Examining the distributional equity of urban tree canopy cover and ecosystem services across United States cities.

Examining the distributional equity of urban tree canopy cover (UTCC) has increasingly become an important interdisciplinary focus of ecologists and social scientists working within the field of environmental justice. However, while UTCC may serve as a useful proxy for the benefits provided by the urban forest, it is ultimately not a direct measure. In this study, we quantified the monetary value of multiple ecosystem services (ESD) provisioned by urban forests across nine U.S. cities. Next, we examined the distributional equity of UTCC and ESD using a number of commonly investigated socioeconomic variables. Based on trends in the literature, we predicted that UTCC and ESD would be positively associated with the variables median income and percent with an undergraduate degree and negatively associated with the variables percent minority, percent poverty, percent without a high school degree, percent renters, median year home built, and population density. We also predicted that there would be differences in the relationships between each response variable (UTCC and ESD) and the suite of socioeconomic predictor variables examined because of differences in how each response variable is derived. We utilized methods promoted within the environmental justice literature, including a multi-city comparative analysis, the incorporation of high-resolution social and environmental datasets, and the use of spatially explicit models. Patterns between the socioeconomic variables and UTCC and ESD did not consistently support our predictions, highlighting that inequities are generally not universal but rather context dependent. Our results also illustrated that although the variables UTCC and ESD had largely similar relationships with the predictor variables, differences did occur between them. Future distributional equity research should move beyond the use of proxies for environmental amenities when possible while making sure to consider that the use of ecosystem service estimates may result in different patterns with socioeconomic variables of interest. Based on our findings, we conclude that understanding and remedying the challenges associated with inequities requires an understanding of the local social-ecological system if larger sustainability goals are to be achieved.

Healthy Cities Programme in the Eastern Mediterranean Region: concurrent progress and future prospects.

Urbanization has been rapidly increasing during the past two decades and it is estimated that by 2030, two thirds of the world's population would be living in urban areas, exposing the population to a large number of environmental, social, cultural, economic and behavioural factors that impact population health and wellbeing.In response to such challenges, the Healthy Cities concept was instigated in 1977 that, along with the Alma Ata Declaration and commitment of countries at the Thirtieth World Health Assembly in Geneva, Switzerland, would empower communities to lead socially and economically productive lives. A number of policy documents from the World Health Organization (WHO) and other bodies suggested introducing new approaches to managing cities and addressing health challenges, focusing more on health determinants and prevention than medical interventions.

Effects of Superblocks on health and health inequities: a proposed evaluation framework.

The following essay outlines the intervention and presents a framework that will serve as a guide in the evaluation of the different effects of the Superblocks. Superblocks consist of amalgamations of blocks throughout the city, with the goal of improving the habitability of public spaces, advancing sustainable mobility, increasing urban green, and promoting residents' participation and coresponsibility, while ultimately influencing residents' health and health inequities. The evaluation framework considers the following aspects: the interventions implemented in the Superblock strategy, the changes that occur at neighbourhood and individual level and the population turnover as intermediate factors and finally the health outcomes. Inequity dimensions are also considered.

Supporting Active Living Through Community Plans: The Association of Planning Documents With Design Standards and Features.

PURPOSE: The purpose of this study was to examine the association between the presence of supportive community planning documents in US municipalities with design standards and requirements supportive of active living. DESIGN: Cross-sectional study using data from the 2014 National Survey of Community-Based Policy and Environmental Supports for Healthy Eating and Active Living. SETTING: Nationally representative sample of US municipalities. PARTICIPANTS: Respondents are 2005 local officials. MEASURES: Assessed: (1) The presence of design standards and feature requirements and (2) the association between planning documents and design standards and feature requirements supportive of active living in policies for development. ANALYSIS: Using logistic regression, significant trends were identified in the presence of design standards and feature requirements by plan and number of supportive objectives present. RESULTS: Prevalence of design standards ranged from 19% (developer dedicated right-of-way for bicycle infrastructure development) to 50% (traffic-calming features in areas with high pedestrian and bicycle volume). Features required in policies for development ranged from 14% (short/medium pedestrian-scale block sizes) to 44% (minimum sidewalk widths of 5 feet) of municipalities. As the number of objectives in municipal plans increased, there was a significant and positive trend ( P < .05) in the prevalence of each design standard and requirement. CONCLUSIONS: Municipal planning documents containing objectives supportive of physical activity are associated with design standards and feature requirements supportive of activity-friendly communities.

