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I will now dedicate this section to setting the problem. What are the issues related to living in urban settings? How are mental and physical health affected by cities? What is urban health?

I will answer these questions in this section and provide more context about what it means to live in a city. The focus of my research will therefore be on a local level, as it is city-based. It will take into account various cities, mostly situated in Europe, but also elsewhere.

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This research will analyse how much mental and physical health are impacted by living in urban environments, like cities. More specifically, this study will look into the negative side effects of living in a city. Cities with bad air pollution, traffic, where people deal with high levels of stress and practice little physical activity, can indeed have a negative influence on a person's mental and physical well-being. With more than half of the world's population expected to live in cities by 2050, urban health is a growing issue that must be tackled in order to preserve and promote public health and human well-being.

That being said, this research will focus on nature-based solutions, specifically in urban settings (local level), and how they can increase physical and mental health for people living in urban environments. This solution is based off the evidence that green and blue spaces, for example, can have a positive impact on overall human well-being.

This padlet has 6 sections. Each section focuses on a specific topic about the research. Overall, the padlet includes over 25 peer-reviewed papers, research articles, policies, figures and websites that I consider relevant to my research and that will be incorporated into my final essay. I will add some personal comments, reflections and lessons learned to some of the papers, stating what I found interesting and what I particularly liked about them. A final section is dedicated to the references.

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Urban health: a major issue for most cities

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Urban health: a major issue for most cities

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This webpage provided by the World Health Organisation gives useful information about the problems that arise while living in urban environments.

The webpage gives us the following information:
- half of the world's population lives in cities, and this is set to increase to 68% by 2050.
- 91% of the world's population living in cities breathes polluted air.
- Most citizens suffer from noise pollution, road traffic, unsustainable transport systems and housing emissions.
- Non-communicable diseases are set to increase in urban environments, like diabetes and heart diseases due to unhealthy lifestyles, no physical activity, barriers to outdoors sports and activities.
- Communicable diseases are also set to increase due to humid, hotter weather, and polluted air.
- Urban environments suffer from climate change the most due to higher temperatures and the urban heat island effect.

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Overview

The rising noncommunicable disease burden, the persistent threat of infectious disease outbreaks and an increased risk of violence and injuries are key public health concerns in urban areas. This triple threat includes:

Noncommunicable diseases like heart disease, asthma, cancer and diabetes are made worse by unhealthy living and working conditions, inadequate green space, pollution such as noise, water and soil contamination, urban heat islands and a lack of space for walking, cycling and active living. Diabetes is linked to obesity and physical inactivity in cities lacking good transit and walking/cycling infrastructure. Urbanization is also linked to high rates of depression, anxiety and mental ill health.

Injuries (including road traffic injury) and interpersonal violence particularly affect children, young adults, older people and the most marginalized groups as a result of poor working and living conditions and a lack of safe transport and infrastructure.

Infectious diseases like COVID-19, tuberculosis, dengue and diarrhoea thrive in poor and overcrowded environments and are closely related to unhealthy housing and poor sanitation and waste management. Poor urban waste management fuels transmission of diseases such as the Zika and Ebola viruses.

Health inequities in urban areas

While urbanization can bring health and economic benefits, rapid and unplanned urbanization can have many negative social and environmental health impacts, which hit the poorest and most vulnerable the hardest. Health inequities are perhaps most stark in urban areas, sometimes varying from street to street. Migrants and other disadvantaged groups tend to be clustered in the most deprived and environmentally degraded neighbourhoods with the fewest mobility, work and educational opportunities, the poorest access to health services and below average health outcomes.

Urban health and climate change

Cities consume over two-thirds of the world's energy and are responsible for over 60% of greenhouse gas emissions. Urban populations are among the most vulnerable to climate change: inland cities may experience temperatures 3-5ºC higher than surrounding rural areas due to the so-called heat island effect of large concrete expanses and lack of green cover.

Urban health and COVID-19

The COVID-19 pandemic has shown that cities often bear the brunt of emergencies. Citizens frequently have high exposure to the virus and have no space or the means to protect themselves. Overcrowding and lack of clean sanitation services increase the risk of contagion, limit residents' ability to adhere to public health measures and increase the likelihood of interpersonal violence. Around the globe, COVID-19 has spread quickly in areas with other existing health inequities, such as the unfair and preventable differences in people's health, well-being and access to quality health services. COVID-19 cases and deaths in deprived areas are double those of more advantaged areas.

