Urban environments and their impact on

population healthDr Daniela Fecht

UK Small Area Health Statistics Unit

MRC-PHE Centre for Environment and Health

Imperial College London

Historic background

Health status in urban areas historically

lower compared with rural areas, e.g.

higher mortality rates from infectious

diseases

Historic background

Health status in urban areas historically

lower compared with rural areas, e.g.

higher mortality rates from infectious

diseases

Industrialisation in 19th century

accounted for poorer health in urban areas

e.g. higher infant mortality, shorter life

span

Historic background

Sanitary awakening in the late 19th

century led to significantly improved

health status for urban residents

The situation today

Differences is health status between urban and rural areas still persist today

Not all are due to socio-economic differences

Kyte L, Wells C. 2010. Variations in life expectancy between rural and urban areas of England, 2001-07. Health Statistics Quarterly 46. Office for National Statistics.

Index of Multiple Deprivation 2007

Why focus on urban areas?

Source: Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat, World Population Prospects: The 2011 Revision.

Main challenges facing

urban areas:

Obesity epidemic

Climate change

1950

1955

1960

1965

1970

1975

1980

1985

1990

1995

2000

2005

2010

2015

2020

2025

2030

2035

2040

2045

2050

0

1000000

2000000

3000000

4000000

5000000

6000000

7000000Rural population (thousands)

Urban population (thousands)

Wor

ld p

opul

atio

n

1950

1955

1960

1965

1970

1975

1980

1985

1990

1995

2000

2005

2010

2015

2020

2025

2030

2035

2040

2045

2050

0

100000

200000

300000

400000

500000

600000

700000Rural populationUrban population

Year

Euro

pean

pop

ulat

ion

Factors influencing urban health

Social support network

Neighbourhood

cohesion Crime

Diet Smoking Drinking habits Substance abuse Physical activity

Topography

Geology Meteorology

Hydrology

Air pollution

Noise

Radon

EMF

Land cover mix Transport network Street layout Population density

Genetic factors Demographic

factors

Age & sex

Ethnicity

Education

Occupation

Socio-economic s

tatus

Lifestyle

choices

Social environ-ment

Health care provision

Phys

ical

featu

res

Urban structure

Enviro-

mental

exposure

Demographic factors

Genetic factors Demographic

factors

The Marmot Review 2012: Fair Society, Healthy Lives.

Age & sex Ethnicity Education Occupation Socio-economic status

1999 - 2003

Life expectancyDisability-free life expectancyPension age increase 2026 - 2046

Lifestyle choices

Genetic factors Demographic

factors

Lifestyle

choices

Diet Smoking Drinking habits Substance abuse Physical activity

Health Survey for England, 2009

Prevalence of obesity among adults, by gender, 1993 to 2009

1993 20090%

5%

10%

15%

20%

25%

30%

men women

Social environment

Genetic factors Demographic

factors

Lifestyle

choices

Social support network Neighbourhood cohesion Crime Socio-economic status Number of hospitals and

special care units

Social environ-mentHealth

care provision

Environmental exposure

Genetic factors Demographic

factors

Lifestyle

choices

Air pollution (indoor & outdoor) Noise pollution (indoor & outdoor) Water contamination Electromagnetic fields

Social environ-mentHealth

care provision

Environ-

mental

exposure

Urban structure

Genetic factors Demographic

factors

Lifestyle

choices

Land cover mix Transport network Street layout Population density

Social environ-mentHealth

care provision

Environ-

mental

exposure

Urban structure

Physical features

Genetic factors Demographic

factors

Lifestyle

choices

Topography Geology Meteorology Hydrology

Social environ-mentHealth

care provision

Environ-

mental

exposure

Phys

ical

featu

res

Urban structure

Factors influencing urban health

Social support network

Neighbourhood

cohesion Crime

Diet Smoking Drinking habits Substance abuse Physical activity

Topography

Geology Meteorology

Hydrology

Air pollution

Noise

Radon

EMF

Land cover mix Transport network Street layout Population density

Genetic factors Demographic

factors

Age & sex

Ethnicity

Education

Occupation

Socio-economic s

tatus

Lifestyle

choices

Social environ-ment

Health care provision

Phys

ical

featu

res

Urban structure

Environ-

mental

exposure

Can we detect any associations between urban form and mortality rates in cities in Great Britain?

Research question

Study aims: To create measures to quantify the probable influence of population distribution,

land cover, transport network and geographical characteristics (e.g. location, terrain)

on human health,

To select relevant health outcomes that are potentially influenced by urban form,

To investigate whether physical features within a city and the urban structure are

factors that influence the health of the urban population.

Fecht D, Fortunato L, Morley D, Hansell A, Gulliver J. 2016. Associations between urban metrics and mortality rates in England. Environmental Health. In press.

