The European Urban Burden of Disease Project

Coordinator

Mark Nieuwenhuijsen (on behalf the consortium)

Website

https://isglobalranking.org/

Cities have long been known to be society’s predominant engine of innovation and wealth creation, yet they are also hotspots of pollution and disease partly due to current urban and transport planning practices. The aim of the European Urban Burden of Disease (UBD) project is to:

1. evaluate the health burden and its determinants related to current and future potential urban and transport planning practices and related exposures (e.g, air pollution, noise, islands, green space, physical activity) in European cities and
2. make this evidence available for policy and decision making for healthy and sustainable futures (Nieuwenhuijsen et al 2022).

Cities provide good opportunities for policy change as city councils have direct local accountability and have more agile governance structures compared to national governments. However, they often lack the expertise and resources to conduct quantitative health impact assessments to quantify the health impacts of their current urban and transport planning practices, or alternative or future scenarios. The urban burden of disease project will provide exposure and health estimates for around 1000 cities in Europe and publish these on a publicly accessible website: isglobalranking.org 

Appropriate and efficient urban planning and transport systems are essential for cities to thrive, but evidence suggests that current urban and transport planning practices can cause increased exposure to air pollution and noise, heat islands and a lack of green space and physical inactivity that have detrimental effects on health such as increasing morbidity and premature mortality. A recent health impact assessment study in Barcelona found that suboptimal urban and transport planning practices may be responsible for nearly 3,000 premature deaths annually or around 20% of the total of number of deaths (Mueller et al 2017).

The Urban Burden of Disease Project will provide exposure and health estimates for around 1000 cities in Europe.

The UBD project draws on an established comparative risk assessment methodology (i.e. Urban and Transport Planning Health Impact Assessment UTOPHIA tool). The project has only recently become possible because of the availability of new data on city boundaries, exposures, and mortality data for such a large number of cities and new exposure response functions. Unfortunately, city specific morbidity data and data on other determinants of health such as physical activity or transport mode are lacking and/or not available in easy accessible format for most of the cities, but may become available in the future. Please contact the UBD project team if you know of good available data sources.

Furthermore, the UBD project will conduct an in-depth assessment of current status of urban and transport planning and develop alternative, sustainable and healthy scenarios for a number of cities (e.g. Barcelona, Paris, Utrecht, Kiev). It will conduct an in-depth evaluation of current land use and transport practices in the cities and linkages between urban and transport planning, environment, physical activity and health. It will assess the health burden of current and alternative urban and transport planning practices. The work will be conducted with local stakeholders.

The UBD project will provide many European cities with burden of disease estimates that can be used to inform policies to reduce this burden.

So far the UBD project team conducted quantitative burden of disease assessments for the year 2015 to estimate the effect of air pollution exposure (PM_^2.5 and NO₂) and lack of green space on natural-cause mortality for adult residents (aged ≥20 years) in 969 cities and 47 greater cities in Europe (Khomenko et al 2021) We found that the reduction of air pollution to the lowest measured concentrations could prevent nearly 125,000 deaths per year for PM_^2.5 exposure and 80,000 deaths per year for NO₂ exposure. Increasing green space in the cities could prevent around 40,000 premature deaths annually (Pereira et al 2021).

The UBD project will provide many European cities with burden of disease estimates that can be used to inform policies to reduce this burden. Improved urban and transport practices are needed to reduce the current related burden of disease. New urban models such as the Barcelona Superblocks, the Paris 15-minute city or the Car free city/neighbourhood such as Vauban Freiburg (Nieuwenhuijsen 2021) and/or a shift in private car use towards public and active transportation and greening of cities are urgently need to make our cities more sustainable, liveable and healthier (Nieuwenhuijsen 2020).