WHO response

Urban health is a growing priority for WHO and the scale of the challenges to urban health means that approaches to deal with them must be strategic, multisectoral and coordinated. WHO addresses urban health in multiple cross-cutting ways, focusing on better air quality, water and sanitation and other environmental determinants; healthy urban planning; healthier and smoke-free environments; safe and healthy mobility; prevention of violence and injuries; healthy food systems and diets; environmental management of vector-borne diseases; emergency preparedness and responses in urban settings. Addressing risks and needs of specific population groups, such as children and older people and migrants, is also a priority. The interlinked nature of urban health challenges means that action in one sector can have benefits for many other sectors.

To help Member States address the above priorities, WHO supports the strengthening of the evidence base to allow policy-makers to make informed decisions when addressing health risks. It provides tools and guidance on what works and supports monitoring of key health-related indicators. WHO leads and engages in partnership activities fostering city-to-city exchanges and helps develop institutional and policy frameworks for good urban governance for health and well-being in cities.

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The rising noncommunicable disease burden, the persistent threat of infectious disease outbreaks and an increased risk of violence and injuries are key public health concerns in urban areas.

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How living in cities affects physical health

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How living in cities affects physical health

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This paper summarises some of the key aspects of physical health linked to cities. As urban environments and cities are spreading across the world, the health risks associated to these environments are also increasing.

Having lived in cities my whole life, I can agree on the key messages provided by this paper. The paper argues that cities in particular are often associated to higher air pollution due to heavy road traffic and housing emissions. Indeed, air pollution and physical inactivity are the two biggest challenges that people face when living in a city. Air pollution, like particulate matter and nitrogen oxide, is the fourth biggest cause for premature deaths caused by non-communicable diseases, and generates heart and respiratory diseases and lung cancer. Physical inactivity also contributes to cardiovascular diseases and obesity.

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Let's start at the beginning: how is health defined?

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Let's start at the beginning: how is health defined?

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This journey will start off by analysing how much mental and physical health are impacted by living in urban environments. Factors like air quality, the built environment, segregation and economic inequities can all have negative influences on a person's mental and physical well-being.

Before starting this journey, it is important to firstly define what health is. The most common definition was given by the World Health Organization in 1948, which identifies health as a "complete
physical, mental and social well-being, not merely negatively as the absence of disease or infirmity".

Brief key points about mental and physical health are given in the following posts.

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Similar to the definition given by the WHO, this paper describes physical health as a dynamic state with functioning physical, biological and mental conditions (e.g.: healthy cardiovascular and respiratory systems, strong immune system, balance between internal and external relations etc). A good physical state also incorporates factors such as social health, the ability of adapting to change and not suffering from any diseases.

I think this is a very clear and inclusive definition of physical health. Although I have added mental and physical health into two different posts, they are very much interconnected and interdependent. As the above-mentioned paper says, good physical health also means having a healthy mental state, which I completely agree on.

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The definition of mental health by the World Health Organization

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The definition of mental health by the World Health Organization

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I think that the definition for physical health is a bit more straight forward, as it is less stigmatized and easier to grasp. Thus, I will start by describing mental health first, since in my experience, it is something that I find more difficult to describe and to talk about.

The website of the World Health Organization holds some useful information about mental health.
Mental health problems usually cover mental disorders and psycho-social disabilities. People who suffer from mental health disorders can manifest symptoms of distress, anxiety, depression. Some disorders can also cause self-harming practices.

On the contrary, having a good mental health status means that a person is in a state of well-being, self-awareness, and is able to build relationships and make decisions in everyday life.

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WHO fact sheet on mental health covering risks and protective factors, promotion and prevention, care and treatment, and WHO’s work in this area.

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Data from the European Environment Agency on air pollution in cities

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Data from the European Environment Agency on air pollution in cities

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In addition to what the World Health Organization provides, the European Environment Agency shows that 97% of the total population of the EU is exposed to particulate matter, caused by road traffic, energy sources, industries and agriculture. 307,000 premature deaths were counted in 2019 due to air pollution in the EU.

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The EEA ' Air quality in Europe 2021' report updates and expands on an earlier assessment of the status of air quality by comparing pollutant concentrations in ambient air across Europe against the new WHO air quality guidelines published in September 2021. It finds that the majority of Europeans are exposed to levels of air pollutants known to damage health.

In the 27 Member States of the European Union (EU), 97% of the urban population is exposed to levels of fine particulate matter above the WHO guideline. Levels of particulate matter are driven by emissions from energy use, road transport, industry and agriculture.

Regarding nitrogen dioxide, 94% of the urban population is exposed to levels above the WHO guideline, due predominantly to emissions from road transport.

99% of the urban population is exposed to levels of ozone above the WHO guideline, linked to emissions of nitrogen oxides and volatile organic compounds, including methane, and high temperatures associated with climate change.

