Health impact assessment of urban and transport planning policies

Urbanization processes are ongoing. Some aspects of urban life such as a sedentary lifestyle, the risk of traffic incidents, high levels of air pollution, noise and heat, and a lack of green spaces can have detrimental effects on our health and well-being. Despite consensus that these exposures related to urban and transport planning affect our health, there is little quantification of these health risk factors in the urban context. Quantitative health impact assessment (HIA) can provide numeric indices of health risk factors and can inform the health benefit-risk tradeoff of public policies. The present thesis sheds light on the utility of quantitative HIA in urban and transport planning policies. Almost 3,000 premature deaths, over 50,000 disability-adjusted life-years (DALYs) and over 20 million € in direct health care spending were estimated to be attributable to current urban and transport planning practices in Barcelona, Spain annually. The present thesis suggests that overwhelming motor transport fleets in cities need to be reduced through (1) the promotion of active transport (i.e. walking and cycling for transport in combination with public transport), facilitated by for instance the expansion of cycling networks and (2) the reinforcement of green spaces. Active transport together with green spaces, were assessed to provide considerable net health benefits through increases in physical activity levels and mitigation of motor transport-associated emissions of air pollution, noise and heat. The present thesis concludes that HIA is a useful tool for quantification of anticipated health impacts of public policies and more extensive application of HIA is encouraged.Algunas de las características de la vida urbana como el estilo de vida sedentario, el riesgo de sufrir accidentes de tráfico, los altos niveles de contaminación atmosférica, el ruido, el calor y la falta de espacios verdes pueden tener efectos perjudiciales en nuestra salud y bienestar. Aunque se sabe que estas exposiciones afectan nuestra salud, existe poca cuantificación de estos factores de riesgo en el contexto urbano. Las evaluaciones del impacto sobre la salud cuantitativas (HIA por sus siglas en inglés) proporcionan datos sobre los factores de riesgo en la salud e información del equilibrio entre beneficio y riesgo de las políticas públicas. Se estima que cada año casi 3,000 muertes prematuras, más de 50,000 años de vida ajustados por discapacidad (DALYs por sus siglas en inglés) y más de 20 millones de € de gastos directos en el sistema de salud que son atribuibles a las actuales políticas urbanas y de transporte en Barcelona, España. Esta tesis sugiere que el tráfico rodado en las ciudades necesita ser reducido mediante (1) la promoción del transporte activo (caminar, ir en bicicleta, transporte público), facilitada p.ej. por la expansión de la red de carril de bicicleta, y (2) con el aumento de los espacios verdes. Se estimó que el transporte activo y los espacios verdes proporcionan considerables beneficios netos para la salud a través del aumento de la actividad física y de la mitigación de las emisiones de contaminantes atmosféricos, ruido y calor asociadas al transporte motorizado. La presente tesis concluye que la HIA es una herramienta útil para la cuantificación anticipada de los impactos en la salud de las políticas públicas y se recomienda una aplicación extensiva de esta metodologí