Current Status and Policy Planning for Promoting Age-Friendly Cities in Taitung County: Dialogue Between Older Adults and Service Providers.

The World Health Organization has promoted age-friendly city (AFC) projects in response to the aging population. Taiwan has also promoted AFC policies. This study was conducted in Taitung County, where 15.37% of the population is older adults in Taiwan. The aim was to understand the perceptions of older adults and service providers with regard to the current status of AFC policies to influence future policies. The participants of this study were older adults and service providers in various regions of Taitung. Quantitative questionnaires were completed by older adults and qualitative interviews were held with focus groups. The older adults were the most satisfied with the AFC domains of "respect and social inclusion" and "community and health services", and the least satisfied with "transportation" and "civic participation and employment". Homogeneity existed between the older adults' satisfaction levels in different regions and the service providers' opinions; however, there were notable differences between them. Both economic development and the ethnicity of groups in different regions are influential factors that determine the success of government policies. In promoting AFC policies, local governments should consider their applicability based on local conditions and resources to meet the needs of the aging population in rural areas.

City planning and population health: a global challenge.

Significant global health challenges are being confronted in the 21st century, prompting calls to rethink approaches to disease prevention. A key part of the solution is city planning that reduces non-communicable diseases and road trauma while also managing rapid urbanisation. This Series of papers considers the health impacts of city planning through transport mode choices. In this, the first paper, we identify eight integrated regional and local interventions that, when combined, encourage walking, cycling, and public transport use, while reducing private motor vehicle use. These interventions are destination accessibility, equitable distribution of employment across cities, managing demand by reducing the availability and increasing the cost of parking, designing pedestrian-friendly and cycling-friendly movement networks, achieving optimum levels of residential density, reducing distance to public transport, and enhancing the desirability of active travel modes (eg, creating safe attractive neighbourhoods and safe, affordable, and convenient public transport). Together, these interventions will create healthier and more sustainable compact cities that reduce the environmental, social, and behavioural risk factors that affect lifestyle choices, levels of traffic, environmental pollution, noise, and crime. The health sector, including health ministers, must lead in advocating for integrated multisector city planning that prioritises health, sustainability, and liveability outcomes, particularly in rapidly changing low-income and middle-income countries. We recommend establishing a set of indicators to benchmark and monitor progress towards achievement of more compact cities that promote health and reduce health inequities.

Mapping Environmental Inequalities Relevant for Health for Informing Urban Planning Interventions-A Case Study in the City of Dortmund, Germany.

Spatial differences in urban environmental conditions contribute to health inequalities within cities. The purpose of the paper is to map environmental inequalities relevant for health in the City of Dortmund, Germany, in order to identify needs for planning interventions. We develop suitable indicators for mapping socioeconomically-driven environmental inequalities at the neighborhood level based on published scientific evidence and inputs from local stakeholders. Relationships between socioeconomic and environmental indicators at the level of 170 neighborhoods were analyzed continuously with Spearman rank correlation coefficients and categorically applying chi-squared tests. Reclassified socioeconomic and environmental indicators were then mapped at the neighborhood level in order to determine multiple environmental burdens and hotspots of environmental inequalities related to health. Results show that the majority of environmental indicators correlate significantly, leading to multiple environmental burdens in specific neighborhoods. Some of these neighborhoods also have significantly larger proportions of inhabitants of a lower socioeconomic position indicating hotspots of environmental inequalities. Suitable planning interventions mainly comprise transport planning and green space management. In the conclusions, we discuss how the analysis can be used to improve state of the art planning instruments, such as clean air action planning or noise reduction planning towards the consideration of the vulnerability of the population.