Study design Units of analysis:

City levelAll cities in England with > 100,000 residents (N=50)

Urban metrics:

Computation of urban metrics for each city

Health outcomes:All death and cause-specific mortality (2002-2009): Cardiovascular disease (CVD: heard disease, stroke) Road traffic accidents

Separate analysis for men and womenAll ages and premature mortality (< 65 years olds)

Confounders:Socio-economic status: Income domain from IMD 2004 (city level)Smoking: using lung cancer mortality as proxyAir pollution: PM10 (µg/m3) concentrations, city average

Genetic factors Dem

ographic

factors

Lifestyle

choices

Social environ-mentHealth care

provision

Phys

ical

featu

res

Urban structure

Environ-

mental

exposure

Theme Urban characteristic

Urban metrics Potential health related benefits Potential health related concerns

Population Population density

Population density (pop/km2) city average

easy to walk/cycleincrease of physical activity

spread of infectious diseases elevated air pollution levels potential loss of green spacesocial stress

Road network

Walkability of cities

Minor road density (km/km2) easy to walk/cycleincrease of physical activity

elevated pollution levelshigher road-traffic noise levels

Connectivity of road network

Junction density (N/km2): number of junctions over city area (km2)

easy to walk/cycleincrease of physical activity

elevated air pollution levelshigher road-traffic noise levelsincreased number of road traffic accidents

Urban sprawl Population within 100m of major roads (%)

higher noise and air pollution exposure across city population less likely to walk/cycle and reduction in physical activity increased number of road traffic accidents related to higher speed

Land cover Land cover mix Shannon’s diversity index (SDI) [24]:

where pi is the proportion of land cover i relative to the total number of land cover classes

easy to walk/cycle increase of physical activityless car usagelower air pollution levels

residential areas potentially close to polluted areas

Urban metrics

Descriptive results

Premature mortality (<65 years) for men in England

Socioeconomic status (tertiles)

most affluent

most deprived

Cardiovascular mortality Traffic accident mortality

Urban metrics Women 0 – 65 yrs Men 0 – 65 yrs Women 0 – 65 yrs Men 0 – 65 yrs

Population density

Low 1.00 1.00 1.00 1.00

Medium 1.04 (0.99 – 1.09) 1.04 (1.01 – 1.07)* 0.90 (0.73 – 1.11) 0.91 (0.82 – 1.00)

High 1.13 (1.07 – 1.18)* 1.10 (1.06 – 1.13)* 0.75 (0.60 – 0.93)* 0.77 (0.70 – 0.85)*

Minor road density

Low 1.00 1.00 1.00 1.00

Medium 1.05 (0.99 – 1.11) 1.05 (1.01 – 1.09)* 0.83 (0.66 – 1.05) 0.87 (0.78 – 0.97)*

High 1.10 (105 – 1.16)* 1.09 (1.06 – 1.13)* 0.75 (0.60 – 0.93)* 0.71 (0.64 – 0.78)*

Junction density Low 1.00 1.00 1.00 1.00

Medium 1.12 (1.07 – 1.18)* 1.09 (1.06 – 1.12)* 0.93 (0.72 – 1.15) 0.99 (0.89 – 1.10)

High 1.16 (1.10 – 1.22)* 1.12 (1.09 – 1.16)* 0.90 (0.72 – 1.13) 0.81 (0.73 – 0.91)*

Population next to main roads

Low 1.00 1.00 1.00 1.00

Medium 1.01 (0.96 – 1.06) 0.98 (0.95 – 1.01) 0.68 (0.55 – 0.85)* 0.98 (0.89 – 1.09)

High 1.04 (0.99 – 1.09) 1.04 (1.01 – 1.07)* 0.87 (0.72 – 1.05) 0.86 (0.78 – 0.95)*

Shannon’s Diversity Index

Low 1.00 1.00 1.00 1.00

Medium 0.97 (0.93 – 1.01) 1.02 (0.99 – 1.04) 1.13 (0.93 – 1.40) 1.09 (1.00 – 1.19)*

High 0.95 (0.91 – 1.00) 0.97 (0.94 – 1.00) 1.39 (1.12 – 1.73)* 1.22 (1.10 – 1.35)*

* p < 0.05Models account for age, socio-economic deprivation and smoking

Risk of premature mortality

Conclusions

We found an association between transport patterns and population density and risk

of premature mortality but only weak associations with land cover patterns.

We have seen a similar increase in the risk of all deaths and CVD mortality with

increasing population, minor road and junction density whilst the risk of death from

traffic accidents decreased.

Associations between urban form and mortality observed in this study suggest that

characteristics of city structure might have negative effects on the overall health of

urban communities.

Future urban planning and regeneration strategies can benefit from such knowledge

to promote a healthy living environment for an increasing urban population.

Acknowledgements

The work of the UK Small Area Health Statistics Unit is funded by Public Health

England as part of the MRC-PHE Centre for Environment and Health, funded also by

the UK Medical Research Council.

The mortality and population data were supplied by the ONS, derived from the

national mortality registrations and the Census.