Healthy urban planning in European cities

Assessing the association between overcrowding and human physiological stress response in different urban contexts: a case study in Salzburg, Austria

Overcrowding in densely populated urban areas is increasingly becoming an issue for mental health disorders. Yet, only few studies have examined the association between overcrowding in cities and physiological stress responses. Thus, this study employed wearable sensors (a wearable camera, an Empatica E4 wristband and a smartphone-based GPS) to assess the association between overcrowding and human physiological stress response in four types of urban contexts (green space, transit space, commercial space, and blue space). A case study with 26 participants was conducted in Salzburg, Austria. We used Mask R-CNN to detect elements related to overcrowding such as human crowds, sitting facilities, vehicles and bikes from first-person video data collected by wearable cameras, and calculated a change score (CS) to assess human physiological stress response based on galvanic skin response (GSR) and skin temperature from the physiological data collected by the wristband, then this study used statistical and spatial analysis to assess the association between the change score and the above elements. The results demonstrate the feasibility of using sensor-based measurement and quantitative analysis to investigate the relationship between human stress and overcrowding in relation to different urban elements. The findings of this study indicate the importance of considering human crowds, sitting facilities, vehicles and bikes to assess the impact of overcrowding on human stress at street level.

Integrating Health into Local Plans: A Comparative Review of Health Requirements for Urban Development in Seven Local Planning Authorities in England

A local plan is a statutory policy document that supports urban development decisions across a local government area in England. Local plans are reported to need more specific requirements for development proposals regarding wider health determinants to address potential health outcomes and health inequalities. This study reviews the integration of Health in Local Plans of seven local planning authorities through documentary analysis methods. A review framework was formulated based on health and planning literature regarding local plans, health policy and determinants of health and dialogue with a local government partner. The findings identify opportunities to strengthen the consideration of Health in Local Plans, including ensuring that policies are informed by local health priorities and signpost national guidance, strengthening health-related requirements for developers (e.g., indoor air quality, fuel poverty and security of tenure) and improving implementation of requirements for developers (e.g., through adoption of health management plans and community ownership). The study identifies further research needs regarding how policies are interpreted by developers in practice, and on national guidance for Health Impact Assessment. It highlights the benefit of undertaking a comparative review, contrasting local plan policy language and identifying opportunities to share, adapt and strengthen planning requirements regarding health outcomes.

How to Evaluate Health in All Policies at the Local Level: Methodological Insights Within Municipalities From the WHO French Healthy Cities Network

BACKGROUND

This article proposes a method for analysing the degree of maturity of Health in All Policies (HiAP) among World Health Organization-French Healthy Cities Network (WHO-FHCN) as part of the GoveRnance for Equity, EnviroNment and Health in the City (GREENH-City) project. We focused on the creation or enhancement of health-promoting environments, and more specifically, public green spaces.

METHODS

We conducted a cross-sectional quantitative study guided by the evaluative framework of the HiAP maturity level developed by Storm et al mixed with a qualitative interpretation. A self-administered questionnaire was sent to elected officials and health department officers in the 85 member cities of the WHO-FHCN in 2017. Subsequently 58 cities were included in the analysis, which was based on a multiple correspondence analysis (MCA) and a hierarchical ascending classification (HAC).

RESULTS

Thirty-two criteria among a total of 100 were identified and were used to organize the cities into 8 groups which was then reduced to three profiles among the cities: a less advanced HiAP profile, an established HiAP profile and an advanced HiAP profile. This process allows us to identify 4 dimensions that make it possible to evaluate the level of maturity of cities in the HiAP process, namely: (1) the consideration of social inequalities in health and/or health issues in the policies/actions of the sector studied, (2) occasional intersectoral collaboration, ie, one-off initiatives between the health department and others sectors, (3) the existence of joint projects, ie, common projects between two or more sectors, (4) the existence of intersectoral bodies, in this case on the theme of urban green spaces including an intersectoral committee and/or working groups.

