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High ambient temperatures are associated with many health effects, including premature mortality. The combination of global warming due to climate change and the expansion of the global built environment mean that the intensification of urban heat islands (UHIs) is expected, accompanied by adverse effects on population health. Urban green infrastructure can reduce local temperatures. We aimed to estimate the mortality burden that could be attributed to UHIs and the mortality burden that would be prevented by increasing urban tree coverage in 93 European cities. We did a quantitative health impact assessment for summer (June 1–Aug 31), 2015, of the effect of UHIs on all-cause mortality for adults aged 20 years or older in 93 European cities. We also estimated the temperature reductions that would result from increasing tree coverage to 30% for each city and estimated the number of deaths that could be potentially prevented as a result. We did all analyses at a high-resolution grid-cell level (250 × 250 m). We propagated uncertainties in input analyses by using Monte Carlo simulations to obtain point estimates and 95% CIs. We also did sensitivity analyses to test the robustness of our estimates. The population-weighted mean city temperature increase due to UHI effects was 1·5°C (SD 0·5; range 0·5–3·0). Overall, 6700 (95% CI 5254–8162) premature deaths could be attributable to the effects of UHIs (corresponding to around 4·33% [95% CI 3·37–5·28] of all summer deaths). We estimated that increasing tree coverage to 30% would cool cities by a mean of 0·4°C (SD 0·2; range 0·0–1·3). We also estimated that 2644 (95% CI 2444–2824) premature deaths could be prevented by increasing city tree coverage to 30%, corresponding to 1·84% (1·69–1·97) of all summer deaths. Our results showed the deleterious effects of UHIs on mortality and highlighted the health benefits of increasing tree coverage to cool urban environments, which would also result in more sustainable and climate-resilient cities. GoGreenRoutes, Spanish Ministry of Science and Innovation, Institute for Global Health, UK Medical Research Council, European Union's Horizon 2020 Project Exhaustion. [ABSTRACT FROM AUTHOR]

The population living in urban areas is growing rapidly. The level of exposure to adverse environmental factors is detrimental to human health and is directly related to urban and transport planning practices. To estimate the premature mortality burden of non-compliance with international exposure guidelines for air pollution, noise, access to green space and heat for Barcelona and Madrid (Spain), and its distribution among the population by the socioeconomic status (SES). The Urban and TranspOrt planning Health Impact Assessment (UTOPHIA) tool was applied and the attributable premature mortality due to non-compliance with recommended exposure levels was estimated. The distribution of the attributable mortality burden among the population by SES was investigated through Generalized Additive Models (GAMs) adjusting for spatial autocorrelation and a cluster analysis was performed to identify attributable mortality hot spots. Annually, 7.1% and 3.4% of premature mortality in Barcelona and Madrid, respectively, could be attributed to non-compliance with the international exposure recommendations for air pollution, noise, heat and access to green space. In addition, analysis by SES showed that in Barcelona lower SES areas had an overall greater attributable mortality rate, while in Madrid, the distribution of the attributable mortality burden by SES varied by exposure. This study shows the impact of environmental exposures on mortality and highlights the importance of taking integrated actions when designing cities considering the health impacts, but also the specificities of each city such as the socio-demographic context. Moreover, the high precision scale of the analysis enables the identification of environmental hazards and mortality hot spots providing a powerful tool to support priority-setting and guide policymakers towards a healthy, sustainable and just city for all of their residents. • Exposure to adverse environmental factors is detrimental to human health and is related to urban and transport planning. • 7.1% and 3.4% of premature mortality in Barcelona and Madrid was attributed to breaching the environmental exposure guidelines. • In Barcelona low SES had an overall greater attributable mortality rate. • In Madrid, the distribution of the attributable mortality burden by SES varied by exposure. • The high precision scale of the analysis provides a powerful tool to support priority-setting and guide policymakers. [ABSTRACT FROM AUTHOR]

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. We used a narrative meta-review approach and PubMed and Google scholar databases were searched using specific terms. 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. 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. [ABSTRACT FROM AUTHOR]