Developing a dementia-friendly Christchurch: Perspectives of people with dementia.

AIM: Christchurch, New Zealand has a unique opportunity to potentially rebuild as a dementia-friendly city in the wake of the 2010 and 2011 earthquakes. The present study gathered insights from people with dementia about what would make it possible for them to live better in Christchurch. METHODS: Twenty-six older people living with dementia were interviewed using a semi-structured questionnaire. Interviews were transcribed for thematic analysis. RESULTS: Participants talked about the importance of being connected and engaged; of accommodation from service providers and others in the community and raising awareness of dementia, and attributes of the physical environment requiring consideration in the rebuild. CONCLUSION: The themes that emerged about what people with dementia seek from dementia-friendly communities reinforce previous research, but with an overlay of the difficulties of living in an earthquake-damaged city.

Prioritizing action on health inequities in cities: An evaluation of Urban Health Equity Assessment and Response Tool (Urban HEART) in 15 cities from Asia and Africa.

Following the recommendations of the Commission on Social Determinants of Health (2008), the World Health Organization (WHO) developed the Urban Health Equity Assessment and Response Tool (HEART) to support local stakeholders in identifying and planning action on health inequities. The objective of this report is to analyze the experiences of cities in implementing Urban HEART in order to inform how the future development of the tool could support local stakeholders better in addressing health inequities. The study method is documentary analysis from independent evaluations and city implementation reports submitted to WHO. Independent evaluations were conducted in 2011-12 on Urban HEART piloting in 15 cities from seven countries in Asia and Africa: Indonesia, Iran, Kenya, Mongolia, Philippines, Sri Lanka, and Vietnam. Local or national health departments led Urban HEART piloting in 12 of the 15 cities. Other stakeholders commonly engaged included the city council, budget and planning departments, education sector, urban planning department, and the Mayor's office. Ten of the 12 core indicators recommended in Urban HEART were collected by at least 10 of the 15 cities. Improving access to safe water and sanitation was a priority equity-oriented intervention in 12 of the 15 cities, while unemployment was addressed in seven cities. Cities who piloted Urban HEART displayed confidence in its potential by sustaining or scaling up its use within their countries. Engagement of a wider group of stakeholders was more likely to lead to actions for improving health equity. Indicators that were collected were more likely to be acted upon. Quality of data for neighbourhoods within cities was one of the major issues. As local governments and stakeholders around the world gain greater control of decisions regarding their health, Urban HEART could prove to be a valuable tool in helping them pursue the goal of health equity.

'Including health in systems responsible for urban planning': a realist policy analysis research programme.

INTRODUCTION: Realist methods are increasingly being used to investigate complex public health problems. Despite the extensive evidence base clarifying the built environment as a determinant of health, there is limited knowledge about how and why land-use planning systems take on health concerns. Further, the body of research related to the wider determinants of health suffers from not using political science knowledge to understand how to influence health policy development and systems. This 4-year funded programme of research investigates how the land-use planning system in New South Wales, Australia, incorporates health and health equity at multiple levels. METHODS AND ANALYSIS: The programme uses multiple qualitative methods to develop up to 15 case studies of different activities of the New South Wales land-use planning system. Comparison cases from other jurisdictions will be included where possible and useful. Data collection includes publicly available documentation and purposively sampled stakeholder interviews and focus groups of up to 100 participants across the cases. The units of analysis in each case are institutional structures (rules and mandates constraining and enabling actors), actors (the stakeholders, organisations and networks involved, including health-focused agencies), and ideas (policy content, information, and framing). Data analysis will focus on and develop propositions concerning the mechanisms and conditions within and across each case leading to inclusion or non-inclusion of health. Data will be refined using additional political science and sociological theory. Qualitative comparative analysis will compare cases to develop policy-relevant propositions about the necessary and sufficient conditions needed to include health issues. ETHICS AND DISSEMINATION: Ethics has been approved by Sydney University Human Research Ethics Committee (2014/802 and 2015/178). Given the nature of this research we will incorporate stakeholders, often as collaborators, throughout. We outline our research translation strategies following best practice approaches.