Health impact assessment of urban and transport planning policies

Urbanization processes are ongoing. Some aspects of urban life such as a sedentary lifestyle, the risk of traffic incidents, high levels of air pollution, noise and heat, and a lack of green spaces can have detrimental effects on our health and well-being. Despite consensus that these exposures related to urban and transport planning affect our health, there is little quantification of these health risk factors in the urban context. Quantitative health impact assessment (HIA) can provide numeric indices of health risk factors and can inform the health benefit-risk tradeoff of public policies. The present thesis sheds light on the utility of quantitative HIA in urban and transport planning policies. Almost 3,000 premature deaths, over 50,000 disability-adjusted life-years (DALYs) and over 20 million € in direct health care spending were estimated to be attributable to current urban and transport planning practices in Barcelona, Spain annually. The present thesis suggests that overwhelming motor transport fleets in cities need to be reduced through (1) the promotion of active transport (i.e. walking and cycling for transport in combination with public transport), facilitated by for instance the expansion of cycling networks and (2) the reinforcement of green spaces. Active transport together with green spaces, were assessed to provide considerable net health benefits through increases in physical activity levels and mitigation of motor transport-associated emissions of air pollution, noise and heat. The present thesis concludes that HIA is a useful tool for quantification of anticipated health impacts of public policies and more extensive application of HIA is encouraged.Algunas de las características de la vida urbana como el estilo de vida sedentario, el riesgo de sufrir accidentes de tráfico, los altos niveles de contaminación atmosférica, el ruido, el calor y la falta de espacios verdes pueden tener efectos perjudiciales en nuestra salud y bienestar. Aunque se sabe que estas exposiciones afectan nuestra salud, existe poca cuantificación de estos factores de riesgo en el contexto urbano. Las evaluaciones del impacto sobre la salud cuantitativas (HIA por sus siglas en inglés) proporcionan datos sobre los factores de riesgo en la salud e información del equilibrio entre beneficio y riesgo de las políticas públicas. Se estima que cada año casi 3,000 muertes prematuras, más de 50,000 años de vida ajustados por discapacidad (DALYs por sus siglas en inglés) y más de 20 millones de € de gastos directos en el sistema de salud que son atribuibles a las actuales políticas urbanas y de transporte en Barcelona, España. Esta tesis sugiere que el tráfico rodado en las ciudades necesita ser reducido mediante (1) la promoción del transporte activo (caminar, ir en bicicleta, transporte público), facilitada p.ej. por la expansión de la red de carril de bicicleta, y (2) con el aumento de los espacios verdes. Se estimó que el transporte activo y los espacios verdes proporcionan considerables beneficios netos para la salud a través del aumento de la actividad física y de la mitigación de las emisiones de contaminantes atmosféricos, ruido y calor asociadas al transporte motorizado. La presente tesis concluye que la HIA es una herramienta útil para la cuantificación anticipada de los impactos en la salud de las políticas públicas y se recomienda una aplicación extensiva de esta metodologí

Health impact assessments of shipping and port-sourced air pollution on a global scale: a scoping literature review

Background: Globalisation has led to international trade expand rapidly. Seaborne transport moves 80% of traded goods across the globe, producing around 3% of greenhouse gases and other hazardous pollutants, such as PM, NOx and SOx, known to be harmful to health. Methods: A scoping literature review was conducted reviewing peer-reviewed studies on health impact assessments (HIA) of global shipping and port-sourced air pollution. For review inclusion, studies had to (1) use a HIA methodology; (2) quantify the air pollution concentration attributable to at least one shipping or port activity scenario; (3) assess at least one health outcome (i.e. epidemiological measure or monetization); (4) quantify the attributable health burden of the respective scenario. Results: Thirty-two studies were included, studying predominantly European Sea shipping/ port-sourced emissions with health impacts for global or respective European populations. Also, Global, Asian, North American and Australian Sea shipping/ port-sourced emissions were studied, with attributable health impacts for global or respective populations. The health outcome predominantly studied was mortality (all-cause, cause-specific, loss in life expectancy, years of life lost (YLLs)), but also morbidity (disease cases, hospital admissions, years lived with disability (YLDs)), disability-adjusted life-years (DALYs), restricted activity days and work loss days. The highest air pollution concentrations were identified along major shipping routes and ports, and the strongest health impacts occurred among respective riparian populations. Globally, ∼265,000 premature deaths were projected for 2020 (∼0.5% of global mortality) attributable to global shipping-sourced emissions. Emission control scenarios studied were predominantly sulphur fuel content caps and NOx emission reduction scenarios, consisting of technological interventions, cleaner fuels or fuel switches, and were assessed as effective in reducing shipping-sourced emissions, and hence, health burdens. Conclusions: Our review positions maritime transport an important source of air pollution and health risk factor, which needs more research and policy attention and rigorous emission control efforts, as shipping-sourced emissions are projected to increase with increases in global trade and shipping volumes

