Urban burden of disease estimation for policy making: health impacts of environmental stressors

Abstract

 

The Urban Burden of Disease Estimation for Policy Making (UBD Policy) project aims to advance methodological approaches and provide updated health impact estimates of urban environmental stressors across nearly 1,000 European cities. Previous large-scale health impact assessments quantified premature mortality attributable to air pollution, noise, urban heat islands and insufficient green space for 2015. Ongoing reporting and trend analysis are essential to evaluate how urban and transport planning affect population health over time. We generated updated estimates of health impacts attributable to air pollution exceeding WHO guidelines and insufficient green space across 825 European cities, covering three reporting periods (2015 to 2024). Analyses were conducted employing comparative risk assessment methodology. Methods were improved by applying city-level modelling to refine baseline mortality estimates and adapting an approach to jointly estimate population exposure to PM_2.5 and NO₂. Non-compliance with WHO guidelines resulted in 213,889 deaths (95% CI: 89,224-344,223) jointly attributable to PM_2.5 and NO₂ in 2018, 76,833 fewer than the sum of single-pollutant estimates (PM_2.5: 145,747; NO₂: 143,646), highlighting the importance of joint exposure assessment. For green space, 74% of the population lived in areas with insufficient green space. Achieving optimal green space levels in 2024 could have prevented an estimated 59,954 deaths annually (95% CI: 37,252-79,303). Between 2015 and 2024, around 50% of cities experienced a decrease in burden attributable to insufficient green space, while 37% saw an increase. HIAs are an effective tool for quantifying health impacts of current and future urban policies. By providing robust and comparable burden of disease estimates, this work supports evidence-based decision-making and enables monitoring of policy impacts over time, strengthening the evidence base for cities as drivers of sustainable and healthy living.

Key messages

• Monitoring trends in environmental exposures and health impacts over time is essential for cities to track progress and evaluate the effectiveness of urban policies.

• Joint assessment of PM2.5 and NO2 provides more accurate health impact estimates than single-pollutant approaches, improving burden of disease estimation.