspots of COVID19. COVID19 has led to a rethink of urban public space. Therefore, is it time to re-think our urban models and reduce the health burden? We provide a narrative meta-review around a number of cutting edge and visionary urban models that that may affect health and that have been reported over the past few years. New urban concepts such as the Superblocks, the low traffic neighbourhood, 15 Minute city, Car free city or a mixture of these that may go some way in reducing the health burden related to current urban and transport practices. They will reduce air pollution and noise, heat island effects and increase green space and physical activity levels. What is still lacking though is a thorough evaluation of the effectiveness and acceptability of the schemes and the impacts on not only health, but also liveability and sustainability, although they are expected to be positive. Finally, the COVID19 pandemic may accelerate these developments and stimulus funding like the EU Next Generation funding should be used to make these changes.

Premature Mortality of 2050 High Bike Use Scenarios in 17 Countries

BACKGROUND

Biking plays a significant role in urban mobility and has been suggested as a tool to promote public health. A recent study has proposed 2050 global biking scenarios based on large shifts from motorized vehicles to bikes. No previous studies have estimated the health impacts of global cycling scenarios, either future car-bike shift substitutions.

OBJECTIVES

We aimed to quantify changes in premature mortality of 2050 global biking scenarios in urban populations from 17 countries.

METHODS

Through a quantitative Health Impact Assessment, the mortality risks and benefits of replacing car trips by bike (mechanica bike and electric bike) in urban populations from 17 countries were estimated. Multiple bike scenarios were created based on current transport trends or large shifts from car trips to bike trips. We quantified the estimated change in the number of premature deaths (reduced or increased) concerning road traffic fatalities, air pollution, and physical activity. This study focuses on urban populations between 20 and 64 y old.

RESULTS

We found that, among the urban populations (20-64 y old) of 17 countries, 205,424 annual premature deaths could be prevented if high bike-use scenarios are achieved by 2050 (assuming that 100% of bike trips replace car trips). If only 8% of bike trips replace car trips in a more conservative scenario, 18,589 annual premature deaths could be prevented by 2050 in the same population. In all the countries and scenarios, the mortality benefits related to bike use (rather than car use) outweighed the mortality risks.

DISCUSSION

We found that global biking policies may provide important mortality benefits in 2050. Current and future bike- vs. car-trip policies should be considered key public health interventions for a healthy urban design. https://doi.org/10.1289/EHP9073.

Urban Climate Policy and Action through a Health Lens-An Untapped Opportunity

Motivated by a growing recognition of the climate emergency, reflected in the 26th Conference of the Parties (COP26), we outline untapped opportunities to improve health through ambitious climate actions in cities. Health is a primary reason for climate action yet is rarely integrated in urban climate plans as a policy goal. This is a missed opportunity to create sustainable alliances across sectors and groups, to engage a broad set of stakeholders, and to develop structural health promotion. In this statement, we first briefly review the literature on health co-benefits of urban climate change strategies and make the case for health-promoting climate action; we then describe barriers to integrating health in climate action. We found that the evidence-base is often insufficiently policy-relevant to be impactful. Research rarely integrates the complexity of real-world systems, including multiple and dynamic impacts of strategies, and consideration of how decision-making processes contend with competing interests and short-term electoral cycles. Due to siloed-thinking and restrictive funding opportunities, research often falls short of the type of evidence that would be most useful for decision-making, and research outputs can be cryptic to decision makers. As a way forward, we urge researchers and stakeholders to engage in co-production and systems thinking approaches. Partnering across sectors and disciplines is urgently needed so pathways to climate change mitigation and adaptation fully embrace their health-promoting potential and engage society towards the huge transformations needed. This commentary is endorsed by the International Society for Environmental Epidemiology (ISEE) and the International Society for Urban Health (ISUH) and accompanies a sister statement oriented towards stakeholders (published on the societies' websites).