The report finds that human activities are the key driver behind the dangerous levels of particulate matter, nitrogen dioxide and ozone in urban air. Overall emissions of all key air pollutants across the EU declined in 2019, maintaining the trend seen since 2005. Nevertheless, delivering clean and safe air for Europe will require ongoing and additional reductions in emissions. Looking ahead, the report says more action is required by all Member States if they are to meet future emission reduction commitments under the EU's National Emissions reduction Commitments Directive (NEC Directive).

The EU has also set standards for key air pollutants in the EU's Ambient Air Quality Directives. Under the European Green Deal's Zero Pollution Action Plan, the European Commission set the 2030 goal of reducing the number of premature deaths caused by PM 2.5 by at least 55% compared with 2005 levels.

To this end, the European Commission initiated a revision of the Ambient Air Quality Directives, which includes a revision of EU air quality standards to align them more closely with WHO recommendations. Citizens and stakeholders are invited to express their views through a public consultation run by the European Commission until 16 December 2021.

In 2019, air pollution continued to drive a significant burden of premature death and disease in Europe. In the EU, 307,000 premature deaths were linked to exposure to fine particulate matter in 2019, a decrease of 33% on 2005.

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Europe's urban population remains at risk due to levels of air pollution known to damage health

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The EEA ' Air quality in Europe 2021' report updates and expands on an earlier assessment of the status of air quality by comparing pollutant concentrations in ambient air across Europe against the new WHO air quality guidelines published in September 2021.

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Climate change, urban heat and physical health

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Climate change, urban heat and physical health

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When talking about urban health, I felt the need to include climate change into my research, as it is one of the most persistent problems when it comes to health. Indeed, human-driven activities and the consequent release of CO2 emissions into the atmosphere have caused a rise in temperatures around the world, especially in high-population density cities.

Over the past few years, rising temperatures have caused heat waves and droughts throughout European cities, not only harming our ecosystems and natural habitats, but also human health. Severe heat waves have generated heat strokes, cardiovascular mortalities and decreased mobility across Europe.

One of the underlying determinants to this issue is the urban heat island effect, caused by climate change. Cities tend to have higher temperatures than in rural areas, almost 4 degrees higher. The built environment, made mostly by concrete and bricks, absorbs and traps more heat rather than letting it evaporate, thus forming a heat bubble over the city.

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Europe's current solutions to healthier urban environments

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Europe's current solutions to healthier urban environments

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This section will map out strengths and weaknesses of current urban health policy frameworks and tools implemented by the EU and the UN.

I discovered that unfortunately the EU has not yet developed a framework or regulation that specifically tackles mental and physical health issues in urban environments. We can only find policies on how to achieve greener, cleaner and healthier cities, such as the European Green Deal.

Moreover, research on this matter has been tackled by EU projects funded by the Horizon Europe Programme. Nevertheless, there is still a missing connection in EU policymaking on the correlation between cities and human well-being.

This section will look into existing solutions that help cities become healthier environments. Some of these solutions are included into the European Green Deal, others have been taken from EU agencies and EU funded research projects.

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The urban heat island effect: further research

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The urban heat island effect: further research

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Here is more information about the urban heat island effect that I deemed relevant to my research:

- The urban heat island effect causes a rise in temperatures in cities, thus increasing the risk of droughts, air pollution and a reduction in water quality.
- The difference in temperatures between cities and rural areas can be up to 10°C in extreme cases.
- One of the most extreme heat waves in 2003 in Europe caused several illnesses such as heat strokes.
- Extreme heat waves are expected to increase due to climate change drawbacks.

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Mental health, especially for young people, is highly influenced by living conditions and surrounding neighborhoods of a city.

This paper specifically mentions young people and how they suffer from mental health disorders, like depression, anxiety or social instability due to polluted, segregated and grey neighborhoods.

The key messages of the paper are the following:
- Some neighborhoods do not have appropriate and accessible facilities which causes social exclusion and isolation.
- Increased air and noise pollution cause annoyance, anxiety and sleeping problems.
- Abandoned, dirty and derelict built environments cause frustration and depression.
- Non-functional road and transportation systems cause marginalisation.

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A specific example: the city of Brussels and mental health

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A specific example: the city of Brussels and mental health

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I wanted to add this paper to my research as it talks about a city that is very dear to me. Having lived in Brussels for most of my life, I feel that its urban spaces and overall structure play a significant role for my mental health.

This paper supports the argument of the previous paper, since it mentions that urban environments can affect mental well-being due to, for example, higher air pollution. The latter causes oxidative stress, neuro-inflammation, and disincentivizes people to spend time outdoors. Noise pollution is also attributed to increased mental health disorders.

