How Urban Design Shapes Health and Sustainable Living

To foster healthier and more sustainable cities, city planning should integrate considerations of health, environmental sustainability, and social equity.

As the world becomes increasingly urbanised, the dynamics of city living are rapidly changing. Today, almost 60% of the global population resides in urban areas, and by 2050, an additional 2.7 billion people are expected to inhabit cities. While urban environments offer numerous benefits—such as economic opportunities, social interaction, and cultural activities—they are also hotspots for environmental stressors like air pollution, noise, limited green space, and heat. Additionally, cities contribute to 75% of global energy-related greenhouse gas emissions, which exacerbates health disparities and environmental inequities.

Understanding how urban form, transportation systems, environmental quality, and public health are interconnected is crucial, particularly in the face of climate change. Unfortunately, the complex pathways by which urban living influences health outcomes are not fully understood. The complexity is reflected in research; a limited number of large-scale studies explore the different relationships (e.g., urban form and air pollution, urban form and green space) which limits generalisable evidence and in turn the development of effective policies and interventions.

Urban form, transport, environmental quality, and health are deeply interconnected, yet these relationships are often overlooked in city planning due to siloed approaches

For this reason, a group of researchers sought to synthesise evidence from relevant urban studies that analysed 90 cities or more, to better understand how urban design shapes health and sustainable living. With the current climate trajectory suggesting that the Paris Climate Agreement targets may not be met, it is more important than ever to understand these relationships and guide future urban and transport policies.

The Role of Urban Design in Health

Urban design significantly influences public health. Different urban models, such as the compact city model, characterised by high population density and infrastructure, and the sprawling city model, characterised by low-density development and greater distances from the city centre, have varied impacts on health and well-being.

Compact cities, generally, have positive health outcomes, including lower rates of chronic diseases and premature mortality, which is influenced by higher public and active transport networks, increased walkability, and enhanced social cohesion. However, the benefits are not universal. For example, cities with high sprawl can sometimes reduce the urban heat island (UHI) effect—a phenomenon where urban areas experience higher temperatures than their rural surroundings due to human activities and dense infrastructure.

Urban and transport planning must transcend traditional boundaries and integrate considerations of health, environmental sustainability, and social equity

These divergent outcomes highlight that while compact cities may promote physical activity and reduce vehicle dependency, they must be optimised based on specific local contexts to address potential downsides such as congestion and pollution.

The Downside of Car-Centric Urban Planning

Cities designed around car use have considerable environmental and health drawbacks. Higher density and compactness can lead to increased pollutant emissions, reduced green space, and exacerbated UHI effects, all of which contribute to higher rates of pollution-related diseases and mortality. Studies have shown that in Europe, Western and Southern European capitals have the highest NO₂ mortality burdens; whilst a global study found 86% (2·5 billion inhabitants) of studied urban inhabitants lived in urban areas that exceeded WHO’s 2005 guideline annual average in 2019. Eliminating traffic emissions could significantly improve air quality in cities worldwide, underscoring the need for robust measures to meet air quality standards and reduce health risks.

Embracing Nature-Based Solutions

To address the environmental challenges posed by urbanisation, cities must adopt nature-based solutions (NbS). These strategies, which include increasing green space and enhancing biodiversity, can mitigate the negative impacts of compact urban forms, such as reduced green space and heightened UHI effects. For instance, increasing green areas to recommended levels in Europe could potentially prevent nearly 42,698 annual deaths. Similarly, NbS can lower urban temperatures, thereby reducing heat-related mortality and improving overall public health.

Addressing Urban Health Inequities

Health outcomes in urban environments are not distributed evenly across populations. Socioeconomic factors significantly affect the extent to which people are exposed to environmental hazards and benefit from urban amenities. Despite this, there is limited understanding of how social determinants intersect with environmental quality, transportation, and health outcomes. More localised research is needed to uncover disparities in exposure and vulnerability and to ensure that urban policies effectively protect the most vulnerable populations.

Moving Forward: Integrating Health and Sustainability in Urban Planning

Urban form, transport, environmental quality, and health are deeply interconnected, yet these relationships are often overlooked in city planning due to siloed approaches. To foster healthier and more sustainable cities, a multi-sectoral, evidence-based approach is essential. Urban and transport planning must transcend traditional boundaries and integrate considerations of health, environmental sustainability, and social equity.

By balancing the trade-offs of different urban models and prioritising equity, urban policies can maximise their positive impacts and ensure cities serve as hubs of healthy and sustainable living

By balancing the trade-offs of different urban models and prioritising equity, urban policies can maximise their positive impacts and ensure cities serve as hubs of healthy and sustainable living.

As urbanisation continues to reshape our world, it is imperative to adopt holistic and inclusive approaches to urban planning. This will enable cities to become not only centres of economic growth and cultural exchange but also drivers of public health and environmental sustainability.

[This blog was developed based on a review: Dyer GMC, Khomenko S, Adlakha D, Anenberg S, Behnisch M, Boeing G, et al. Exploring the nexus of urban form, transport, environment and health in large-scale urban studies: a state-of-the-art scoping review. Environ Res. 2024;257.

This project has been funded by the European Union under grant agreement no. 101094639. For more information on UBDPolicy, visit: https://ubdpolicy.eu/]