Functional and Morphological Transformations of the Urban Block—Contribution to the Expected Modernization of Zagreb’s Historical Core

The paper explores the possibilities of the structural and functional transformation of blocks in the historical center of Zagreb as a part of modernization after many years of neglect as well as earthquakes in 2020. The research aims to determine how the existing block tissue corresponds with the needs of today’s residents and the possibility of its improvement. The historical circumstances in which the blocks were formed and underwent the most significant changes and modern processes that affect the state and value are determined. There is a special focus on the interior of the block (courtyards), as well as on the spaces on the ground floors of street facades, where numerous, unexplored changes can be observed. The findings provide starting points for desirable structural–functional transformations of blocks and stem from the synthesis and interpretation of knowledge from four interrelated parts of the research. The characteristics of blocks have changed during city development stages, as depicted by an analysis and graphic interpretation of historical maps and urban plans (1864–2021). Influences of modern processes on changes of the city are determined on the basis of the synthesis of previous research from different interdisciplinary points of view; a detailed analysis of the structural–functional changes is conducted on the example of three selected blocks. Transformation models for three selected blocks are proposed.

Observed inequality in urban greenspace exposure in China

Given the important role of green environments playing in healthy cities, the inequality in urban greenspace exposure has aroused growing attentions. However, few comparative studies are available to quantify this phenomenon for cities with different population sizes across a country, especially for those in the developing world. Besides, commonly used inequality measures are always hindered by the conceptual simplification without accounting for human mobility in greenspace exposure assessments. To fill this knowledge gap, we leverage multi-source geospatial big data and a modified assessment framework to evaluate the inequality in urban greenspace exposure for 303 cities in China. Our findings reveal that the majority of Chinese cities are facing high inequality in greenspace exposure, with 207 cities having a Gini index larger than 0.6. Driven by the spatiotemporal variability of human distribution, the magnitude of inequality varies over different times of the day. We also find that exposure inequality is correlated with low greenspace provision with a statistical significance (p-value < 0.05). The inadequate provision may result from various factors, such as dry cold climate and urbanization patterns. Our study provides evidence and insights for central and local governments in China to implement more effective and sustainable greening programs adjusted to different local circumstances and incorporate the public participatory engagement to achieve a real balance between greenspace supply and demand for developing healthy cities.

Citizens’ Perceptions in Relation to Transport Systems and Infrastructures: A Nationwide Study in the Dominican Republic

One of the challenges currently faced by emerging countries is to get their citizens to decide to use sustainable transport for their regular trips, in order to reduce the current vehicular pollution rates. The objective of this descriptive research is to examine the perceptions of Dominicans regarding the state of the country’s transport systems and road infrastructure. For this purpose, a nationwide survey procedure was performed. This cross-sectional research used the data retrieved from a sample of 1260 citizens aged over 18, proportional in gender, age, habitat, and province of the Dominican Republic. The results showed how Dominicans believe that, compared to other road features, pedestrian roads and public transport vehicles remain in a very poor condition. Further, citizens report to be more interested about the improvement of road infrastructures than in the implementation of any other set of measures performed to promote sustainable road mobility, including those related with alternative transport means. Finally, this study claims for the need of fostering educational, communicative and participative actions and measures aimed at increasing the value given to sustainable transportation, and the relevance of integrate potential structural and vehicular improvements with those related to human behavior in mobility.

Environmental risk factors and cardiovascular diseases: a comprehensive review

Noncommunicable diseases (NCDs) are fatal for more than 38 million people each year and are thus the main contributors to the global burden of disease accounting for 70% of mortality. The majority of these deaths are caused by cardiovascular disease. The risk of NCDs is strongly associated with exposure to environmental stressors such as pollutants in the air, noise exposure, artificial light at night and climate change, including heat extremes, desert storms and wildfires. In addition to the traditional risk factors for cardiovascular disease such as diabetes, arterial hypertension, smoking, hypercholesterolemia and genetic predisposition, there is a growing body of evidence showing that physicochemical factors in the environment contribute significantly to the high NCD numbers. Furthermore, urbanization is associated with accumulation and intensification of these stressors. This comprehensive expert review will summarize the epidemiology and pathophysiology of environmental stressors with a focus on cardiovascular NCDs. We will also discuss solutions and mitigation measures to lower the impact of environmental risk factors with focus on cardiovascular disease.