Specifically to Brussels, the study shows that sleeping disorders, depressive disorders and anxiety disorders were the most common health issues associated with exposure to black carbon, noise pollution and grey, narrow streets.

From my personal experience, I have always perceived Brussels as a polluted and noisy city. Neighborhoods such as the city center are very much crowded and do not offer loads of open public spaces for physical activity or social engagement. However, a lot has been done so far to improve this situation; parks have been incorporated, roads have been transformed into pedestrian streets, and bicycle lanes have been added as well. Since then, my perception of Brussels has changed, and my mood and anxiety levels towards this city have decreased as well, as I feel more secure, healthy and happy while walking or jogging through the streets.

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The European Green Deal: a roadmap to cleaner and greener cities

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The European Green Deal: a roadmap to cleaner and greener cities

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The European Green Deal (EGD) is an overarching framework that sets environmentally-friendly and climate targets for Europe such as:
- becoming the first climate-neutral continent by 2050
- reducing at least 55% of net emissions by 2030 compared to 1990 levels
- planting 3 billion additional trees by 2030

The aim of the EGD is to provide a just and sustainable transition for all EU citizens. Sub-aims include:
- more energy efficiency and eradicating energy poverty
- healthy and affordable food systems
- access to clean air and fresh water
- cleaner and more resilient cities
- climate neutrality and biodiversity preservation

All in all, the EGD is a supporting tool that will help urban environments become cleaner. Sustainable transport systems and energy-efficient buildings are two of the many solutions that will contribute to promoting better mental and physical health to people living in cities.

Nevertheless, no specific objective is sent about mental and physical health in cities. However, I think that the above-mentioned sub-aims will indirectly help achieving better urban health for citizens in the EU.

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Discover the European Commission’s proposals to transform the EU into a modern, resource-efficient and competitive economy while reaching climate neutrality by 2050.

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From this brief introduction about physical and mental health, these are my comments and takeaways about well-being:
- Well-being can take many forms, and can be attributed to mental, physical and social health
- There is a wide span of mental health disorders, ranging from everyday stress to self-harming practices.
- Physical health includes having a healthy balance between physiological and biological functions
- Both health statuses are connected; being in a bad physical state can alter moods and subjective well-being and vice versa
- Well-being is also determined by a person's social health, economic inequalities, life style, or living conditions
- Physical health can be altered due to external factors such as climate change, bad air quality and noise
- Mood swings and anxiety highly depend on the environment a person is living in

In the next sections, I will apply these definitions and forms of well-being into my research, and put these definitions into a more detailed context (cities' level) and look at how well-being varies in people who live in cities.

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Since my research focuses on sustainable development, I wanted to mention the Sustainable Development Goals as part of the implementation tools to achieving urban health.

The 11th Sustainable Development Goal focuses on Sustainable Cities. Within this goal, seven sub-targets and three implementation tools are found. SDG 11 aims to transform cities into more resilient, inclusive, sustainable and clean environments. What I would like to emphasize on is target 11.7, which specifically aims to promote the inclusion of green and public spaces into cities. Green and blue spaces are common areas used to improve human well-being. From my personal experience, walking along the coast increases my mood, lowers my heart beat and increases my appreciation for life overall.

This brief, written by UNEP, highlights the importance of introducing ecosystems and biodiversity into cities in order to make them more resilient to climate change. Also, it mentions how transforming cities into more sustainable environments should be guided by an inclusive, participatory and bottom-up approach, where citizens take part in urban planning strategies. The target also emphasizes the need to build energy efficient buildings, electric transportation systems, sustainable water treatment centers and urban parks. These objectives will indeed lead to better air quality and the reduction of the urban heat island effect.

Again, I noticed that SDG 11 does not mention the role that cities play specifically on mental and physical health, and how increasing resilience and sustainability in cities can lead to overall better human well-being. I think that target 11.7 indirectly links sustainable cities to urban health, through the promotion of green and blue spaces. That is why we will focus on this aspect in the following post.

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Green and blue spaces: people who live closer to water are healthier

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Green and blue spaces: people who live closer to water are healthier

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I found a lot of articles and research papers that examine the relationship between living in close proximity to green and blue spaces (i.e.: a creek, a park, the sea, a river) and subjective well-being. Most of them acknowledge the positive correlation between the proximity to water and greenery and being more happy in life, living a healthier lifestyle and feeling less depressed, stressed or bored.

This paper in particular focuses on the EU funded project "BlueHealth2020". It studies the relationship between blue spaces and well-being in Europe. The paper shows that living in proximity to the coast, lakes and rivers is positively correlated with increased mood states and lower stress levels. Living close to blue spaces also promotes physical activity, outdoor walks, runs and social encounters.

