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Introduction: The European climate is getting warmer and the impact on childhood health and development is insufficiently understood. Equally, how heat-related health risks can be reduced through nature-based solutions, such as exposure to urban natural environments, is unknown. Green CURe In Outdoor CITY spaces (Green CURIOCITY) will analyse how heat exposure during pregnancy affects birth outcomes and how long-term heat exposure may influence children's neurodevelopment. We will also investigate if adverse effects can be mitigated by urban natural environments. A final goal is to visualise intraurban patterns of heat vulnerability and assist planning towards healthier cities. Methods and analysis: We will use existing data from the Human Early-Life Exposure cohort, which includes information on birth outcomes and neurodevelopment from six European birth cohorts. The cohort is linked to data on prenatal heat exposure and impact on birth outcomes will be analysed with logistic regression models, adjusting for air pollution and noise and sociobehavioural covariates. Similarly, impact of cumulative and immediate heat exposure on neurodevelopmental outcomes at age 5 will be assessed. For both analyses, the potentially moderating impact of natural environments will be quantified. For visualisation, Geographical information systems data will be combined to develop vulnerability maps, demonstrating urban 'hot spots' where the risk of negative impacts of heat is aggravated due to sociodemographic and land use patterns. Finally, geospatial and meteorological data will be used for informing GreenUr, an existing software prototype developed by the WHO Regional Office for Europe to quantify health impacts and augment policy tools for urban green space planning. Ethics and dissemination: The protocol was approved by the Comité Ético de Investigación Clínica Parc de Salut MAR, Spain. Findings will be published in peer-reviewed journals and presented at policy events. Through stakeholder engagement, the results will also reach user groups and practitioners. This work is supported by the European Commission through a Horizon 2020 Marie Skłodowska-Curie Grant, Reference number 891 538.LM is funded by a Juan de la Cierva-Incorporación fellowship (IJC2018-035394-I) awarded by the Spanish Ministerio de Economía, Industria y Competitividad.

We evaluated the associations between marine recreational fishing, stress, seafood consumption, and sleep quality in a cross-sectional questionnaire-based survey of a convenience sample of 244 fishers recruited in 2019 in Spain. Fishers' stress levels were moderate, with a mean stress index score of 36.4 units on a scale from 14 (very low stress) to 70 (very high). Their average emotional condition was positive, with a mean index of negative affect of 7.8 units on a scale from 5 (very low negative affect) to 25 (very high). Seafood intake was low, with a mean index of seafood in diets of 38.0 units on a scale from 20 (very low seafood consumption) to 160 (very high). Fishers' perceived quality of night sleep was good because the mean index of sleep problems was 39.5 units on a scale from 21 (very low sleep problems) to 107 (very high). Each hour of self-reported monthly fishing activity was associated with 0.016 units of lower stress score. Thus, the most engaged fishers reported up to 15.4% lower stress score than less avid fishers. Since recreational fishing is a highly accessible outdoor activity for people in older age groups, it is possible that public health could be improved by access to sustainably managed recreational fisheries. Fishing engagement was positively associated with seafood intake. Each hour of fishing per month was associated with one-unit higher seafood consumption. The higher seafood consumption observed among avid recreational fishers compared with less avid fishers might have health implications.

The “Earthrise” photograph, taken on the 1968 Apollo 8 mission, became one of the most significant images of the 20th Century. It triggered a profound shift in environmental awareness and the potential for human unity—inspiring the first Earth Day in 1970. Taking inspiration from these events 50 years later, we initiated Project Earthrise at our 2020 annual conference of inVIVO Planetary Health. This builds on the emergent concept of planetary health, which provides a shared narrative to integrate rich and diverse approaches from all aspects of society towards shared solutions to global challenges. The acute catastrophe of the COVID-19 pandemic has drawn greater attention to many other interconnected global health, environmental, social, spiritual, and economic problems that have been underappreciated or neglected for decades. This is accelerating opportunities for greater collaborative action, as many groups now focus on the necessity of a “Great Transition”. While ambitious integrative efforts have never been more important, it is imperative to apply these with mutualistic value systems as a compass, as we seek to make wiser choices. Project Earthrise is our contribution to this important process. This underscores the imperative for creative ecological solutions to challenges in all systems, on all scales with advancing global urbanization in the digital age—for personal, environmental, economic and societal health alike. At the same time, our agenda seeks to equally consider our social and spiritual ecology as it does natural ecology. Revisiting the inspiration of “Earthrise”, we welcome diverse perspectives from across all dimensions of the arts and the sciences, to explore novel solutions and new normative values. Building on academic rigor, we seek to place greater value on imagination, kindness and mutualism as we address our greatest challenges, for the health of people, places and planet.