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

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.

METHODS

In 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 age-structures 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.

FUNDING

GoGreenRoutes, Internal ISGlobal fund, and the United States Department of Agriculture Forest Service.

Heart healthy cities: genetics loads the gun but the environment pulls the trigger

The world's population is estimated to reach 10 billion by 2050 and 75% of this population will live in cities. Two-third of the European population already live in urban areas and this proportion continues to grow. Between 60% and 80% of the global energy use is consumed by urban areas, with 70% of the greenhouse gas emissions produced within urban areas. The World Health Organization states that city planning is now recognized as a critical part of a comprehensive solution to tackle adverse health outcomes. In the present review, we address non-communicable diseases with a focus on cardiovascular disease and the urbanization process in relation to environmental risk exposures including noise, air pollution, temperature, and outdoor light. The present review reports why heat islands develop in urban areas, and how greening of cities can improve public health, and address climate concerns, sustainability, and liveability. In addition, we discuss urban planning, transport interventions, and novel technologies to assess external environmental exposures, e.g. using digital technologies, to promote heart healthy cities in the future. Lastly, we highlight new paradigms of integrative thinking such as the exposome and planetary health, challenging the one-exposure-one-health-outcome association and expand our understanding of the totality of human environmental exposures.

Towards Smart City Governance. Case Study: Improving the Interpretation of Quantitative Traffic Measurement Data through Citizen Participation

Citizens play a core role in sustainable cities as users of the services delivered by cities and as active participants in initiatives aimed at making cities more sustainable. This paper considers the role of citizens as information providers and discusses the conditions under which citizens can participate in the development of sustainable cities. The objective of this study is to document the sustainability of an urban transit system and evaluate its compliance, with citizen participation as a major contributor. The methodology used is intensive field visits, interviews, and a mixed analysis of Sant Andreu de Palomar District in Barcelona city. The circulating vehicles are quantitatively monitored, qualitative problems are detected, and the typology of vehicles and other aspects identified and detailed in the study are indicated. All this information is contrasted with that of the technological sensors in the sectors. The results indicate that vehicles in the current pattern of urban density planned under incorrect sensor operation influence sustainable behavior through agglomerative clustering. This paper provides recommendations for future urban sustainability assessment research, including the employment of mixed-methods research, among other strategies. This article is intended to assist policymakers and traffic engineers in evaluating the sustainability of urban transportation infrastructure projects considering citizens as sensors.

Working from Home: Is Our Housing Ready?

The COVID-19 pandemic and the precautionary measures applied globally (lockdowns and curfews) have impacted homes, including work. Working from home (WFH) has emerged as a growing trend in the post-pandemic era. The research question was: Are our homes ready for teleworking? To respond, a national prospective mixed approach was launched for Spanish households during the spring 2020 lockdown, using two online questionnaires, one quantitative and the other qualitative. Through a survey, photographs, and narratives, the study evaluates the perceived adequacy of telework spaces and their specific characteristics, the availability of digital resources and the internet. A total of 1800 surveys and over 200 images and texts related to telework environments were obtained. The results suggest that the adequacy of these spaces was insufficient for more than a quarter of the homes. Also, strong relations between the perceived workspace adequacy and a social status or stability of homes were shown and validated, despite other sociodemographic features, the home composition or habitat were not related. Some other variables statistically significant were occupation regime, type and surface of dwellings; their indoor environmental quality; the availability of exclusive spaces for teleworking; quality of digital resources; and the specific space features. The analysis was completed with qualitative insights through photos and texts. Telework, lived in this context as an experiment, needs this reflection from an environmental, resource-availability, and ergonomic point of view.