Publications

Urban health impact assessments

Transport and health

• Rojas-Rueda D, de Nazelle A, Tainio M, NIEUWENHUIJSEN MJ. Bike sharing system (bicing) in barcelona, spain; a description and estimated health impacts. BMJ 2011;343:d452
• Rojas-Rueda D, de Nazelle A, Teixidó O, Nieuwenhuijsen MJ. Replacing car trips by increasing bike and public transport in the greater Barcelona metropolitan area: A Health Impact Assessment Study. Environ Int 2012; 49: 100–109
• Rojas-Rueda D, de Nazelle, A, Teixidó O, Nieuwenhuijsen M. Health impact assessment of increasing public transport and cycling use in Barcelona: A morbidity and burden of disease approach. Prev Med. 2013 57(5):573-9
• Rojas-Rueda D, de Nazelle A, Andersen ZJ, Braun-Fahrländer C, Bruha J, Bruhova-Foltynova H, Desqueyroux H, Praznoczy C, Ragettli MS, Tainio M, Nieuwenhuijsen MJ. Health Impacts of Active Transportation in Europe. PLoS One. 2016 Mar 1;11(3):e0149990
• Pérez, K., Olabarria, M., Rojas-Rueda, D., Santamariña-Rubio, E., Borrell, C., & Nieuwenhuijsen, M. The health and economic benefits of active transport policies in Barcelona. Journal of Transport & Health. 2017
• Mueller N, Rojas-Rueda D, Salmon M, Martinez D, Ambros A, Brand C, de Nazelle A, Dons E, Gaupp-Berghausen M, Gerike R, Götschi T, Iacorossi F, Panis LI, Kahlmeier S, Raser E, Nieuwenhuijsen M; PASTA consortium. Health impact assessment of cycling network expansions in European cities. Prev Med. 2018;.pii: S0091-7435(17)30497-8
• Otero I, Nieuwenhuijsen MJ, Rojas-Rueda D. Health impacts of bike sharing systems in Europe. Environ Int. 2018 Apr 15. pii: S0160-4120(17)32156-6
• Thondoo M, Mueller N, Rojas-Rueda D, de Vries D, Gupta J, Nieuwenhuijsen MJ. Participatory quantitative health impact assessment of urban transport planning: A case study from Eastern Africa. Environ Int. 2020 Aug 19;144:106027.

Green and blue and health

• Vert C, Nieuwenhuijsen M, Gascon M, Grellier J, Fleming LE, White MP, Rojas-Rueda D. Health Benefits of Physical Activity Related to an Urban Riverside Regeneration.Int J Environ Res Public Health. 2019 Feb 5;16(3). pii: E462.
• Kondo MC, Mueller N, Locke DH, Roman LA, Rojas-Rueda D, Schinasi LH, Gascon M, Nieuwenhuijsen MJ. Health impact assessment of Philadelphia's 2025 tree canopy cover goals. Lancet Planet Health. 2020 Apr;4(4):e149-e157.
• Vidal Yañez D, Pereira Barboza E, Cirach M, Daher C, Nieuwenhuijsen M, Mueller N. An urban green space intervention with benefits for mental health: A health impact assessment of the Barcelona "Eixos Verds" Plan. Environ Int. 2023 Mar 27:107880. doi: 10.1016/j.envint.2023.107880. Epub ahead of print. PMID: 37002012.