Summary Background Exposure to greenspace is associated with improved childhood development, but the pathways behind this relationship are insufficiently understood. Therefore, we aimed to investigate the association between lifetime residential exposure to greenspace and early childhood development and evaluate the extent to which this association is mediated by reductions in traffic-related air pollution and noise. Methods This population-based birth cohort study comprised singleton births in Metro Vancouver, BC, Canada, between April 1, 2000, and Dec 31, 2005. Children and mothers had to be registered with the mandatory provincial health insurance programme, Medical Services Plan, and have lived within the study area from the child's birth to the time of outcome assessment. Early childhood development was assessed via teacher ratings on the Early Development Instrument (EDI), and we used the total EDI score as the primary outcome variable. We estimated greenspace using percentage vegetation derived from spectral unmixing of annual Landsat satellite image composites. Lifetime residential exposure to greenspace was estimated as the mean of annual percentage vegetation values within 250 m of participants’ residential postal codes. Multilevel modelling, adjusted for eight covariates, was used to investigate associations between greenspace exposure and EDI scores. We estimated the mediation effects of nitrogen dioxide (NO2), fine particulate matter (PM2·5), and noise levels using causal mediation analyses. Findings Of the 37 745 children born in Metro Vancouver between April 1, 2000, and Dec 31, 2005, 27 372 were included in our final study sample. In the adjusted model, 1 IQR increase in percentage vegetation was associated with a 0·16 (95% CI 0·04–0·28; p=0·0073) increase in total EDI score, indicating small improvements in early childhood development. We estimated that 97·1% (95% CI 43·0–396·0), 29·5% (12·0–117·0), and 35·2% (17·9–139·0) of the association was mediated through reductions in NO2, PM2·5, and noise, respectively. Interpretation Increased exposure to residential greenspace might improve childhood development by reducing the adverse developmental effects of traffic-related exposures, especially NO2 air pollution. Our study supports the implementation of healthy urban planning and green infrastructure interventions. Funding Canadian Institutes of Health Research.

Living near, recreating in, and feeling psychologically connected to, the natural world are all associated with better mental health, but many exposure-related questions remain. Using data from an 18-country survey (n = 16,307) we explored associations between multiple measures of mental health (positive well-being, mental distress, depression/anxiety medication use) and: (a) exposures (residential/recreational visits) to different natural settings (green/inland-blue/coastal-blue spaces); and (b) nature connectedness, across season and country. People who lived in greener/coastal neighbourhoods reported higher positive well-being, but this association largely disappeared when recreational visits were controlled for. Frequency of recreational visits to green, inland-blue, and coastal-blue spaces in the last 4 weeks were all positively associated with positive well-being and negatively associated with mental distress. Associations with green space visits were relatively consistent across seasons and countries but associations with blue space visits showed greater heterogeneity. Nature connectedness was also positively associated with positive well-being and negatively associated with mental distress and was, along with green space visits, associated with a lower likelihood of using medication for depression. By contrast inland-blue space visits were associated with a greater likelihood of using anxiety medication. Results highlight the benefits of multi-exposure, multi-response, multi-country studies in exploring complexity in nature-health associations. This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 666773 (BlueHealth). Data collection in California was supported by the Center for Conservation Biology, Stanford University. Data collection in Canada was supported by the Faculty of Forestry, University of British Columbia. Data collection in Finland was supported by the Natural Resources Institute Finland (Luke). Data collection in Australia was supported by Griffith University and the University of the Sunshine Coast. Data collection in Portugal was supported by ISCTE—University Institute of Lisbon. Data collection in Ireland was supported by the Environmental Protection Agency, Ireland. Data collection in Hong Kong was supported by an internal University of Exeter—Chinese University of Hong Kong international collaboration fund. The funders had no role in the conceptualisation, design, analysis, decision to publish or preparation of the manuscript.

