Natural outdoor environments including green spaces
play an important role in preserving population health and wellbeing in cities, but the number
of deaths that could be prevented by increasing green space in European cities is not known.
We aimed to estimate the number of natural-cause deaths among adult residents that could be
prevented in cities in 31 European countries, if the WHO recommendation for universal access
to green space was achieved.
Methods
In this health impact assessment study we focused
on adult residents (aged ≥20 years; n=169 134 322) in 978 cities and 49 greater cities, in 31
European countries. We used two green space proxies: normalised difference vegetation index
(NDVI), and percentage of green area (%GA). The exposure was estimated at a fine grid-cell
level (250 m × 250 m) and the preventable mortality burden for 2015 was estimated at the local
city-level.
Findings
For 2015 we found that meeting the WHO
recommendation of access to green space could prevent 42 968 (95% CI 32 296–64 177) deaths
annually using the NDVI proxy (ie, 20% [95% CI 15–30] of deaths per 100 000 inhabitants-year),
which represents 2·3% (95% CI 1·7–3·4) of the total natural-cause mortality and 245 (95% CI
184–366) years of life lost per 100 000 inhabitants-year. For the %GA proxy 17 947 (95%CI
0–35 747) deaths could be prevented annually. For %GA the number of attributable deaths were
half of that of the NDVI and results were non-significant due to the exposure response
function considered. The distribution of NDVI and %GA varied between cities and was not
equally distributed within cities. Among European capitals, Athens, Brussels, Budapest,
Copenhagen, and Riga showed some of the highest mortality burdens due to the lack of green
space. The main source of uncertainty for our results was the choice of the age-structures of
the population for the NDVI analysis, and exposure-response function for the %GA analysis.
Interpretation
A large number of premature deaths in European
cities could be prevented by increasing exposure to green space, while contributing to
sustainable, liveable and healthy cities.
Funding
GoGreenRoutes, Internal ISGlobal fund, and the
United States Department of Agriculture Forest Service.