Acoustic Properties of Larch Bark Panels

The potential of tree bark, a by-product of the woodworking industry, has been studied for more than seven decades. Bark, as a sustainable raw material, can replace wood or other resources in numerous applications in construction. In this study, the acoustic properties of bark-based panels were analyzed. The roles of the particle size (4–11 mm and 10–30 mm), particle orientation (parallel and perpendicular) and density (350–700 kg/m3) of samples with 30 mm and 60 mm thicknesses were studied at frequencies ranging from 50 to 6400 Hz. Bark-based boards with fine-grained particles have been shown to be better in terms of sound absorption coefficient values compared with coarse-grained particles. Bark composites mixed with popcorn bonded with UF did not return the expected results, and it is not possible to recommend this solution. The best density of bark boards to obtain the best sound absorption coefficients is about 350 kg/m3. These lightweight panels achieved better sound-absorbing properties (especially at lower frequencies) at higher thicknesses. The noise reduction coefficient of 0.5 obtained a sample with fine particles with a parallel orientation and a density of around 360 kg/m3.

Evidence-informed policy for tackling adverse climate change effects on health: Linking regional and global assessments of science to catalyse action

Robin Fears and co-authors discuss evidence-informed regional and global policy responses to health impacts of climate change.

A Comprehensive Review of Urban Regeneration Governance for Developing Appropriate Governance Arrangements

Urban regeneration governance (URG) has become a popular issue in academia, politics and civil society because it has a significant influence on the success of urban regeneration activities. However, a comprehensive review on URG has yet to be produced, which hinders providing references to developing appropriate governance arrangements. Therefore, this study selected 88 relevant literatures from 1990 to 2019 to conduct a critical review. The goal of this review is to conceptualize URG, refine the signature elements of URG, compare the main modes of URG, and analyze the influential factors of URG. As a decision-making mode or a partnership, URG consists of three elements—partner, power and procedure—and influenced by three factors, the plan, place and person. There are three main modes of URG and each has pros and cons. Based on a comprehensive review, this paper concludes some findings and draws an 8p model that can provide an analysis framework for decision makers. Finally, four avenues for future research are proposed.

Australia in 2030: what is our path to health for all?