European Healthy City Network Phase V: patterns emerging for healthy urban planning.

There is a tradition of planning cities and their infrastructure to successfully tackle communicable disease arising from urban development. Non-communicable disease follows a different course. Development brings in its wake a basket of adverse health and health equity outcomes that are proving difficult to tackle. In response, within Phase V of the European Healthy Cities Network, municipalities have implemented a range of policy and physical interventions using a settings approach. Owing to the time lag between physical interventions and health outcomes, this research interrogates city activity itself to develop better understanding. Self-reported city case studies and questionnaire data were analysed to reveal patterns using an inductive approach. Findings indicate that some categories of intervention, such as whole city planning and transport, have a systemic impact across the wider determinants of health. Addressing transferability and stakeholder understanding helped cities create conditions for successful outcomes. Cities had varying urban development approaches for tackling climate change. Improvements to current practice are discussed, including; a distinction between supply side and demand side in healthy urban planning; valuing co-benefits and developing integrative approaches to the evidence-base. This evaluative article is important for cities wanting to learn how to maximize benefits to public health through urban development and for researchers exploring, with a systemic approach, the experiences of European cities acting at the interface of urban development and public health. This article also provides recommendations for future phases of the WHO European Healthy Cities programme, posing questions to better address governance and equity in spatial planning.

Building partnerships for healthy environments: research, leadership and education.

As populations across the globe face an increasing health burden from rising rates of obesity, diabetes and other lifestyle-related diseases, health professionals are collaborating with urban planners to influence city design that supports healthy ways of living. This paper details the establishment and operation of an innovative, interdisciplinary collaboration that brings together urban planning and health. Situated in a built environment faculty at one of Australia's most prestigious universities, the Healthy Built Environments Program (HBEP) partners planning academics, a health non-government organisation, local councils and private planning consultants in a state government health department funded consortium. The HBEP focuses on three strategic areas: research, workforce development and education, and leadership and advocacy. Interdisciplinary research includes a comprehensive literature review that establishes Australian-based evidence to support the development, prioritisation and implementation of healthy built environment policies and practices. Another ongoing study examines the design features, social interventions and locational qualities that positively benefit human health. Formal courses, workshops, public lectures and e-learning develop professional capacity, as well as skills in interdisciplinary practice to support productive collaborations between health professionals and planners. The third area involves working with government and non-government agencies, and the private sector and the community, to advocate closer links between health and the built environment. Our paper presents an overview of the HBEP's major achievements. We conclude with a critical review of the challenges, revealing lessons in bringing health and planning closer together to create health-supportive cities for the 21st century.

Developing age-friendly cities and communities in Australia.

OBJECTIVE: The aim of the study is to present case studies and assess the impact of political, policy, consultative, and research processes used to implement Age Friendly Cities (AFC) initiatives in Australia. METHOD: A review and interpretation was conducted based on public documents, community consultations, survey analyses, and participant observation. RESULTS: Governments in Australia have drawn on World Health Organization (WHO) concepts to establish AFC initiatives. In Melbourne, state political leadership established Positive Ageing plans that have reinforced local government actions. In Canberra, a baseline survey and an Older Persons Assembly were followed by modest positive ageing plans. In Sydney, a State Ageing Strategy developed a whole-of-government plan that has yet to be incorporated into budget processes. DISCUSSION: AFC initiatives in Australia have had promising and varied starts with some aims to benefit disadvantaged older people. Notwithstanding the potential benefits, AFC influence on mainstream actions of government has been limited by uncertain political commitment and growing fiscal austerity.