In addition, the term "therapeutic landscape" is used in the paper to define the relationship between human well-being and water. The research also focuses on how people's behaviour changes in relation to blue exposure, promoting restorative environmental practices and care for nature.

Even though I agree with the key statements of this paper, this solution can not be considered a "one size fits all" solution. I think living close to blue spaces is very advantageous, however, not all cities border the coast, a lake or a river. Therefore, I would not consider this as only solution.

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Here, I wanted to put emphasis on green spaces, the wilderness and biodiversity.

This paper shows that being in contact with nature reduces everyday anxiety, stress levels, and feelings of loneliness. By simply walking in a forest to being sounded by trees and flowers, a person will become more socially active (e.g.: spending time outside with family and friends). Being myself a jogger, I can confirm that walking through a forest gives me comfort and mindfulness, as I forget about everyday life stress and work anxiety.

The outcomes of this study show that:
- being in contact with wild nature boosts everyday motivation and gratefulness for life.
- social and physical activities will increase.
- feelings of achievement and self-fulfillment will rise.
- biodiverse and natural ecosystems will increase awareness for caring for nature and restorative practices.

This positive relationship between green spaces and human well-being is further nurtured by promoting nature-based tourism and ecotourism. The latter induces a positive behaviour towards nature while feelings of comfort and life satisfaction rise.

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Everyday green space and experienced well being the significance of wildlife encounters ISSN 0142 6397

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UN HABITAT & World Health Organization, 2020

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This sourcebook is a really good instrument for providing solutions and best practices on how to achieve better and healthier urban environments.

It is important to state that health and urban planning must be once and for all merged and not tackled separately. Some of the solutions provided by the WHO in promoting healthy urban environments are the following:
1.  Setting standards for housing quality
2. Reducing street and air pollution
3. Sustainable waste management practices
4. Provision of cycling infrastructures
5. Nearby nature and public spaces
6. Local biodiversity and climate action plans
7. Better water and sanitation measures

Cross-cutting policies such as constant health assessments, are also important to evaluate the needs of each population. Inclusive governance (i.e.: civil involvement and workshops) is also key to improving a sustainable transition.

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Integrating social, economic and environmental solutions into urban health

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Integrating social, economic and environmental solutions into urban health

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As a conclusion, this figure depicts the different dimensions that are needed to achieve a healthy urban environment.

These can be categorised into environmental, social and economic dimensions. Climate stability, rich biodiversity, territorial strategies, social capital, and healthy lifestyles are all solutions to living in sustainable environments.

I think it is important to state that these determinants need to be interoperable and codependent in order to achieve an inclusive and sustainable approach to healthy cities.

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Assessing urban nature-based solutions as modern, effective and sustainable solutions to urban health

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Assessing urban nature-based solutions as modern, effective and sustainable solutions to urban health

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This section will provide new solutions to sustainable urban environments and public health. There is a growing body of research on urban nature-based solutions (NBS) that examines how the latter can have positive effects on public health. I will closely examine urban NBS and its multifaceted aspects and benefits, and see how these can be modern and strong solutions for urban health.

As mentioned in the previous section, there is still a lack of EU policy developments on this matter. Therefore, this section will focus on the opportunities of urban nature-based solutions and what cities can do to improve their citizens' well-being.

Urban nature-based solutions as main proposed solution aim to promote urban health in cities, while increasing physical and mental health. Additionally, NBS will reduce climate change impacts, pollution, grey environments, and will boost social inclusion, community engagement, and clean, safe blue and green spaces etc.

The objective is to develop modern and resilient urban planning strategies that are sustainable in the long term, improve citizen's quality of life, well-being and overall health status. Urban NBS will lead to more salutogenic cities, therapeutic landscapes and ecological areas.

All in all, I want to strengthen this solution and give more evidence and background about why this proposed solution on NBS can be a sustainable tool for urban health in all cities of the world.

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An introductory video by WWF International on what urban NBS are

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An introductory video by WWF International on what urban NBS are

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This is a really good video made by WW International that gives a clear overview of the problem, the solutions and the outcomes.
- It talks about the issues that cities are facing, such as climate change, droughts, pollution and natural disasters.
- A weaknesses is that the video unfortunately does not mention health and well-being at all, which I would consider as an essential aspect of urban health.
- Nevertheless, the video emphasizes urban NBS, what they are and how to implement them in cities.
- Some of the images in the video will be added as success stories to this Padlet, so that I can talk specially about best case practices.
- Long-term environmental sustainability is mentioned as beneficial outcome of urban NBS. Not much attention is given to social and economic sustainability, which I will also address in this Padlet.

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Urban Nature-based Solutions: What are they and why are they so important?