CONCLUSION

Four dimensions which allow to the measurement of the degree of progress in implementing health-all-policies are proposed. With a view to integrating knowledge into public action, this study carried out under real conditions offers a realistic method to evaluate HiAP.

Implementation of Green Infrastructure in Existing Urban Structures: Tracking Changes in Ferencváros, Budapest

Understanding the resilience of urban forms as a latent force that drives a place’s physical characterization and social cohesion is essential for defining successful adaptive processes of pre-existing urban fabrics. Budapest’s ninth district (Ferencváros) is an outstanding example of transforming a complex historical urban context, which underwent renovation strategies guided by maintaining and enhancing essential morphological elements. Courtyards have great relevance in conditioning the well-being in areas of high occupational density, especially in terms of accessibility to urban green infrastructure. In the case of Ferencváros, they were reframed to add new layers of use and to improve territorial integration by unifying smaller private courtyard unities into more extensive communal areas, creating a comprehensive urban green network, preserving urban heritage, and increasing green coverage. This study assesses how this recent re-urbanization phenomenon is related to political changes in a post-socialist city. The conjuncture found in Ferencváros is unique, yet it can be applied in other similar contexts. The methodology applied to this study is supervised classification for the quantitative analysis of remote-sensing image data with GIS software assistance—a procedure rarely applied in medium-scale urban analysis. However, it was verified to be precise and effective in tracking morphological changes. The preliminary results indicate a significant intensification in greenery in the urban pattern, especially in the core areas of the blocks: the courtyards. After the intervention, green areas became more predominant, cohesive, and articulated.

Comparative Study on the Evaluation of Healthy City Construction in Typical Chinese Cities Based on Statistical Data and Land Use Data

The 17 Sustainable Development Goals of the United Nations propose to “ensure healthy lives and promote well-being for all at all ages”, and to achieve this goal requires that countries strengthen their capacity to manage health risks. As a concept to describe urban construction, advocated by the World Health Organization, healthy cities can effectively solve the contradictions existing along the current urban development path at a macro level. A healthy city is a sustainable city that interacts with its environment, economy, population, services, and space, and realizes the well-being of its population from all perspectives. The construction of a healthy city is an important part of the transformation of Chinese urbanization. This article refers to the index systems of domestic and foreign government agencies, along with a literature research, to construct a healthy city evaluation index that takes into account the five aspects of environment, economy, population, service, and space, and selects Beijing (a policy-oriented city), Shanghai (an economy-oriented city), Nanchang (an industry-oriented city), Guiyang (a tourism-oriented city), Datong (resource-oriented city) as five cities according to type of urban development, using the entire-array-polygon method to analyze the construction level of these cities in terms of environment, economy, population, service, space and overall state of health from 2014 to 2018 based on statistical and land use data. The results of the study found that, in general, the construction of healthy cities in China currently experiences large year-to-year fluctuations and significant differences between cities. The construction and development of healthy cities are also closely related to factors such as urban economic strength, social welfare, and policy support.

The Application of 'Elite Interviewing' Methodology in Transdisciplinary Research: a Record of Process and Lessons Learned during a 3-Year Pilot in Urban Planetary Health Research

This paper sets out the rationale and process for the interviewing methodology utilized during a 3-year research pilot, 'Moving Health Upstream in Urban Development' (UPSTREAM). The project had two primary aims: firstly, to attempt to value economically the health cost benefits associated with the quality of urban environments and secondly, to engage with those in control of urban development in the UK in order to determine what are the barriers to and opportunities for creating healthy urban environments, including those identified through the utilisation of economic valuation. Engagement at senior level with those who have most control over key facets of planning and development implementation-such as land disposal, investment, development delivery and planning permission-was central to the approach, which encompassed the adoption of 'elite interviewing', a method developed in the USA in the 1950s and used in the political sciences but relatively unutilized in the health and environmental sciences [1]. Two rounds of semi-structured interviews were undertaken with 15 senior decision-makers from the UK's main urban development delivery agencies, both public and private. The 'elite interviewing' approach successfully enabled the UPSTREAM project to capture and analyse the information received from the interviewees, all of whom held influential or leadership posts in organisations that are important actors in the process of planning, developing and constructing the built environment in the UK. Having academic and practitioner research leads on an equal footing created some minor tensions, but it also appeared to strengthen the rigor of the approach through a broad knowledge of context 'in-house'. This form of co-production at times challenged academic traditions in qualitative analysis, but it also appeared to build trust with interviewees and provided greater clarity of the real-world context under investigation. Findings from this study are written up in a separate paper.