Traffic-related air pollution and the local burden of childhood asthma in Bradford, UK

Background: Asthma is the most common chronic disease in children. Traffic-related air pollution (TRAP) may be an important exposure contributing to its development. In the UK, Bradford is a deprived city suffering from childhood asthma rates higher than national and regional averages and TRAP is of particular concern to the local communities. Aims: We estimated the burden of childhood asthma attributable to air pollution and specifically TRAP in Bradford. Air pollution exposures were estimated using a newly developed full-chain exposure assessment model and an existing land-use regression model (LUR). Methods: We estimated childhood population exposure to NOx and, by conversion, NO2 at the smallest census area level using a newly developed full-chain model knitting together distinct traffic (SATURN), vehicle emission (COPERT) and atmospheric dispersion (ADMS-Urban) models. We compared these estimates with measurements and estimates from ESCAPE's LUR model. Using the UK incidence rate for childhood asthma, meta-analytical exposure-response functions, and estimates from the two exposure models, we estimated annual number of asthma cases attributable to NO2 and NOx in Bradford, and annual number of asthma cases specifically attributable to traffic. Results: The annual average census tract levels of NO2 and NOx estimated using the full-chain model were 15.41 and 25.68 μg/m3, respectively. On average, 2.75 μg/m3 NO2 and 4.59 μg/m3 NOx were specifically contributed by traffic, without minor roads and cold starts. The annual average census tract levels of NO2 and NOx estimated using the LUR model were 21.93 and 35.60 μg/m3, respectively. The results indicated that up to 687 (or 38% of all) annual childhood asthma cases in Bradford may be attributable to air pollution. Up to 109 cases (6%) and 219 cases (12%) may be specifically attributable to TRAP, with and without minor roads and cold starts, espectively. Conclusions: This is the first study undertaking full-chain health impact assessment of TRAP and childhood asthma in a disadvantaged population with public concern about TRAP. It further adds to scarce literature exploring the impact of different exposure assessments. In conservative estimates, air pollution and TRAP are estimated to cause a large, but largely preventable, childhood asthma burden. Future progress with childhood asthma requires a move beyond the prevalent disease control-based approach toward asthma prevention

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.We acknowledge support from the Spanish Ministry of Science and Innovation and State Research Agency through the “Centro de Excelencia Severo Ochoa 2019–2023” Program (CEX2018-000806-S), and support from the Generalitat de Catalunya through the CERCA Program”. The SUPERBE project (“Potenziale von Superblock-Konzepten als Beitrag zur Planung energieeffizienter Stadtquartiere”) has received funding from the Austrian research funding programme “Stadt der Zukunft”. “Stadt der Zukunft” is a Funding Programme of the Republic of Austria, Federal Ministry for Transport, Innovation and Technology. The Austrian Research Promotion Agency (FFG) has been authorised for the Programme Management. The TuneOurBlock project (“Transforming urban quarters to human scale environments: applying superblock concepts for different urban structures”) has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 875022. The authors also acknowledge financial support from the Slovenian Research and Innovation Agency (H6-8290) under agreement no. 1000-23-0618 and research core/project funding Geography of Slovenia (P6-0101). Strategic research and innovation program for the development of Medical University – Plovdiv” № BG-RRP-2.004-0007-C01, Establishment of a network of research higher schools, National plan for recovery and resilience, financed by the European Union – NextGenerationEU. Angel M. Dzhambov's and Mark J. Nieuwenhuijsen's time on this publication is partially supported by the “Strategic research and innovation program for the development of Medical University – Plovdiv” № BG-RRP-2.004-0007-C01, Establishment of a network of research higher schools, National plan for recovery and resilience, financed by the European Union – NextGenerationEU". This project has received funding from the European Union's, Horizon Europe Framework Programme (HORIZON) under GA No 101094639 - THE URBAN BURDEN OF DISEASE ESTIMATION FOR POLICY MAKING (UBDPolicy)