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Here I will be describing what nature-based solutions are.
This report by the European Commission describes NBS as "an aim to help societies address a variety of environmental, social and
economic challenges in sustainable ways". NBS are inspired, supported by, or copied from nature. In addition, NBS use the features of nature to act as carbon sinks, reduce natural hazards, improve human well-being and green care.

The key messages from this report are the following:
- NBS improve sustainable urbanisation, by enhancing well-being of citizens
- NBS restore degraded ecosystems, by rewilding cities, parks and coastlines
- NBS develop climate change adaptation and mitigation strategies, by ensuring energy efficiency and absorbing carbon
- NBS improve risk management and resilience, by reducing flood risks and extreme heat waves

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I came across this digital platform, called Oppla, that brings together communities, scientists and policy-makers on matters like urban NBS. It offers knowledge and tools to implement nature-based solutions in specific cities. It is therefore an efficient tool that supports urban NBS and gives advice to cities on how to achieve sustainable development.

I think that raising awareness about platforms like Oppla are part of the key to success, as they strengthen and support solutions, spread best practices and give the right tools for implementation.

While browsing through this platform, I came across the city of Dublin. Within the 2016-2022 Sustainable Development Plan, Dublin aimed to develop more green infrastructures, such as green roofs and walls, and build more energy-efficient buildings with solar panels. Dublin also committed to opening green and blue corridors throughout the city and enhancing public open spaces for community engagement. City canals have been reopened to increase biodiversity, natural habitats, green care and nature-based recreation.

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The Development Plan recognises that 'fiscal restraint has led to a new energy for civic participation, social entrepreneurship, volunteerism and collaboration across the community, cultural, corporate and institutional sectors. These new ways of working can result in innovative and vibrant solutions, whilst strengthening local communities' (1, p. 189). The Local Economic and Community Plan seeks to promote and support local economic and community development in collaboration with the communities concerned (1).

The FP7 project TURAS project has sought to bring urban communities and businesses together with local authorities and academic researchers to innovate and collaborate on developing practical ways of making European cities sustainable and resilient. The project focused on co-developing projects and knowledge around urban/industrial regeneration, land use planning and creative design in partnership with the relevant authorities and citizens, often by testing ways of co-developing nature-based solutions. It involved working closely with Dublin City Council, as well as various local communities, running a number of events using different approaches to get people involved, such as art or pop-up events. For example, on the Cork Street Park Demonstration Site, the project sought to facilitate and support an existing community-driven action to create a new public park in Dublin 8, an area that is short of green space, as well as seeking to learn transferable lessons from the process. TURAS has thus helped to develop a deeper understanding of the concepts of physical and social urban resilience; its outcomes can also help inform the development of processes and practices that lead to systemic responses.

In Pelletstown, a partially constructed residential area where some of the land remained undeveloped due to the financial situation, various activities have been organised to stimulate community involvement in planning what to do with existing open spaces in the area ( http://www.turas-cities.org/editorial_article/6). These have included informal awareness-raising events introducing local people, including children, to the activity of bee keeping and to local plants and insects, followed by various artistic activities ( http://www.turas-cities.org/blog/17). This has helped get the local community involved in developing Pelletstown. The remaining land is now being developed to include some open green space (Collier, personal communication).

Other TURAS activities with local communities have involved looking into how underused or vacant land. For example, the project helped the Bridgefoot Park Community Campaign raise awareness of the Bridgefoot Street site's potential as a neighbourhood park for the Liberties area. Given the lack of quality green space in the area (0.7 m2/person) compared to the rest of the city (49 m2/person), it has been earmarked as a park in the Liberties Environmental Improvements Plan. With the support of Dublin City Council, TURAS organised a pop-up event to find out what the area's residents would like in terms of green space and recreational facilities. Their wish list included a community park, a forest park, a water feature, removing asphalt, putting in railings, planting trees and flowers, putting in benches, a playground and a football pitch.

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Dublin - NBS for a more sustainable city by 2030

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In its 2016-2022 Development Plan the city has set out a vision for a 'Sustainable, Resilient Dublin based on economy, environment and equity' (1). The Development Plan's principles for green infrastructure include sustainable buildings which should use 'sustainable energy technologies and innovative design solutions such as living walls, roofs as well as solar panels'.

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But how do urban NBS affect mental and physical health?

Here, I will review how urban NBS affect urban health, which is the ultimate goal of my research. This systematic literature review addresses all articles that focus on NBS and their effects on public health. The paper is very clear and analyses every mental and physical health variable.