The relationship between air pollution and diabetes: A study on the municipalities of the Metropolitan City of Milan

AIMS

Urbanisation has been linked with an increased risk of developing diabetes mellitus, dramatically worsening the healthcare system's financial burden. Environmental influences are emerging among the causing factors of the urban diabetes epidemic. We evaluated the relationship between air pollution and the prevalence of diabetes in the Municipalities of the Metropolitan City of Milan, comprising more than 3,4 million citizens.

METHODS

The prevalence of diabetes in the resident population and the mean annual air concentrations of PM10 and NO2 were retrieved from the municipal Agency for Health Protection and the regional Agency for Ambient Protection datasets. Two linear regression models were estimated to inspect the relationships between the (logit-based transformed) diabetes prevalence and air pollution concentrations, namely: (i) PM10, and (ii) NO2. Both models were adjusted for five control variables, including the qualitative variable year (2011-2018).

RESULTS

Both models highlight a statistically significant positive relationship between air pollutants and diabetes prevalence. An increase of one PM10 or NO2 concentrations' unit translates into a rise of 0.81% or 0.41% in diabetes prevalence, respectively.

CONCLUSION

Our results contribute to the ongoing research regarding health outcomes of urbanisation dynamics and should be considered in city planning policies.

Role of Vegetation as a Mitigating Factor in the Urban Context

It is known that the urban environment amplifies the effects of climate change, sometimes with disastrous consequences that put people at risk. These aspects can be affected by urban vegetation and planting design but, while there are thousands of papers related to the effects of climate change, a relatively limited number of them are directly aimed at investigating the role of vegetation as a mitigating factor in the urban context. This paper focuses on reviewing the research on the role of urban vegetation in alleviating the adverse conditions of the urban environment in order to provide some practical guidelines to be applied by city planners. Through an analysis of the documents found in Scopus, Web of Science, and Google Scholar using urban vegetation and climate change-related keywords we selected five major issues related to the urban environment: (1) particulate matter, (2) gaseous pollution, (3) noise pollution, (4) water runoff, (5) urban heat island effect. The analysis of existing knowledge reported here indicates that the roles of urban vegetation on the adverse effect of climate change could not be simply deemed positive or negative, because the role of urban green is also strongly linked to the structure, composition, and distribution of vegetation, as well as to the criteria used for management. Therefore, it could help to better understand the roles of urban green as a complex system and provide the foundation for future studies.

A Spatial Distribution Equilibrium Evaluation of Health Service Resources at Community Grid Scale in Yichang, China

Whether the supplies of health services and related facilities meet the demand is a critical issue when developing healthy cities. The importance of health services and related facilities in public health promotion has been adequately proved. However, since the community population and resource data are usually available at the scale of an administrative region; it is very difficult to perform further fine-scaled spatial distribution equilibrium evaluation studies. Such kinds of activities are highly expected for precise urban planning and management. Yichang is located in Hubei province, the central part of China, along the Yangzi River. It is leading both of China’s smart cities demonstration project and China’s healthy cities pilot project. Yichang has defined 1271 community grids for urban management and service, where each grid consists of 200 households generally with its population distribution data routinely updated. The research set the 15-min walking distances of the residents as impedance factors, and the numbers and the types of health service resources as attractiveness factors for accessibility evaluation. The resource ratio, richness and per capita number of various health service resources that can be reached within 15 min from the community grid building is used as spatial distribution equilibrium evaluation indicators. The entropy weight method is used to assign the indicator weight value. The obtained fine-scale evaluation results were analyzed. In this way, a community grid-scale spatial distribution equilibrium evaluation of health service resources in Yichang was performed. The proposed research could be of value for rapid and precise evaluation of spatial distribution equilibrium evaluation of a variety of healthy city resources, to support healthy city planning and management.