Single or few cities Burden of disease assessment

• Mueller N, Rojas-Rueda D, Basagaña X, Cirach M, Cole-Hunter T, Dadvand P, Donaire-Gonzalez D, Foraster M, Gascon M, Martinez D, Tonne C, Triguero-Mas M, Valentín A, Nieuwenhuijsen M. Urban and Transport Planning Related Exposures and Mortality: A Health Impact Assessment for Cities. Environ Health Perspect. 2017; 125(1):89-96
• Mueller N, Rojas-Rueda D, Basagaña X, Cirach M, Cole-Hunter T, Dadvand P, Donaire-Gonzalez D, Foraster M, Gascon M, Martinez D, Tonne C, Triguero-Mas M, Valentín A, Nieuwenhuijsen M. Health impacts related to urban and transport planning: A burden of disease assessment. Environ Int. 2017 Aug 1;107:243-257
• Mueller N, Rojas-Rueda D, Khreis H, Cirach M, Milà C, Espinosa A, Foraster M, McEachan RRC, Kelly B, Wright J, Nieuwenhuijsen M. Socioeconomic inequalities in urban and transport planning related exposures and mortality: A health impact assessment study for Bradford, UK. Environ Int. 2018 Oct 19;121(Pt 1):931-941.
• Mueller N, Rojas-Rueda D, Khreis H, Cirach M, Andrés D, Ballester J, Bartoll X, Daher C, Deluca A, Echave C, Milà C, Márquez S, Palou J, Pérez K, Tonne C, Stevenson M, Rueda S, Nieuwenhuijsen M. Changing the urban design of cities for health: The superblock model. Environ Int. 2020; 134:105132
• Pierangeli I, Nieuwenhuijsen MJ, Cirach M, Rojas-Rueda D. Health equity and burden of childhood asthma - related to air pollution in Barcelona. Environ Res. 2020 Jan 22:109067. doi: 10.1016/j.envres.2019.109067.
• Khomenko S, Nieuwenhuijsen M, Ambròs A, Wegener S, Mueller N. Is a liveable city a healthy city? Health impacts of urban and transport planning in Vienna, Austria. Environ Res. 2020 Feb 6;183:109238.
• Iungman, T., Khomenko, S., Nieuwenhuijsen, M., Barboza, E. P., Ambròs, A., Padilla, C. M., & Mueller, N. (2021). The impact of urban and transport planning on health: Assessment of the attributable mortality burden in Madrid and Barcelona and its distribution by socioeconomic status. Environmental Research , 110988.
• Pereira Barboza E, Nieuwenhuijsen M, Ambròs A, Sá TH, Mueller N. The impact of urban environmental exposures on health: An assessment of the attributable mortality burden in Sao Paulo city, Brazil. Sci Total Environ. 2022 Mar 26;831:154836.
• Koch S, Khomenko S, Cirach M, Ubalde-Lopez M, Baclet S, Daher C, Hidalgo L, Lõhmus M, Rizzuto D, Rumpler R, Susilo Y, Venkataraman S, Wegener S, Wellenius GA, Woodcock J, Nieuwenhuijsen M. Impacts of changes in environmental exposures and health behaviours due to the COVID-19 pandemic on cardiovascular and mental health: A comparison of Barcelona, Vienna, and Stockholm. Environ Pollut. 2022 Jul 1;304:119124

1000 Cities health impact assessment

• Khomenko S, Cirach M, Pereira-Barboza E, Mueller N, Barrera-Gómez J, Rojas-Rueda D, de Hoogh K, Hoek G, Nieuwenhuijsen M. Premature mortality due to air pollution in European cities: a health impact assessment. Lancet Planet Health. 2021;S2542-5196(20)30272-2
• Khomenko S, Cirach M, Pereira-Barboza E, Mueller N, Barrera-Gómez J, Rojas-Rueda D, de Hoogh K, Hoek G, Nieuwenhuijsen M. Health impacts of the new WHO air quality guidelines in European cities. Lancet Planet Health. 2021 Nov;5(11):e764.
• Pereira Barboza E, Cirach M, Khomenko S, Iungman T, Mueller N, Barrera-Gómez J, Rojas-Rueda D, Kondo M, Nieuwenhuijsen M. Green space and mortality in European cities: a health impact assessment study. Lancet Planet Health. 2021 Oct;5(10):e718-e730.
• Khomenko S, Cirach M, Barrera-Gómez J, Pereira-Barboza E, Iungman T, Mueller N, Foraster M, Tonne C, Thondoo M, Jephcote C, Gulliver J, Woodcock J, Nieuwenhuijsen M. Impact of road traffic noise on annoyance and preventable mortality in European cities: A health impact assessment. Environ Int. 2022 Feb 26;162:107160.
• Iungman T, Cirach M, Marando F, Pereira Barboza E, Khomenko S, Masselot P, Quijal-Zamorano M, Mueller N, Gasparrini A, Urquiza J, Heris M, Thondoo M, Nieuwenhuijsen M. Cooling cities through urban green infrastructure: a health impact assessment of European cities. Lancet. 2023 Jan 31:S0140-6736(22)02585-5.
• Masselot P, Mistry M, Vanoli J, Schneider R, Iungman T, Garcia-Leon D, Ciscar JC, Feyen L, Orru H, Urban A, Breitner S, Huber V, Schneider A, Samoli E, Stafoggia M, de'Donato F, Rao S, Armstrong B, Nieuwenhuijsen M, Vicedo-Cabrera AM, Gasparrini A; MCC Collaborative Research Network; EXHAUSTION project. Excess mortality attributed to heat and cold: a health impact assessment study in 854 cities in Europe. Lancet Planet Health. 2023 Mar 16:S2542-5196(23)00023-2. doi: 10.1016/S2542-5196(23)00023-2. Epub ahead of print. PMID: 36934727.
• Khomenko S, Pisoni E, Thunis P, Bessagnet B, Cirach M, Iungman T, Barboza EP, Khreis H, Mueller N, Tonne C, de Hoogh K, Hoek G, Chowdhury S, Lelieveld J, Nieuwenhuijsen M. Spatial and sector-specific contributions of emissions to ambient air pollution and mortality in European cities: a health impact assessment. Lancet Public Health. 2023 Jul;8(7):e546-e558. doi: 10.1016/S2468-2667(23)00106-8. PMID: 37393093.