Background: Greenspace exposure is associated with improved childhood development, yet the pathways behind this relation are insufficiently understood. Here, we investigated the association between lifetime residential exposure to greenspace and early childhood development and evaluated the extent to which this association was mediated by reductions in traffic-related air pollution and noise. Methods: In a large population-based birth cohort in Metro Vancouver, Canada (n=27,593), early childhood development was assessed via teacher-ratings on the Early Development Instrument (EDI) (mean age = 5·6 years). Greenspace was estimated using vegetation percentage derived from spectral unmixing of annual Landsat satellite-image composites. Lifetime residential exposure to greenspace (from birth to time of EDI assessment) was estimated as the mean of annual vegetation percentage values within 250 m of participants’ residential postal code. Multilevel modeling was used to investigate associations between greenspace exposure and EDI scores. The mediation effects of NO2, PM2.5, and noise levels were estimated using causal mediation analyses. Findings: In adjusted models, one interquartile range increase in vegetation percentage was associated with a 0·16 increase in EDI score (95% CI: 0·03, 0·29), indicating small improvements in early childhood development. 86·6%, 20·6%, and 37·3% of the association was mediated through reductions of NO2, PM2.5, and noise exposure levels, respectively. Interpretation: Increased residential greenspace exposure may improve childhood development by reducing the adverse developmental effects of traffic-related exposures, especially NO2 air pollution. This study contributes to knowledge of pathways between greenspace exposure and childhood development and supports healthy urban planning. Funding Information: This work was supported by the Canadian Institute of Health Research (grant reference number: 156152). Declaration of Interests: We declare no competing interests. Ethics Approval Statement: Ethics approval for this study was granted by the University of British Columbia Behavioral Research Ethics Board (certificate H18-00908).

Background Diabetes is among the most prevalent non-communicable diseases causing significant morbidity and mortality globally. The aetiology and disease development of diabetes are influenced by genetic, lifestyle, and environmental factors. Due to an increasing number of cases each year, it is imperative to improve the understanding of modifiable environmental risk and protective factors. In this study we aimed to analyse associations between built and natural environment features and diabetes prevalence; and two major risk factors: physical activity and obesity and their mediation effects. Methods We analysed relationships between walkability and park availability with physical activity, obesity, and diabetes, using self-reported data from a large cross-sectional survey in British Columbia, Canada (n = 22,418). We validated results with an independent cohort (n = 11,972) in a subset of the analyses. The outcome measures included walking, moderate to vigorous physical activity (MVPA), body mass index (BMI), and diabetes. Built and natural environment features within a 1 km road network buffer around residential postal code centroids were assessed using validated indicators of walkability and park availability. We used general linear multivariable models (GLM) to examine the direct relationship between environmental features, physical activity, obesity, and diabetes respectively. Path models were developed to analyse mediation effects of physical activity and obesity on the association between environmental indicators and diabetes. The relative contribution of direct versus indirect effects was assessed. All models were adjusted for age, gender, income. ethnicity, years lived in neighbourhood and regional accessibility. Results Walkable neighbourhoods and areas with greater park availability were associated with lower rates of diabetes. There was a direct association of walkability and park availability on physical activity (highest vs. lowest quintile OR = 1.15; 95% CI: 1.00, 1.33 and OR = 1.28, 95% CI: 1.13, 1.45 respectively), obesity (highest vs. lowest quintile OR = 0.58, 95% CI: 0.49, 0.70 and OR = 0.57, 95% CI: 0.48, 0.68 respectively) and diabetes (highest vs. lowest quintile OR = 0.62, 95% CI: 0.45, 0.85, and OR = 0.63, 95% CI: 0.47, 0.84 respectively). Results were similar in the independent cohort. The associations between diabetes and walkability and park availability respectively were partly mediated by obesity (41% of total association for walkability and 53% of total association for park availability). The mediating effect of physical activity was negligible. Conclusion Results support investments in walkability through active transportation and transit infrastructure. Changes in zoning and subdivision regulations governing land use actions are required to enable compact mixed-use environments with access to parks and high quality transit service. Future studies including cost-benefit analyses of health-related economic impacts of such investments can contribute to evidence-based decisions for healthier cities.