Not All Green Space Is Created Equal: Biodiversity Predicts Psychological Restorative Benefits From Urban Green Space

Contemporary epidemiological methods testing the associations between green space and psychological well-being treat all vegetation cover as equal. However, there is very good reason to expect that variations in ecological "quality" (number of species, integrity of ecological processes) may influence the link between access to green space and benefits to human health and well-being. We test the relationship between green space quality and restorative benefit in an inner city urban population in Bradford, United Kingdom. We selected 12 urban parks for study where we carried out botanical and faunal surveys to quantify biodiversity and assessed the site facilities of the green space (cleanliness, provision of amenities). We also conducted 128 surveys with park users to quantify psychological restoration based on four self-reported measure of general restoration, attention-grabbing distractions, being away from everyday life, and site preference. We present three key results. First, there is a positive association between site facilities and biodiversity. Second, restorative benefit is predicted by biodiversity, which explained 43% of the variance in restorative benefit across the parks, with minimal input from other variables. Third, the benefits accrued through access to green space were unrelated to age, gender, and ethnic background. The results add to a small but growing body of evidence that emphasize the role of nature in contributing to the well-being of urban populations and, hence, the need to consider biodiversity in the design of landscapes that enhance multiple ecosystem services.

Intersectoral Planning for Public Health: Dilemmas and Challenges

BACKGROUND

Intersectoral action is often presented as essential in the promotion of population health and health equity. In Norway, national public health policies are based on the Health in All Policies (HiAP) approach that promotes whole-of-government responsibility. As part of the promotion of this intersectoral responsibility, planning is presented as a tool that every Norwegian municipality should use to integrate public health policies into their planning and management systems. Although research on implementing the HiAP approach is increasing, few studies apply a planning perspective. To address this gap in the literature, our study investigates how three Norwegian municipalities experience the use of planning as a tool when implementing the HiAP approach.

METHODS

To investigate planning practices in three Norwegian municipalities, we used a qualitative multiple case study design based on face-to-face interviews. When analysing and discussing the results, we used the dichotomy of instrumental and communicative planning approaches, in addition to a collaborative planning approach, as the theoretical framework.

RESULTS

The municipalities encounter several dilemmas when using planning as a tool for implementing the HiAP approach. Balancing the use of qualitative and quantitative knowledge and balancing the use of structural and processual procedures are two such dilemmas. Other dilemmas include balancing the use of power and balancing action and understanding in different municipal contexts. They are also faced with the dilemma of whether to place public health issues at the forefront or to present these issues in more general terms.

CONCLUSION

We argue that the dilemmas experienced by the municipalities might be explained by the difficult task of combining instrumental and communicative planning approaches because the balance between them is seldom fixed.

Self-Care for the Prevention and Management of Cardiovascular Disease and Stroke: A Scientific Statement for Healthcare Professionals From the American Heart Association

Self-care is defined as a naturalistic decision-making process addressing both the prevention and management of chronic illness, with core elements of self-care maintenance, self-care monitoring, and self-care management. In this scientific statement, we describe the importance of self-care in the American Heart Association mission and vision of building healthier lives, free of cardiovascular diseases and stroke. The evidence supporting specific self-care behaviors such as diet and exercise, barriers to self-care, and the effectiveness of self-care in improving outcomes is reviewed, as is the evidence supporting various individual, family-based, and community-based approaches to improving self-care. Although there are many nuances to the relationships between self-care and outcomes, there is strong evidence that self-care is effective in achieving the goals of the treatment plan and cannot be ignored. As such, greater emphasis should be placed on self-care in evidence-based guidelines.