Developing age-friendly cities: case studies from Brussels and Manchester and implications for policy and practice.

Developing environments responsive to the aspirations of older people has become a major concern for social and public policy. Policies and programs directed at achieving "age-friendly" communities are considered to require a wide range of interventions, including actions at the level of the social and physical environment. This article compares the age-friendly approaches of two European cities, Brussels and Manchester, with a particular focus on policies and initiatives that promote active aging in an urban context. The article examines, first, the demographic, social, and multicultural contexts of Brussels and Manchester; second, the way in which both cities became members of the World Health Organization Global Network of Age-Friendly Cities and Communities; third, similarities and differences in the age-friendly approaches and actions adopted by both cities; and fourth, opportunities and barriers to the implementation of age-friendly policies. The article concludes by discussing the key elements and resources needed to develop age-friendly cities.

Gestão de áreas verdes no Município de São Paulo, SP - Brasil: ganhos e limites / Management of green areas in the city of São Paulo, SP - Brazil gains and limits

Em um cenário de expansão e precariedade urbana e, ao mesmo tempo, de uma crescente preocupação com a qualidade do ambiente urbano, agravado pelas mudanças climáticas, as áreas verdes agem como atenuantes dos problemas ambientais e de saúde, favorecendo a qualidade de vida. Porém, para que estes espaços favoreçam a qualidade de vida e auxiliem no processo de adaptação das cidades às mudanças climáticas, é imprescindível que ações estratégicas sejam empreendidas para aumentar a oferta de áreas verdes. Considerando a importância da gestão ambiental como estratégia para se buscar qualidade ambiental, o presente trabalho teve como objetivo analisar a gestão de áreas verdes no Município de São Paulo, considerando a política de áreas verdes do Plano Diretor Estratégico (2002), relatos de atores diversos e legislação correspondente. A pesquisa envolveu levantamento bibliográfico, pesquisa documental, análise do conteúdo de entrevistas com atores chave e estruturação de modelo de análise com os instrumentos e elementos necessários para a implementação de uma estrutura adequada de gestão de áreas verdes. Foram identificados ganhos, limites, potencialidades e proposições para a gestão de áreas verdes em São Paulo, a partir de um olhar sistêmico sobre a questão que abrangeu desde a estrutura e aplicação da política de áreas verdes contida no Plano Diretor, passando pelo processo de planejamento, até aspectos relativos à gestão de parques. O poder público possui estrutura institucional e legal para empreender as ações ambientais e tem buscado a concretização de um planejamento pautado em planos, programas e projetos. Existem fontes de financiamento e há mecanismos para efetivar a participação social, através dos conselhos de meio ambiente instituídos. Na última década houve vários avanços em relação às áreas verdes, como a criação de novos parques (urbanos, lineares e naturais) e a criação de um banco de áreas para implantação de futuros parques...

In a setting of expansion and urban precarity, urban green areas act as extenuatory of the environmental and health problems. However, so that these spaces can promote the quality of life and help in the process of adapting cities to climate change, it is essential that strategic actions are thought to increase the supply of these spaces. This research aims to analyze green areas management in the city of São Paulo, considering green areas policy contained in the Strategic Master Plan (2002), reports of various actors and corresponding legislation. The research involved literature survey, documental research, content analysis of interviews with key actors identified and the structuring of and analysis model with tools necessary for the implementation of an appropriate management structure of green areas. Gains, limits, potentials and propositions for the management of green areas in the city were identified, from a systemic perspective on the issue, that ranged from the structure and implementation of the policy of green areas contained in the Master Plan, through the planning process, until aspects of park management. The government has institutional and legal structure to undertake environmental actions and has been seeking the implementation of a planning process based on plans, programs and projects. There are funding sources and mechanisms to enforce social participation, through environmental councils instituted. In the last decade there have been several advances relating to green areas, such as the creation of new parks (urban, linear and natural) and the creation of a bank of areas for the implantation of future parks. However, there are several limitations to be overcome...