To summarize the results, the paper comes up with the following conclusions:
- Urban parks, urban forests, urban trees and water basins are identified as most effective urban NBS.
- Walkability, air quality, noise pollution and heat have the most impacts on well-being.
- Stress, social cohesion, obesity, quality of life, cancer, and cardiovascular diseases are majorly dependent from the above-mentioned variables.
- Stress and cardiovascular diseases are less common in people who are in contact with natural environments.
- NBS increase physical activity, especially running.
- Heat evaporation due to NBS reduces all-cause mortality, cardiovascular diseases and mental disorders.

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van den Bosch & Ode Sang, 2017, page 380

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Diagram on the relationship between urban NBS and health outcomes

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Diagram on the relationship between urban NBS and health outcomes

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This figure, taken from the previous article, depicts how urban NBS influence urban health, such as stress, weight and physical activity.
Most of these health variables are positively (+) influenced by urban NBS. For example, NBS positively influence physical activity, which in turn reduces all-cause mortality, cardiovascular diseases, lung cancer mortality, birth weight and mental disorders.

It is also interesting to note that both noise and heat are important measures for health. Indeed, reducing both noise pollution and extreme heat waves in cities contribute to overall better human well-being.

I am very well aware that lung cancer and cardiovascular diseases can be caused by other variables as well, such as overall unhealthy lifestyles (eg.: smoking), but I believe that increasing urban NBS can be a step forward towards breaking unhealthy habits.

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More evidence about urban NBS being effective solutions for mental health

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More evidence about urban NBS being effective solutions for mental health

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This paper particularly focuses on chronic depression and psychosocial disorders in people living in the city of Belgrade. It studies the effects of urban botanical gardens in the city centre and their impacts on mood and well-being. More specifically, the paper states that practices such as gardening and horticulture have had positive impacts on psychological recovery, stress reduction and overall improved well-being. Two key words that caught my attention were horticultural therapy and restorative environments, which I believe are the essence of this proposed solution. Indeed, when we merge the words nature and well-being together, we get restorative environments as a result.

I find that this paper is full of strengths as it  talks about how success is measured in restorative environments. These are my main takeaways about the long-term successfulness of restorative environments (botanical gardens in particular):
- walking across a botanical or japanese garden is part of a stress coping strategy
- sunbathing on the grass lawn increases relaxation and meditation skills
- gardening activities promote self-esteem, life satisfaction, and increase social engagement and group work

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This figure gives some clear recommendations and solutions on how to achieve SDG 11, which aims to achieve sustainable cities by 2030.
Specific nature-based solutions are given, such as:
- green roofs
- street trees
- community gardens
- afforestation
- green corridors
- water retention systems

I will have a look at some of them in the following posts.

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Tree coverage: reducing the urban heat island effect in Rome

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Tree coverage: reducing the urban heat island effect in Rome

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The urban heat island effect is charactarized by higher temperatures in cities rather than in rural environments. In the city of Rome, for example, 16.9% of deaths over the age of 75 were attributed to heat-caused mortalities. The urban heat island effect also affects air quality, as air pollution gets trapped into the atmosphere, raising the average temperatures and smog.

The city of Rome has therefore implemented over the past years urban nature-based solutions which include natural, semi-natural and artificial green spaces, street trees and periurban forests. Due to the interception of solar radiation, trees are able to reduce the excess heat that gets trapped in the atmosphere. The results show that periurban and urban forests were 2.5 to 3.2°C cooler than high-density grey areas.

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Reducing PM2.5 pollution through urban NBS in Taipei City

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Reducing PM2.5 pollution through urban NBS in Taipei City

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In this article, the authors discuss urban NBS as air quality regulators in the city of Taipei, Taiwan. I wanted to add this paper to the Padlet as it talks about the economic and social benefits of integrating urban NBS into the city. Until now, this Padlet has focused a lot on environmental sustainability, and how the latter promotes climate change adaptation and mitigation and climate resilience. This paper however gives us a new perspective to urban NBS.

The paper values economic benefits in terms of air quality reduction. Urban NBS have the ability to reduce particulate matter in the air, thus increasing long-term economic benefits. These benefits can be defined as:
- economic development for the construction sector (building green roofs, sky gardens, green facades)
- developing urban agriculture
- promotion of jobs, capacity building, know-how
- decreased costs of illness linked to bad air quality (e.g.: less hospitalizations due to cardiovascular and respiratory diseases, cancer, asthma treatments etc)

The results of the paper are really interesting, as they show the effectiveness of urban NBS in Taipei.
- After the implementation of green roofs and vertical green buildings in 2016, economic benefits (less costs of illness and hospitalizations) rose to $29,690,172.
- This shows that urban NBS have an extraordinary ability to reduce PM2.5 concentrations.
- Urban vegetation is a feasible and working solution that can be considered sustainable in the short and long-term.