The urban forest is a green infrastructure system that delivers multiple environmental, economic, social and health services, and functions in cities. Environmental benefits of urban trees are well understood, but no review to date has examined how urban trees affect human health. This review provides a comprehensive summary of existing literature on the health impacts of urban trees that can inform future research, policy, and nature-based public health interventions. A systematic search used keywords representing human health, environmental health, and urban forestry. Following screening and appraisal of several thousand articles, 201 studies were conceptually sorted into a three-part framework. Reducing Harm, representing 41% of studies, includes topics such as air pollution, ultraviolet radiation, heat exposure, and pollen. Restoring Capacities, at 31%, includes attention restoration, mental health, stress reduction, and clinical outcomes. Building Capacities, at 28%, includes topics such as birth outcomes, active living, and weight status. The studies that were reviewed show substantial heterogeneity in purpose and method yet indicate important health outcomes associated with people’s exposure to trees. This review will help inform future research and practice, and demonstrates why urban forest planning and management should strategically promote trees as a social determinant of public health.

Field studies have shown that dense tree canopies and regular tree arrangements reduce noise from a point source. In urban areas, noise sources are multiple and tree arrangements are rarely dense. There is a lack of data on the association between the urban tree canopy characteristics and noise in complex urban settings. Our aim was to investigate the spatial variation of urban tree canopy characteristics, indices of vegetation abundance, and environmental noise levels. Using Light Detection and Ranging point cloud data for 2015, we extracted the characteristics of 1,272,069 public and private trees across the island of Montreal, Canada. We distinguished needle-leaf from broadleaf trees, and calculated the percentage of broadleaf trees, the total area of the crown footprint, the mean crown centroid height, and the mean volume of crowns of trees that were located within 100m, 250m, 500m, and 1000m buffers around 87 in situ noise measurement sites. A random forest model incorporating tree characteristics, the normalized difference vegetation index (NDVI) values, and the distances to major urban noise sources (highways, railways and roads) was employed to estimate variation in noise among measurement locations. We found decreasing trends in noise levels with increases in total area of the crown footprint and mean crown centroid height. The percentages of increased mean squared error of the regression models indicated that in 500m buffers the total area of the crown footprint (29.2%) and the mean crown centroid height (12.6%) had a stronger influence than NDVI (3.2%) in modeling noise levels; similar patterns of influence were observed using other buffers. Our findings suggest that municipal initiatives designed to reduce urban noise should account for tree features, and not just the number of trees or the overall amount of vegetation.

Background There is an increased literature focusing on the role of the built and natural environments in preventing hypertension. However, very few studies have quantitively analyzed specific pathways through which urban form affects blood pressure levels. Objectives To examine how features of the built and natural environments relate to hypertension and the mediating role of transportation and leisure walking and body mass index in this relationship. Methods We examined the association between neighbourhood walkability and park availability with hypertension through generalized linear models in two independent population cohorts. One Cohort was 22,418 adults (My Health My Community) and the other cohort was 11,972 adults (BC Generations Project). We employed a path analysis modelling approach to explore the presence and significance of mediating factors that may contribute to any association between walkability or park availability and hypertension. This study intentionally employed walkability measures enforced through municipal zoning and subdivision regulations legally underpinned by health, safety, and welfare. All models were adjusted for socioeconomic and other characteristics where data were available. Results Our analysis of two population-based Canadian cohorts consistently found that higher levels of walkability and park accessibility were both associated with significantly lower odds of self-reported hypertension, especially for lower income individuals. Mediation analysis showed that obesity accounted for 50% and 52.9% of the total effect of walkability and park accessibility on hypertension, respectively. Discussion We suggest an integrated population health approach that considers multimorbidity as a result of exposure to car-dependent areas and the lack of green spaces. Longitudinal research is needed to document causal effects of built and natural environments on hypertension.

Urban green and blue spaces promote health by offering areas for physical activity, stress relief, and social interaction, which may be considered as cultural ecosystem services. They also provide a number of regulating ecosystem services that can be regarded as nature-based solutions to mitigate impacts from urbanization-induced challenges. Urban trees and other vegetation provide cooling through shade and evapotranspiration, which reduce the impact of the urban heat island on hot summer days. Urban vegetation may improve air quality by removing air pollutants. Open areas in cities, such as parks, gardens, playgrounds and cemeteries, are unsealed spaces that also improve infiltration during extreme precipitation events providing water regulating functions. All these services have the potential to improve the health of urban residents, particularly of specific vulnerable groups such as children and the elderly. The aim of this paper is to provide an overview of the current state of evidence on the relationship between the health of children and the elderly and urban green and blue spaces that can account as nature-based solutions to urbanization-induced challenges. We discuss potential confounding factors and refer to the different green space metrics used to identify associations to health. From the results, we cannot conclude on a universal protective health effect of urban green and blue spaces for children and the elderly. While the association trend is positive, the results remain inconclusive, context dependent and are partly overridden by socioeconomic confounders. However, the research area is consistently increasing, and we advance important prospects for future research on urban green and blue spaces in the face of global challenges such as urbanization.