CHAPTER 1: HOW AUSTRALIA IMPROVED HEALTH EQUITY THROUGH ACTION ON THE SOCIAL DETERMINANTS OF HEALTH: Do not think that the social determinants of health equity are old hat. In reality, Australia is very far away from addressing the societal level drivers of health inequity. There is little progressive policy that touches on the conditions of daily life that matter for health, and action to redress inequities in power, money and resources is almost non-existent. In this chapter we ask you to pause this reality and come on a fantastic journey where we envisage how COVID-19 was a great disruptor and accelerator of positive progressive action. We offer glimmers of what life could be like if there was committed and real policy action on the social determinants of health equity. It is vital that the health sector assists in convening the multisectoral stakeholders necessary to turn this fantasy into reality. CHAPTER 2: ABORIGINAL AND TORRES STRAIT ISLANDER CONNECTION TO CULTURE: BUILDING STRONGER INDIVIDUAL AND COLLECTIVE WELLBEING: Aboriginal and Torres Strait Islander peoples have long maintained that culture (ie, practising, maintaining and reclaiming it) is vital to good health and wellbeing. However, this knowledge and understanding has been dismissed or described as anecdotal or intangible by Western research methods and science. As a result, Aboriginal and Torres Strait Islander culture is a poorly acknowledged determinant of health and wellbeing, despite its significant role in shaping individuals, communities and societies. By extension, the cultural determinants of health have been poorly defined until recently. However, an increasing amount of scientific evidence supports what Aboriginal and Torres Strait Islander people have always said - that strong culture plays a significant and positive role in improved health and wellbeing. Owing to known gaps in knowledge, we aim to define the cultural determinants of health and describe their relationship with the social determinants of health, to provide a full understanding of Aboriginal and Torres Strait Islander wellbeing. We provide examples of evidence on cultural determinants of health and links to improved Aboriginal and Torres Strait Islander health and wellbeing. We also discuss future research directions that will enable a deeper understanding of the cultural determinants of health for Aboriginal and Torres Strait Islander people. CHAPTER 3: PHYSICAL DETERMINANTS OF HEALTH: HEALTHY, LIVEABLE AND SUSTAINABLE COMMUNITIES: Good city planning is essential for protecting and improving human and planetary health. Until recently, however, collaboration between city planners and the public health sector has languished. We review the evidence on the health benefits of good city planning and propose an agenda for public health advocacy relating to health-promoting city planning for all by 2030. Over the next 10 years, there is an urgent need for public health leaders to collaborate with city planners - to advocate for evidence-informed policy, and to evaluate the health effects of city planning efforts. Importantly, we need integrated planning across and between all levels of government and sectors, to create healthy, liveable and sustainable cities for all. CHAPTER 4: HEALTH PROMOTION IN THE ANTHROPOCENE: THE ECOLOGICAL DETERMINANTS OF HEALTH: Human health is inextricably linked to the health of the natural environment. In this chapter, we focus on ecological determinants of health, including the urgent and critical threats to the natural environment, and opportunities for health promotion arising from the human health co-benefits of actions to protect the health of the planet. We characterise ecological determinants in the Anthropocene and provide a sobering snapshot of planetary health science, particularly the momentous climate change health impacts in Australia. We highlight Australia's position as a major fossil fuel producer and exporter, and a country lacking cohesive and timely emissions reduction policy. We offer a roadmap for action, with four priority directions, and point to a scaffold of guiding approaches - planetary health, Indigenous people's knowledge systems, ecological economics, health co-benefits and climate-resilient development. Our situation requires a paradigm shift, and this demands a recalibration of health promotion education, research and practice in Australia over the coming decade. CHAPTER 5: DISRUPTING THE COMMERCIAL DETERMINANTS OF HEALTH: Our vision for 2030 is an Australian economy that promotes optimal human and planetary health for current and future generations. To achieve this, current patterns of corporate practice and consumption of harmful commodities and services need to change. In this chapter, we suggest ways forward for Australia, focusing on pragmatic actions that can be taken now to redress the power imbalances between corporations and Australian governments and citizens. We begin by exploring how the terms of health policy making must change to protect it from conflicted commercial interests. We also examine how marketing unhealthy products and services can be more effectively regulated, and how healthier business practices can be incentivised. Finally, we make recommendations on how various public health stakeholders can hold corporations to account, to ensure that people come before profits in a healthy and prosperous future Australia. CHAPTER 6: DIGITAL DETERMINANTS OF HEALTH: THE DIGITAL TRANSFORMATION: We live in an age of rapid and exponential technological change. Extraordinary digital advancements and the fusion of technologies, such as artificial intelligence, robotics, the Internet of Things and quantum computing constitute what is often referred to as the digital revolution or the Fourth Industrial Revolution (Industry 4.0). Reflections on the future of public health and health promotion require thorough consideration of the role of digital technologies and the systems they influence. Just how the digital revolution will unfold is unknown, but it is clear that advancements and integrations of technologies will fundamentally influence our health and wellbeing in the future. The public health response must be proactive, involving many stakeholders, and thoughtfully considered to ensure equitable and ethical applications and use. CHAPTER 7: GOVERNANCE FOR HEALTH AND EQUITY: A VISION FOR OUR FUTURE: Coronavirus disease 2019 has caused many people and communities to take stock on Australia's direction in relation to health, community, jobs, environmental sustainability, income and wealth. A desire for change is in the air. This chapter imagines how changes in the way we govern our lives and what we value as a society could solve many of the issues Australia is facing - most pressingly, the climate crisis and growing economic and health inequities. We present an imagined future for 2030 where governance structures are designed to ensure transparent and fair behaviour from those in power and to increase the involvement of citizens in these decisions, including a constitutional voice for Indigenous peoples. We imagine that these changes were made by measuring social progress in new ways, ensuring taxation for public good, enshrining human rights (including to health) in legislation, and protecting and encouraging an independent media. Measures to overcome the climate crisis were adopted and democratic processes introduced in the provision of housing, education and community development.