Physical Activity through Sustainable Transport Approaches (PASTA): a study protocol for a multicentre project

Includes supplementary materials for the online appendix.Introduction Only one-third of the European population meets the minimum recommended levels of physical activity (PA). Physical inactivity is a major risk factor for non-communicable diseases. Walking and cycling for transport (active mobility, AM) are well suited to provide regular PA. The European research project Physical Activity through Sustainable Transport Approaches (PASTA) pursues the following aims: (1) to investigate correlates and interrelations of AM, PA, air pollution and crash risk; (2) to evaluate the effectiveness of selected interventions to promote AM; (3) to improve health impact assessment (HIA) of AM; (4) to foster the exchange between the disciplines of public health and transport planning, and between research and practice. Methods and analysis. PASTA pursues a mixed-method and multilevel approach that is consistently applied in seven case study cities. Determinants of AM and the evaluation of measures to increase AM are investigated through a large scale longitudinal survey, with overall 14 000 respondents participating in Antwerp, Barcelona, London, Örebro, Rome, Vienna and Zurich. Contextual factors are systematically gathered in each city. PASTA generates empirical findings to improve HIA for AM, for example, with estimates of crash risks, factors on AM-PA substitution and carbon emissions savings from mode shifts. Findings from PASTA will inform WHO's online Health Economic Assessment Tool on the health benefits from cycling and/or walking. The study's wide scope, the combination of qualitative and quantitative methods and health and transport methods, the innovative survey design, the general and city-specific analyses, and the transdisciplinary composition of the consortium and the wider network of partners promise highly relevant insights for research and practice.This work is supported by the European project Physical Activity through Sustainable Transportation Approaches (PASTA), which has partners in London, Rome, Antwerp, Örebro, Vienna, Zurich, and Barcelona. PASTA (http://www.pastaproject.eu/) is a 4-year project funded by the European Union’s Seventh Framework Program under EC-GA No. 602624-2 (FP7-HEALTH-2013-INNOVATION-1)

Health impact assessment of Philadelphia’s 2025 tree canopy cover goals

Background: Cities across the world are undertaking ambitious projects to expand tree canopy by increasing the number of trees planted throughout public and private spaces. In epidemiological studies, greenspaces in urban environments have been associated with physical and mental health benefits for city dwellers. Greenworks Philadelphia is a plan to increase tree cover across Philadelphia (PA, USA) by the year 2025. We aimed to assess whether an increase in tree canopy or greenspace in Philadelphia could decrease mortality. Methods: We did a greenspace health impact assessment to estimate the annual premature mortality burden for adult residents associated with projected changes in tree canopy cover in Philadelphia between 2014 and 2025. Using up-to-date exposure-response functions, we calculated the number of preventable annual premature deaths city-wide, and for areas of lower versus higher socioeconomic status, for each of three tree canopy scenarios: low, moderate and ambitious. The ambitious scenario reflected the city's goal of 30% tree canopy cover in each of the city's neighbourhoods; and low and moderate scenarios were based on the varying levels of plantable space across neighbourhoods. Findings: We estimated that 403 (95% interval 298-618) premature deaths overall, including 244 (180-373) premature deaths in areas of lower socioeconomic status, could be prevented annually in Philadelphia if the city were able to meet its goal of increasing tree canopy cover to 30%. Interpretation: Bringing all of Philadelphia, and particularly its poorer neighbourhoods, up to the 30% goal of tree canopy cover is not without challenge. Nevertheless, policies are warranted that value urban greening efforts as health-promoting and cost-saving measures. Funding: Spanish Ministry of Science, Innovation and Universities, and Generalitat de Catalunya