Healthy cities as catalysts for caring and supportive environments

'Caring and Supportive Environments' are fundamental to a social model of health and were a core theme of Phase V (2009-13) of the WHO European Healthy Cities Network. Deploying the methodology of realist evaluation, this article synthesizes qualitative evidence from 112 highly structured case studies from 68 Network cities and 71 responses to a General Evaluation Questionnaire, which asked cities to analyze city attributes and trends. A schematic model was developed to describe the interaction between action targeted toward children, migrants, older people and action on social and health services, health literacy and active citizenship-the six subtopics clustered within the theme Caring and Supportive Environments. Four hypotheses were tested: (i) there are prerequisites and processes of local governance that increase city capacity for creating supportive environments; (ii) investing in health and social services, active citizenship and health literacy enhance the social inclusion of vulnerable population groups; (iii) there are synergies between social investment and healthy urban planning; and (iv) these investments promote greater equity in health. The evaluation revealed many innovative practices. Providers of health and social services have developed partnerships with agencies influencing wider determinants of health. Health literacy campaigns address the wider context of people's lives. In a period of economic austerity, cities have utilized the social assets of their citizens. Realist evaluation can help illuminate the pathways from case study interventions to health outcomes, and the prerequisites and processes required to initiate and sustain such investments.

The socio-spatial context as a risk factor for hospitalization due to mental illness in the metropolitan areas of Portugal

Abstract This study’s aims are: (i) identifying spatial patterns for the risk of hospitalization due to mental illness and for the potential risk resulting from contextual factors with influence on mental health; and (ii) analyzing the spatial association between risk of hospitalization due to mental illness and potential risk resulting from contextual factors in the metropolitan areas of Lisbon and Porto, Portugal. A cross-sectional ecological study was conducted by applying statistical methods for assessing spatial dependency and heterogeneity. Results reveal a spatial association between risk of hospitalization due to mental illness and potential risk resulting from contextual factors with a statistical relevance of moderate intensity. 20% of the population under study lives in areas with a simultaneously high potential risk resulting from contextual factors and risk of hospitalization due to mental illness. Porto Metropolitan Area show the highest percentage of population living in parishes with a significantly high risk of hospitalization due to mental health, which puts forward the need for interventions on territory-adjusted contextual factors influencing mental health.

Healthy Toronto by Design: Promoting a healthier built environment

Chronic diseases, obesity and sedentary lifestyles are some of the health challenges facing Canada today. There is increasing recognition and evidence that the way our cities are planned, designed and built can contribute to these problems. Many of the policy levers to address the built environment exist outside the health sector and at the municipal level in areas such as urban planning, transportation, parks and recreation, and housing. The challenge for the public health sector is to build and sustain partnerships and collaboration across various sectors to ensure that health is considered in built environment policies. As the public health unit for the city of Toronto and part of the municipal government, Toronto Public Health is in a unique position to provide leadership, advocacy and support for healthy municipal public policies related to the built environment. This article provides some examples of CLASP (Coalitions Linking Action and Science for Prevention) initiatives undertaken to help create support for healthy public policies in the built environment and suggests that the "Healthy Cities" approach is a useful framework to promote policy change in the built environment at the municipal level.

City leadership for health and well-being: back to the future

The new European Health Policy Framework and Strategy: Health 2020 of the World Health Organization, draws upon the experience and insights of five phases, spanning 25 years, of the WHO European Healthy Cities Network (WHO-EHCN). Applying the 2020 health lens to Healthy Cities, equity in health and human-centered sustainable development are core values and cities have a profound influence on the wider determinants of health in the European population. "Making it Happen" relies on four action elements applied and tested by municipalities and their formal and informal partners: political commitment, vision and strategy, institutional change, and networking. In turn, the renewed commitment by member states of the WHO Regional Committee to work with all spheres and tiers of government is a new dawn for city governance, encouraging cities to redouble their investment in health and health equity in all policies, even in a period of austerity. For phase VI, the WHO-EHCN is being positioned as a strategic vehicle for implementing Health 2020 at the local level. Healthy Cities' leadership is more relevant than ever.