In this study, we assess how the Scania Green Score (SGS5), and the five distinct perceived neighbourhood green dimensions within this area-aggregated index (1 km2 squares), is associated with self-reported physical activity and general health, and if perceived safety and social coherence has a moderating effect. Two independent surveys, both conducted in Scania, Sweden, was used for data on SGS5 and health outcomes (N=28 198 and N=23 693), respectively. SGS5 was more clearly associated with physical activity (OR 1.06; 95% CI 1.02–1.10) than with general health (OR 1.02; 95% CI 1.00–1.04). This association was moderated by safety (p for interaction

Highlights - Urban natural spaces benefit health by cultural and regulating ecosystem services. - The evidence on health impact is insufficiently implemented in urban planning. - Transdisciplinary actions are required to bridge the science policy gap. - Human dependence on healthy urban ecosystems must be brought to the agenda. - Details on disservices and specific features must not overshadow the general good.

Varied categorisations of residential distance to bluespace in population health studies make comparisons difficult. Using survey data from eighteen countries, we modelled relationships between residential distance to blue spaces (coasts, lakes, and rivers), and self-reported recreational visits to these environments at least weekly, with penalised regression splines. We observed exponential declines in visit probability with increasing distance to all three environments and demonstrated the utility of derived categorisations. These categories may be broadly applicable in future research where the assumed underlying mechanism between residential distance to a blue space and a health outcome is direct recreational contact. This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 666773.

inVIVO Planetary Health (inVIVO) is a progressive scientific movement providing evidence, advocacy, and inspiration to align the interests and vitality of people, place, and planet. Our goal is to transform personal and planetary health through awareness, attitudes, and actions, and a deeper understanding of how all systems are interconnected and interdependent. Here, we present the abstracts and proceedings of our 8th annual conference, held in Detroit, Michigan in May 2019, themed “From Challenges, to Opportunities”. Our far-ranging discussions addressed the complex interdependent ecological challenges of advancing global urbanization, including the biopsychosocial interactions in our living environment on physical, mental, and spiritual wellbeing, together with the wider community and societal factors that govern these. We had a strong solutions focus, with diverse strategies spanning from urban-greening and renewal, nature-relatedness, nutritional ecology, planetary diets, and microbiome rewilding, through to initiatives for promoting resilience, positive emotional assets, traditional cultural narratives, creativity, art projects for personal and community health, and exploring ways of positively shifting mindsets and value systems. Our cross-sectoral agenda underscored the importance and global impact of local initiatives everywhere by contributing to new normative values as part of a global interconnected grass-roots movement for planetary health.

Transformations of agriculture and natural lands to urban use are dominant and well known effects of urbanization, but consistent and reliable methods to map regional-scale land transitions are limited. Herein, we develop a land use classification approach to assess spatiotemporal patterns of urban expansion and associated land use changes. We utilized a 33-year annual time series (1984–2016) of fractional land characteristics and cover data from Landsat satellite imagery to summarize multidecadal land use transitions on the pixel and census dissemination area level for 18 major Canadian cities. Across Canada, 41% of peri-urban areas analyzed experienced a transition, converting about 2,700 sq-km of natural and/or agriculture to an urban use. West coast peri-urban areas observed the greatest area conversion of natural to urban use (39%). In contrast, peri-urban areas of the Prairies (i.e. west-center stratum) experienced the greatest area transition from an agriculture to urban use (41%), while west- and east-center observed marked rates of natural to urban transitions (3.9 and 3.5% per annum per sq-km, respectively). Current high population densities were generally associated with historic losses of agriculture or natural use, while regional differences in correlations between land use trends and current levels of income, new residential construction, and single-detached housing highlight the potential influence of urban policies and historic socio-economic trajectories. The developed dynamic land use classification provides a reliable, transparent, and nationally consistent method to tabulate land use intensity across various spatiotemporal scales and may enhance interpretation of interdisciplinary studies involving social and community outcomes.