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

Background: Cities are an important driving force to implement the Sustainable Development Goals (SDGs) and the New Urban Agenda. The SDGs provide an operational framework to consider urbanization globally, while providing local mechanisms for action and careful attention to closing the gaps in the distribution of health gains. While health and well-being are explicitly addressed in SDG 3, health is also present as a pre condition of SDG 11, that aims at inclusive, safe, resilient and sustainable cities. Health in All Policies (HiAP) is an approach to public policy across sectors that systematically takes into account the health implications of decisions, seeks synergies, and avoids harmful health impacts in order to improve population health and health equity. HiAP is key for local decision-making processes in the context of urban policies to promote public health interventions aimed at achieving SDG targets. HiAPs relies heavily on the use of scientific evidence and evaluation tools, such as health impact assessments (HIAs). HIAs may include city-level quantitative burden of disease, health economic assessments, and citizen and other stakeholders' involvement to inform the integration of health recommendations in urban policies. The Barcelona Institute for Global Health (ISGlobal)'s Urban Planning, Environment and Health Initiative provides an example of a successful model of translating scientific evidence into policy and practice with regards to sustainable and healthy urban development. The experiences collected through ISGlobal's participation implementing HIAs in several cities worldwide as a way to promote HiAP are the basis for this analysis. Aim: The aim of this article is threefold: to understand the links between social determinants of health, environmental exposures, behaviour, health outcomes and urban policies within the SDGs, following a HiAP rationale; to review and analyze the key elements of a HiAP approach as an accelerator of the SDGs in the context of urban and transport planning; and to describe lessons learnt from practical implementation of HIAs in cities across Europe, Africa and Latin-America. Methods: We create a comprehensive, urban health related SDGs conceptual framework, by linking already described urban health dimensions to existing SDGs, targets and indicators. We discuss, taking into account the necessary conditions and steps to conduct HiAP, the main barriers and opportunities within the SDGs framework. We conclude by reviewing HIAs in a number of cities worldwide (based on the experiences collected by co-authors of this publication), including city-level quantitative burden of disease and health economic assessments, as practical tools to inform the integration of health recommendations in urban policies. Results: A conceptual framework linking SDGs and urban and transportplanning, environmental exposures, behaviour and health outcomes, following a HiAP rationale, is designed. We found at least 38 SDG targets relevant to urban health, corresponding to 15 SDGs, while 4 important aspects contained in our proposed framework were not present in the SDGs (physical activity, noise, quality of life or social capital). Thus, a more comprehensive HiAP vision within the SDGs could be beneficial. Our analysis confirmed that the SDGs framework provides an opportunity to formulate and implement policies with a HiAP approach. Three important aspects are highlighted: 1) the importance of the intersectoral work and health equity as a cross-cutting issue in sustainable development endeavors; 2) policy coherence, health governance, and stakeholders' participation as key issues; and 3) the need for high quality data. HIAs are a practical tool to implement HiAP. Opportunities and barriers related to the political, legal and health governance context, the capacity to inform policies in other sectors, the involvement of different stakeholders, and the availability of quality data are discussed based on our experience. Quantitative assessments can provide powerful data such as: estimates of annual preventable morbidity and disability-adjusted life-years (DALYs) under compliance with international exposure recommendations for physical activity, exposure to air pollution, noise, heat, and access to green spaces; the associated economic impacts in health care costs per year; and the number of preventable premature deaths when improvements in urban and transport planning are implemented. This information has been used to support the design of policies that promote cycling, walking, public, zero and low-emitting modes of transport, and the provision of urban greening or healthy public open spaces in Barcelona (e.g. Urban Mobility, Green Infrastructure and Biodiversity Plans, or the Superblocks's model), the Bus Rapid Transit and Open Streets initiatives in several Latin American cities or targeted SDGs assessments in Morocco. Conclusions: By applying tools such as HIA, HiAP can be implemented to inform and improve transport and urban planning to achieve the 2030 SDG Agenda. Such a framework could be potentially used in cities worldwide, including those of less developed regions or countries. Data availability, taking into account equity issues, strenghtening the communication between experts, decision makers and citizens, and the involvement of all major stakeholders are crucial elements for the HiAP approach to translate knowledge into SDG implementation

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) agentbased 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