Using GPS technology to quantify human mobility, dynamic contacts and infectious disease dynamics in a resource-poor urban environment

Empiric quantification of human mobility patterns is paramount for better urban planning, understanding social network structure and responding to infectious disease threats, especially in light of rapid growth in urbanization and globalization. This need is of particular relevance for developing countries, since they host the majority of the global urban population and are disproportionally affected by the burden of disease. We used Global Positioning System (GPS) data-loggers to track the fine-scale (within city) mobility patterns of 582 residents from two neighborhoods from the city of Iquitos, Peru. We used ∼2.3 million GPS data-points to quantify age-specific mobility parameters and dynamic co-location networks among all tracked individuals. Geographic space significantly affected human mobility, giving rise to highly local mobility kernels. Most (∼80%) movements occurred within 1 km of an individual's home. Potential hourly contacts among individuals were highly irregular and temporally unstructured. Only up to 38% of the tracked participants showed a regular and predictable mobility routine, a sharp contrast to the situation in the developed world. As a case study, we quantified the impact of spatially and temporally unstructured routines on the dynamics of transmission of an influenza-like pathogen within an Iquitos neighborhood. Temporally unstructured daily routines (e.g., not dominated by a single location, such as a workplace, where an individual repeatedly spent significant amount of time) increased an epidemic's final size and effective reproduction number by 20% in comparison to scenarios modeling temporally structured contacts. Our findings provide a mechanistic description of the basic rules that shape human mobility within a resource-poor urban center, and contribute to the understanding of the role of fine-scale patterns of individual movement and co-location in infectious disease dynamics. More generally, this study emphasizes the need for careful consideration of human social interactions when designing infectious disease mitigation strategies, particularly within resource-poor urban environments.

Intersectoral planning for city health development

The article reviews the evolution and process of city health development planning (CHDP) in municipalities participating in the European Network of Healthy Cities organized by the European Region of the World Health Organization. The concept of CHDP combines elements from three theoretical domains: (a) health development, (b) city governance, and (c) urban planning. The setting was the 77 cities which participated in Phase IV (2003-2008) of the network. Evidence was gathered principally from a general evaluation questionnaire sent to all network cities. CHDPs are strategic documents giving direction to municipalities and partner agencies. Analysis revealed a trend away from "classic" CHDPs with a primary focus on health development towards ensuring a health dimension to other sector plans, and into the overarching strategies of city governments. Linked to the Phase IV priority themes of Healthy aging and healthy urban planning, cities further developed the concept and application of human-centered sustainability. More work is required to utilize cost-benefit analysis and health impact assessment to unmask the synergies between health and economic prosperity.

Strategies to Strengthen Public Health Inputs to Water Policy in Response to Climate Change: An Australian Perspective

Under current climate change projections, the capacity to provide safe drinking water to Australian communities will be challenged. Part of this challenge is the lack of an adaptive governance strategy that transcends jurisdictional boundaries to support integrated policy making, regulation, or infrastructural adaptation. Consequently, some water-related health hazards may not be adequately captured or forecast under existing water resource management policies to ensure safe water supplies. Given the high degree of spatial and temporal variability in climate conditions experienced by Australian communities, new strategies for national health planning and prioritization for safe water supplies are warranted. The challenges facing public health in Australia will be to develop flexible and robust governance strategies that strengthen public health input to existing water policy, regulation, and surveillance infrastructure through proactive risk planning, adopting new technologies, and intersectoral collaborations. The proposed approach could assist policy makers avert or minimize risk to communities arising from changes in climate and water provisions both in Australia and in the wider Asia Pacific region.