Urban and transport planning pathways to carbon neutral, liveable and healthy cities; A review of the current evidence

This Review describes the relationship between urban and transport planning and the city environment, the main cardiovascular risk factors (including physical activity, hypertension, and obesity), and cardiovascular disease and mortality. Good evidence exists for a relationship between built environment measures (such as mixed land use, connectivity and walkability, and physical activity), environmental exposures (such as green space, air pollution, and noise), and cardiovascular disease and mortality. Some good evidence exists for a link between transport mode and cardiovascular disease, but evidence is inconsistent for an association between built environment measures and weight status, and between green space and either weight status or physical activity. Further research is needed into the influence of built environment measures on cardiovascular disease and mortality. Urban and transport planning has an important effect on cardiovascular health and its risk factors. Cardiovascular disease and mortality could be reduced by better urban and transport planning that promotes physical activity; reduces levels of air pollution, noise, and heat island effects; and increases green space.

Influence of urban and transport planning and the city environment on cardiovascular disease.

Background and purpose A growing body of evidence documents multiple ways in which land use and transportation investments influence health. To date, most evidence linking the built environment to health either focuses on behavioral change or environmental exposures. Few studies simultaneously assess how behavior and exposure-based impacts of the built environment interact. This is concerning as increased walkability and transit access can possibly lead to increased exposure to air pollution and injury risk. Method This paper synthesizes recent research on behavior and exposure-based mechanisms that connect land use and transportation investments with various health outcomes. Exploring the nexus between these pathways provides a framework to identify priority areas for research to inform policies and investments. Results The most studied pathway articulates how land use and transportation can support healthy behaviors, such as increased physical activity, healthy diet, and social interactions. The second pathway articulates exposure to harmful substances and stressors and potential differential impacts by travel modes. Increased rates of active travel lead to lower generation of vehicle emissions and kilometers traveled; but may actually result in increased exposure which may have adverse effects on sensitive populations such as elderly and youth. Unhealthy exposures have historically concentrated in areas where the most disadvantaged reside – along major transportation corridors where land is cheapest and more affordable housing is located. Implications A high priority for future research is to examine mechanisms that spatially link built environment and chronic disease. More longitudinal evidence is required inclusive of biomarker data within clinical trials to isolate independent and interactive effects of biological and neurological mechanisms from behavioral and exposure related impacts of the environment. Downstream impacts of the built environment on healthcare utilization and costs and workforce productivity is needed for policy makers to justify the major investments required to plan or retrofit communities.

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Pathways from built environment to health: A conceptual framework linking behavior and exposure-based impacts

The effects of air pollution on health have been generating attention for years. A large number of pulmonologists have recently expressed concerns about this in an open letter to Dutch Members of Parliament. Air pollution arises mainly in all kinds of combustion processes; in addition, atmospheric chemical reactions play a role in the formation of ozone and particulate matter. Health effects are both acute (increase in daily mortality and morbidity after days with increased concentrations of air pollution) as well as chronic (shortened life span and increased incidence of respiratory and cardiovascular diseases in areas with elevated concentrations of air pollution). These effects already occur at concentrations that are clearly lower than those currently observed in the Netherlands.

Air pollution and health

Interest into active modes (i.e. walking and cycling) has increased significantly over the past decades, with governments worldwide ultimately aiming for a modal shift towards active modes. To devise policies that promote this goal, understanding the determinants that influence the choice for an active mode is essential. The Netherlands is country with a large and demographically diverse active mode user population, mature and complete active mode infrastructure, and safe environment. Mode choice research from the Netherlands enables a comparison on relevant determinants with countries that have a low active mode share. Furthermore, it can provide quantitative input for policies aiming at an active mode shift. This paper estimates a mode choice model focusing on active modes, while including a more comprehensive set of modes (i.e. walking, cycling, public transport and car). Based on data from the Netherlands Mobility Panel (MPN) in combination with an additional survey focused on active modes (coined PAW-AM), this study estimates which determinants influence mode choice. The determinants can be categorized as individual characteristics, household characteristics, season and weather characteristics, trip characteristics, built environment, and work conditions. The results show that all categories of determinants influence both walking and cycling. However, the choice for cycling or walking is affected by different determinants and to a different extent. In addition, no active mode nest was found in the model estimation. Cycling and walking should thus be regarded as two distinguished alternatives. Furthermore, the results show that active mode use is most sensitive to changes in the trip characteristics and the built environment.

Y. Wang

Papers

A review on the effects of physical built environment attributes on enhancing walking and cycling activity levels within residential neighborhoods