UBD Protocol

• Nieuwenhuijsen MJ, Barrera-Gómez J, Basagaña X, Cirach M, Daher C, Pulido MF, Iungman T, Gasparrini A, Hoek G, de Hoogh K, Khomenko S, Khreis H, de Nazelle A, Ramos A, Rojas-Rueda D, Pereira Barboza E, Tainio M, Thondoo M, Tonne C, Woodcock J, Mueller N. Study protocol of the European Urban Burden of Disease Project: a health impact assessment study. BMJ Open. 2022 Jan 20;12(1):e054270.

Consortium Members

Mark Nieuwenhuijsen^1-4 (lead), Jose Barrera-Gomez^1-3, Xavier Basagaña^1-3, Marta Cirach^1-3, Carolyn Daher^1-3, Maria Foraster Pulido^{1-3, 5}, Tamara Iungman^1-3, Antonio Gasparrini⁶, Gerard Hoek⁷, Kees de Hoogh^8,9, Sasha Khomenko^1-3, Haneen Khreis^10,11, Audrey de Nazelle¹², Ana Ramos^1-3, David Rojas-Rueda¹³, Evelise Pereira Barboza^1-3, Marko Tainio^14,15, Meelan Thondoo^1-3, Cathryn Tonne^1-3, James Woodcock^{1-3, 11}, Natalie Mueller^1-3

1. ISGlobal, Barcelona, Spain
2. Universitat Pompeu Fabra (UPF), Barcelona, Spain
3. CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
4. Mary MacKillop Institute for Health Research, Melbourne, Australia
5. PHAGEX Research Group, Blanquerna School of Health Science, Universitat Ramon Lull (URL), Barcelona, Spain
6. London School of Hygiene & Tropical Medicine
7. Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
8. Swiss Tropical and Public Health Institute, Basel, Switzerland
9. University of Basel, Basel, Switzerland
10. TTI, Texas A&M
11. Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge
12. Imperial College London, UK
13. Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, USA
14. Sustainable Urbanisation Programme, Finnish Environment Institute SYKE, Helsinki, Finland
15. Systems Research Institute, Polish Academy of Sciences, Warsaw, Poland

Funding Statement

This project receives funding and support from:

• SURREAL through the European Union’s Horizon 2020 research and innovation programme under grant agreement No 956780,
• GoGreenRoutes through the European Union’s Horizon 2020 research and innovation programme under grant agreement No 869764,
• EXPANSE through the European Union’s Horizon 2020 research and innovation programme under grant agreement No 874627, and
• A Fellowship from the Spanish Ministry of Science and Innovation through the "ayudas para la formación de profesorado universitario 2020–24" doctoral funding.