Background Several studies have assessed the relationship between exposure to natural environments (NEs) and childhood mental health and development. In most cases, a positive association has been found, but results are inconsistent, and the strength of association is unclear. This inconsistency may reflect the heterogeneity in measurements used to assess NE. Objectives This systematic review aims to identify the most common NE metrics used in childhood mental health and development research. Our second aim is to identify the metrics that are most consistently associated with health and assess the relative strength of association depending on type of NE exposure measurement, in terms of metric used (i.e., measurement technique, such as remote sensing), but also rate (i.e., spatial and temporal exposure). Methods We used the PRISMA protocol to identify eligible studies, following a set of pre-defined inclusion criteria based on the PECOS strategy. A number of keywords were used for retrieving relevant articles from Medline, Embase, PsychINFO, and Web of Science databases between January 2000–November 2020. From these, we extracted data on type of NE measurement and relative association to a number of indicators of childhood mental health and development. We conducted a systematic assessment of quality and risk of bias in the included articles to evaluate the level of evidence. Case studies and qualitative studies were excluded. Results After screening of title (283 studies included), abstract, and full article, 45 studies were included in our review. A majority of which were conducted in North America and Europe (n = 36; 80%). The majority of studies used land use or land covers (LULC, n = 24; 35%) to determine exposures to NEs. Other metrics included the normalized difference vegetation index (NDVI), expert measures (e.g., surveys of data collection done by experts), surveys (e.g., self-reported assessments), and use of NE (e.g., measures of a participant's use of NE such as through GPS tracts or parent reports). Rate was most commonly determined by buffer zones around residential addresses or postal codes. The most consistent association to health outcomes was found for buffers of 100 m, 250 m, 500 m, and within polygons boundaries (e.g., census tracts). Six health categories, academic achievement, prevalence of doctor diagnosed disorders, emotional and behavioral functioning, well-being, social functioning, and cognitive skills, were created post hoc. We found sufficient evidence between NDVI (Landsat) and emotional and behavioral well-being. Additionally, we found limited evidence between LULC datasets and academic achievement; use of NE, parent/guardian reported greenness, and expert measures of greenness and emotional and behavioral functioning; and use of NE and social functioning. Discussion This review demonstrates that several NE measurements must be evaluated further before sufficient evidence for a potential association between distinct NE exposure metrics and childhood mental health and development can be established. Further, we suggest increased coordination between research efforts, for example, by replication of studies and comparing different NE measurements systematically, so that effect sizes can be confirmed for various health outcomes. Finally, we recommend implementing research designs that assess underlying pathways of nature-health relations and utilize measurement techniques that adequately assess exposure, access, use, and perception of NEs in order to contribute to a better understanding of health impacts of surrounding natural environments.

Research suggests that certain forest environments can contribute to lower stress levels in humans. This might be increasingly important to consider given the rising prevalence of stress-related diseases and illness absence. To make it feasible to plan for forest management strategies that take such restorative effects into account, it would seem to be important to identify the precise physical properties that contribute to the restorative qualities of forest stands. It would also be useful if forest stand data typically already collected by forest owners could be used for this purpose. In the present study, forest stands in northern, central, and southern Sweden were visited and assessed regarding their restorative potential. These assessments were analysed together with available forest stand data for each region using statistical models. Our results indicate that of the available forest stand data parameters, the most important individual indicators of forest stands’ restorative qualities were tree age, tree sparsity, and tree height. Models based on these parameters explained 30–40 % of the variation in restorative qualities among the evaluated stands, indicating that they can be useful in planning and modelling scenarios where restorative properties of forest stands are considered.