Background: The GoGreenRoutes project aims to introduce co-created nature-based solutions (NBS) to enhance environmental quality in six medium-sized cities (Burgas, Lahti, Limerick, Tallinn, Umeå, and Versailles). We estimated the mortality and economic impacts attributed to suboptimal exposure to green space and air pollution, economic impacts, and the distribution thereof the adult population by socioeconomic status. Methods: We retrieved data from publicly accessible databases on green space (NDVI and % Green Area), air pollution (NO 2 and PM 2.5) and population (≥20 years, n = 804,975) at a 250m × 250m grid-cell level, and mortality for each city for 2015. We compared baseline exposures at the grid-cell to World Health Organization's recommendations and guidelines. We applied a comparative risk assessment to estimate the mortality burden attributable to not achieving the recommendations and guidelines. We estimated attributable mortality distributions and the association with income levels. Results: We found high variability in air pollution and green spaces levels. Around 60% of the population lacked green space and 90% were exposed to harmful air pollution. Overall, we estimated age-standardized mortality rates varying from 10 (Umeå) to 92 (Burgas) deaths per 100,000 persons attributable to low NDVI levels; 3 (Lahti) to 38 (Burgas) per 100,000 persons to lack of % Green Area; 1 (Umeå) to 88 (Tallinn) per 100,000 persons to exceedances of NO 2 guidelines; and 1 (Umeå) to 206 (Burgas) per 100,000 persons to exceedances of PM 2.5 guidelines. Lower income associated with higher or lower mortality impacts depending on whether deprived populations lived in the densely constructed, highly-trafficked city centre or greener, less polluted outskirts. Conclusions: We attributed a considerable mortality burden to lack of green spaces and higher air pollution, which was unevenly distributed across different social groups. NBS and health-promoting initiatives should consider socioeconomic aspects to regenerate urban areas while providing equally good environments. • Suboptimal green space and air pollution impacted on mortality rates substantially • Population density plays a role in the mortality impact estimations • Green space-related impacts can be greater than those of air pollution in some cities • Inequality patterns varied, mainly depending on where deprived populations live • Inequalities in exposures should be specifically considered prior to local action [ABSTRACT FROM AUTHOR]

[Display omitted] • Road traffic noise is one of the main environmental risks to health and wellbeing. • The study provides an in-depth assessment of available road traffic noise data and estimates population exposure and health impacts for >700 cities in Europe. • Almost 60 million adults were exposed to road traffic noise levels harmful to health across the analysed cities. • 11 million adults were highly annoyed by road traffic noise and>3600 deaths from Ischaemic Heart Disease (IHD) could be prevented annually. • There was variability in the available data due to adistinct noise mapping methods, data formats and noise exposure assessment. • Further efforts to standardize the noise data, increase data availability and quality and provide more comprehensive estimates at the city level are needed. Road traffic is the main source of environmental noise in European cities and one of the main environmental risks to health and wellbeing. In this study we aimed to provide an in-depth assessment of available road traffic noise data and to estimate population exposure and health impacts for cities in Europe. We conducted the analysis for 724 cities and 25 greater cities in 25 European countries. We retrieved road traffic strategic noise maps delivered under the Environmental Noise Directive (END) or available from local sources. We assessed noise exposure using the 24 h day-evening-night noise level indicator (L den) starting at exposure levels of 55 dB L den – based on data availability – for the adult population aged 20 and over (n = 123,966,346). For the adults exposed to noise levels above 55 dB L den we estimated the health impacts of compliance with the World Health Organization (WHO) recommendation of 53 dB L den. Two primary health outcomes were assessed: high noise annoyance and Ischemic Heart Disease (IHD), using mortality from IHD causes as indicator. Exposure Response Functions (ERFs) relating road traffic noise exposure to annoyance and IHD mortality were retrieved from the literature. Uncertainties in input parameters were propagated using Monte Carlo simulations to obtain point estimates and empirical 95% Confidence Intervals (CIs). Lastly, the noise maps were categorized as high, moderate and low quality following a qualitative approach. Strategic noise map data was delivered in three distinct formats (i.e. raster, polygon or polyline) and had distinct noise ranges and levels of categorization. The majority of noise maps (i.e. 83.2%) were considered of moderate or low quality. Based on the data provided, almost 60 million adults were exposed to road traffic noise levels above 55 dB L den , equating to a median of 42% (Interquartile Range (IQR): 31.8–64.8) of the adult population across the analysed cities. We estimated that approximately 11 million adults were highly annoyed by road traffic noise and that 3608 deaths from IHD (95% CI: 843–6266) could be prevented annually with compliance of the WHO recommendation. The proportion of highly annoyed adults by city had a median value of 7.6% (IQR: 5.6–11.8) across the analysed cities, while the number preventable deaths had a median of 2.2 deaths per 100,000 population (IQR: 1.4–3.1). Based on the provided strategic noise maps a considerable number of adults in European cities are exposed to road traffic noise levels harmful for health. Efforts to standardize the strategic noise maps and to increase noise and disease data availability at the city level are needed. These would allow for a more accurate and comprehensive assessment of the health impacts and further help local governments to address the adverse health effects of road traffic noise. [ABSTRACT FROM AUTHOR]