Urban and transport planning related exposures and mortality: a health impact assessment for cities

Background: By 2050, almost 70% of people globally are projected to live in urban areas. As the environments we inhabit affect our health, urban and transport designs that promote healthy living are needed. We conducted a... [ view full abstract ]

Background: By 2050, almost 70% of people globally are projected to live in urban areas. As the environments we inhabit affect our health, urban and transport designs that promote healthy living are needed. We conducted a health impact assessment study for exposures related to urban and transport planning in Barcelona. We estimated the number of premature deaths preventable from compliance with international exposure recommendations for physical activity (PA), air pollution, noise, heat, and access to green spaces.

Methods: We developed and applied the Urban and TranspOrt Planning Health Impact Assessment (UTOPHIA) tool to Barcelona. Exposure estimates and mortality data were available for 1,357,361 Barcelona residents. We compared recommended with current exposure levels. We quantified the associations between exposures and mortality and calculated population attributable fractions to estimate the number of premature deaths preventable under compliance with exposure recommendations. We also modeled life-expectancy and economic impacts.

Results: Annually 8.5% of mortality (N=1,273) could be prevented, if international recommendations for performance of PA, exposure to air pollution, noise, heat, and access to green space were complied with. The biggest share in preventable deaths was attributable to increases in PA, followed by exposure reductions in traffic noise, air pollution, and heat. Access to green spaces had smaller effects on mortality. Compliance was estimated to increase average life expectancy by 187 (95% CI: 72-242) days and result in savings of 4.0 (95% CI: 2.1-5.7) bn €.

Conclusions: Environmental exposures and PA factors can be modified by changes in urban and transport planning. We recommend considering health impacts when designing cities and emphasize the need for (1) the reduction of motorized traffic through the promotion of active and public transport and (2) the provision of green infrastructure, as suggested to provide PA opportunities as well as air pollution, noise, and heat mitigation.