Canada’s urban areas have experienced extensive growth over the past quarter century; however, there has been no consistent, spatially explicit approach for quantifying the loss and gain of greenness in cities nationally. Herein, we developed a novel urban greenness score metric using greenness fractions from a multi-decadal time series (1984–2016) of spectrally unmixed annual Landsat satellite image composites to characterize final year (2016) greenness and its overall change for 18 major Canadian urban areas, summarized by census dissemination area (DA). The applied validation procedure confirmed correlation coefficients (ρ) ranging from 0.67 – 0.85 between reference and estimated greenness fractions, indicating that spectral unmixing is an appropriate method for extracting urban greenness from a time series of medium spatial resolution satellite imagery. Most DAs across Canada sustained a moderate (∼20 % – 40 %) or low (≲ 20 %) level of greenness between 1984 and 2016, but overall there was a decreasing trend in greenness. Eastern urban areas maintained the most greenness over time, while urban areas in the Prairies had the greatest increase in greenness. Densely populated urban areas experienced the greatest loss in greenness (16 % of DAs); whereas, urban areas with a moderately-low density experienced the greatest increase (14 % of DAs). In agreement with previous studies, we found that greenness was negatively associated with urban infilling, with lower greenness levels typically found in urban cores, and greenness loss most often found in the urban periphery in conjunction with urban expansion. Methods presented in this analysis take advantage of the open and longstanding Landsat archive, as well as multiple spatial scales, including sub-pixel unmixing techniques, pixel level greenness faction data summarized for management units, and analysis conducted nationally. The developed urban greenness score provides a comprehensive framework to understand current urban greenness and relate it to its recent past, which supports long-term strategic planning, and can be transferred to other regions across spatial and temporal scales.

Background Growing evidence suggests health benefits of natural environments. Yet, the effects of different types of natural environments (vegetation and water features) and forms of human-nature contact (access versus exposure) remain relatively unexplored. Methods A cross-sectional observational survey was used to analyse the relationship between both access and exposure to different types of urban natural environments and health outcomes in Metro Vancouver, Canada. Data for health outcomes (self-reported general health, mental health, and common mental disorders) and key confounders were obtained from the 2013–2014 Canadian Community Health Survey. Natural environments were quantified using local land use and land cover data, and linked to survey respondents by six-digit postal code. Access was defined as living within 300 m of a public greenspace (≥ 1 hectare) and exposure as the percentage of different land cover types within multiple buffer distances of postal code centroids. Separate logistic regression models were used to estimate the associations of the access and exposure metrics with the three health outcomes. Results Exposure to water within 1,000 m buffers was associated with a reduced odds of reporting poor general health (OR = 0.982, 95% CI = 0.965, 0.999). A similar association was found for exposure to shrub and grass-herb vegetation types for reported mental health and common mental disorder, respectively (OR = 0.741, 95% CI = 0.576, 0.953 for shrubs in 250 m; OR = 0.737, 95% CI = 0.577, 0.942 for shrubs in 500 m; OR = 0.731, 95% CI = 0.570, 0.938 for shrubs in 1,000 m; OR = 0.980, 95% CI = 0.965, 0.995 for grass-herbs in 250 m). Neither access to public greenspace nor aggregated greenspace exposure were associated with self-reported health. Results from stratified analyses suggest that observed associations between human-nature contact and self-reported health differ according to gender. Conclusions Results suggest that type of natural environment should be considered in future research studying the health-promoting aspects of natural environments, and that positive health effects may be more consistent for daily life exposure than for access to public greenspace.

Mental health and well-being are consistently influenced—directly or indirectly—by multiple environmental exposures. In this review, we have attempted to address some of the most common exposures of the biophysical environment, with a goal of demonstrating how those factors interact with central structures and functions of the brain and thus influence the neurobiology of depression. We emphasize biochemical mechanisms, observational evidence, and areas for future research. Finally, we include aspects of contextual environments—city living, nature, natural disasters, and climate change—and call for improved integration of environmental issues in public health science, policies, and activities. This integration is necessary for reducing the global pandemic of depression.

We provide consensus on the benefits of nature experience for mental health, and a model for integrating them into urban design., A growing body of empirical evidence is revealing the value of nature experience for mental health. With rapid urbanization and declines in human contact with nature globally, crucial decisions must be made about how to preserve and enhance opportunities for nature experience. Here, we first provide points of consensus across the natural, social, and health sciences on the impacts of nature experience on cognitive functioning, emotional well-being, and other dimensions of mental health. We then show how ecosystem service assessments can be expanded to include mental health, and provide a heuristic, conceptual model for doing so.