Towards sustainable structures for neighbourhood development? Healthy city research in four Swedish municipalities 2003-2009.

PURPOSE: A vehicle to reduce health inequalities and improve public health has been provided by programmes at a neighbourhood level. The purpose of this paper is to analyse the development processes in four municipalities for achieving sustainable structures in area-based development programmes during and after a formal partnership period. DESIGN/METHODOLOGY/APPROACH: A case-study database was compiled based on the strategic and local work of four municipalities and four municipal housing companies who cooperated in the Partnership for Sustainable Welfare Development 2003-2009. The case-study database includes nine in-depth studies with interviews (n = 68), participant observations (n = 125), a survey (n = 1,160), and documents. The data are analysed using three theoretical concepts: political support, alliances, and citizen participation. FINDINGS: Political support, alliances, and citizen participation are important building blocks in neighbourhood development work. However, when the partnership ended there was little left that could function as a sustainable structure. Political support seems to be a means to reach the target, including ensuring a consistent approach and allocation of resources. However, the support must continue also after the intervention period, when the formal partnership collaboration ends, otherwise the established structure will soon decompose. Citizen participation is another precondition for a sustainable structure able to continue despite reduced municipal support. Alliances have the best chance of forming sustainable structures when they involve both the strategic and the operational level. ORIGINALITY/VALUE: Even though many evaluations have been conducted to capture the process of interventions, little attention has been given to the challenges facing the outcomes of the intervention when it comes to making permanent the activities for reducing health inequalities. This paper is an attempt to deal with these challenges.

Evaluation of partnership working in cities in phase IV of the WHO Healthy Cities Network.

An intersectoral partnership for health improvement is a requirement of the WHO European Healthy Cities Network of municipalities. A review was undertaken in 59 cities based on responses to a structured questionnaire covering phase IV of the network (2003-2008). Cities usually combined formal and informal working partnerships in a pattern seen in previous phases. However, these encompassed more sectors than previously and achieved greater degrees of collaborative planning and implementation. Additional WHO technical support and networking in phase IV significantly enhanced collaboration with the urban planning sector. Critical success factors were high-level political commitment and a well-organized Healthy City office. Partnerships remain a successful component of Healthy City working. The core principles, purpose and intellectual rationale for intersectoral partnerships remain valid and fit for purpose. This applied to long-established phase III cities as well as newcomers to phase IV. The network, and in particular the WHO brand, is well regarded and encourages political and organizational engagement and is a source of support and technical expertise. A key challenge is to apply a more rigorous analytical framework and theory-informed approach to reviewing partnership and collaboration parameters.

Promoting active living in healthy cities of Europe.

Local governments in Europe have a vital role in promoting physical activity in the daily life of citizens. However, explicit investment in active living has been limited. One of the four core themes for Phase IV (2003-2008) of the World Health Organization (WHO) European Healthy Cities Network (WHO-EHCN) was to encourage local governments and their partners to implement programs in favor of active living. This study analyzes the performance of network cities during this period. Responses to a general evaluation questionnaire are analyzed by content according to a checklist, and categorized into themes and dimensions. Most cities viewed "active living" as an important issue for urban planning; to improve visual appeal, enhance social cohesion, create a more sustainable transport system to promote walkability and cyclability and to reduce inequalities in public health. Almost all member cities reported on existing policies that support the promotion of active living. However, only eight (of the 59) responding cities mentioned an integrated framework specific for active living. Many efforts to promote active living are nested in programs to prevent obesity among adults or children. Future challenges include establishing integrated policies specifically for active living, introducing a larger range of actions, as well as increasing funding and capacity to make a difference at the population level.