Urban natural spaces have gained increasing attention in the public health agenda due to their reported association with better health outcomes. Improved measurement of urban natural spaces and a better understanding of the relative effects of different types of natural space in different socio-geographical contexts are required to optimize evidence for urban planning. This case study of Metro Vancouver examines relationships between different accessibility and exposure metrics, the distribution of different land cover types across an urban-rural gradient, and the correlation to area-level marginalization. Local land use and land designation data were used to assess accessibility to public greenspace, a high-resolution land cover dataset was used to determine residential exposure to different land cover types, and the widely applied CAN-Marg index was used to obtain information on area-level marginalization. In addition to descriptive statistics, correlation coefficients were computed to determine relationships between the different variables. Access to public greenspace was weakly correlated with measures of residential exposure to natural land cover types. Although residential exposure varied with level of urbanization, access to public greenspace remained relatively constant across the region. Both access and exposure were significantly correlated with three Can-Marg dimensions: residential instability, material deprivation and ethnic concentration. We recommend that future health research include assessment of both access and exposure as distinct measures, as well as consideration of geographical and social context to potentially target urban green planning for maximal population health impacts.

IntroductionDeficiencies in childhood development is a major global issue and inequalities are large. The influence of environmental exposures on childhood development is currently insufficiently explored. This project will analyse the impact of various modifiable early life environmental exposures on different dimensions of childhood development.MethodsBorn to be Wise will study a Canadian cohort of approximately 34 000 children who have completed an early development test at the age of 5. Land use regression models of air pollution and spatially defined noise models will be linked to geocoded data on early development to analyse any harmful effects of these exposures. The potentially beneficial effect on early development of early life exposure to natural environments, as measured by fine-grained remote sensing data and various land use indexes, will also be explored. The project will use data linkages and analyse overall and age-specific impact, including variability depending on cumulative exposure by assigning time-weighted exposure estimates and by studying subsamples who have changed residence and exposure. Potentially moderating effects of natural environments on air pollution or noise exposures will be studied by mediation analyses. A matched case–control design will be applied to study moderating effects of natural environments on the association between low socioeconomic status and early development. The main statistical approach will be mixed effects models, applying a specific software to deal with multilevel random effects of nested data. Extensive confounding control will be achieved by including data on a range of detailed health and sociodemographic variables.Ethics and disseminationThe study protocol has been ethically approved by the Behavioural Research Ethics Board at the University of British Columbia. The findings will be published in peer-reviewed journals and presented at scholarly conferences. Through stakeholder engagement, the results will also reach policy and a broader audience.

Based on scientific evidence, the World Health Organization advocates for public green space as an important component of healthy cities. Different pathways and mechanisms are likely to mediate the health effects of exposure to green spaces. Those range from stress reduction and increased physical activity to regulating ecosystem services, such as heat and noise reduction. Many of these pathways are causally related to common non-communicable diseases, for example, depression, and urban heat related morbidity, disorders that have been negatively associated with exposure to green spaces. The evidence is limited by various factors, such as lack of validation of exposure metrics and shortness of experimental data.Attempts to standardise and optimise exposure metrics are ongoing, but depending on what health outcome is studied different types of measurements are needed. For example, measuring the impact on heat related morbidity may require different metrics than for estimating mental health benefits. Aspects...

Urban greenness has been associated with a wide range of health benefits, partially due to local cooling. Several studies on these health benefits have assessed individual and population exposure to urban greenness using the Normalized Difference Vegetation Index (NDVI) from different satellite platforms. Recent comparisons between birds-eye NDVI and street-level measurements suggest that NDVI can severely misclassify individual exposure which, in turn, can bias epidemiologic effect estimates. Pedestrian video data may provide a novel source of individual, eye-level information on both indoor and outdoor exposure to vegetation. The objective of this pilot study was to examine the potential of pedestrian video data for assessing exposure to urban greenness using secondary data collected for a different study on microscale urban air temperatures. Image processing was used to extract green, yellow, and shaded pixels from ˜10 million frames of video footage collected during 40 sampling runs of 20 urban routes measuring 8–10 km each. Resulting greenness values (combined total of green, yellow, and shaded pixels) were compared with concurrent air temperatures using correlations, time series plots, and maps. Correlations ranged from -0.61 to 0.34 and were in the expected direction for 31 of 40 runs. Time series plots and overlay maps showed clear inverse relationships in many cases. Most routes originally chosen to characterize higher temperature areas had negative correlations. Flat and weakly positive relationships tended to occur when conditions were overcast or routes were closer to large waterways. Secondary data are limited for such assessments, but the methods described here are promising for future exposure assessment at the individual level and evaluation of methods applied at the population level.