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Having lived in Milan for two and a half years, I wanted to add this picture as it is considered a milestone for the city of Milan. I remember when this neighborhood used to be considered as dangerous, polluted and dirty. Nowadays, it is one of the most popular neighborhoods of the city, thanks to these urban NBS that sought to increase greenery, fresh air and social health.

These buildings, called vertical forests, mimic nature. Built in Milan, these NBS provide a net reduction in 30% of housing emissions, help decrease the average air temperature and prevent bad air quality. 15,000 plants and trees have been incorporated into this urban area, improving carbon sequestration and reducing particulate matter.

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This figure beautifully summarizes the spill over effects of green roofs onto sustainable development.

I was a little disappointed to see a medium impact of green roofs on well-being, being that my primary focus. As it is shown in the diagram, biodiversity, climate resilience and social cohesion draw the most benefits from green roofs. However, I believe that all these benefits are well interconnected and interdependent, and I think that urban health can still be heavily impacted by nature based solutions.

In the diagram, all sides of sustainable development are mentioned. In regards to environmental sustainability, climate resilience, disaster reduction, water, food and biodiversity are mentioned. The diagram also emphasizes economic benefits, such as promoting green job opportunities. Lastly, social sustainability is defined as social cohesion and overall better health. Overall, this diagram shows that NBS, particularly green roofs, can holistically increase sustainable development.

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Success stories: Mixed green and blue neighborhoods managed by the community

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Success stories: Mixed green and blue neighborhoods managed by the community

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Another example is given by the city of Malmö. The city has incorporated botanical roof gardens, pollination reserves and bio-water retention basins in its urban planning strategy. These nature-based solutions are managed by citizens and rely on community engagement. Ultimately, these natural areas have increased biodiversity richness and green spaces by 50%.

Mixed green and blue spaces are important for social sustainability. Indeed, the community feels empowered to manage these areas in order to preserve well-being. They also support local initiatives and create more opportunities for greener and innovative jobs. I wanted to state that these are important measures for success, as they boost social sustainability, inclusivity, participative decision-making and bottom-up approaches.

In addition, this solution has put barriers to flood and heat waves risks, and has improved water quality, drainage systems, and carbon reduction.

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In this section, the main focus will be on the environmental, socioeconomic and political determinants of urban health and how they influence physical and mental health.

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What influences well-being in urban environments?

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What influences well-being in urban environments?

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This paper shows that people who have a lower socioeconomic status and live in poorer neighborhoods have double the chances of living an unhealthier lifestyle. Cities amenities and facilities, i.e.: urban public spaces, affordable housing, access to food, are all variables that determine the general well-being of a population.

In this paper, the main determinants of well-being in urban environments are education, employment, food, green spaces, housing, transport and walkability.

What mostly grasped my attention was access to public green spaces, transport and walkability, as these determinants are usually less known and taken for granted. I agree that green spaces play a huge role in the built environment, as they promote social cohesion, physical activity, and mental well-being. Nevertheless, green space availability can also play a big role in health inequities. Indeed, the study shows that people with smaller or less available green spaces in their neighborhood will most likely have worse health outcomes.

Moreover, cities with less pedestrian infrastructures, residential streets and well-connected roads will drive to health disadvantages. In fact, people will be more exposed to traffic emissions, poor air quality and noise pollution.

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This is a well-written and clear diagram, taken from the previous paper, that clearly and concisely summarizes how each determinant of urban settings influences well-being.

These determinants can be categorised into social, environmental and economic determinants. The socioeconomic context seems to be the most relevant to health. People who live in segregated and gentrified areas are in fact less likely to have positive health outcomes.

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This paper supports the previous articles about the determinants of health in urban environments. The study conducted by the authors states that poor physical health and spread of communicable diseases are closely related to housing conditions, such as polluted streets, trash, abandoned facilities, and illegal dumping sites.

Living in such conditions increases the risk of asthma, infectious diseases, injuries, chronic respiratory diseases, anxiety and chronic stress.
Lower social and economic statuses determine whether people are more exposed to these unhealthy conditions or not.

This paper makes also a strong argument about segregation and social exclusion in North American cities, especially in the United States of America. There, for example, health disparities are mostly seen between dominantly white neighborhoods and African-American neighborhoods. Minorities in certain cities suffer more from environmental and health inequalities.

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Mapping socioeconomic determinants for urban health

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Mapping socioeconomic determinants for urban health

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What was really interesting to read in this paper is that it focuses on the history of urban planning and how the latter has been affected mostly by socioeconomic and geographical factors of a city.

The author critically discusses about urban planning, stating that it has lead, over the past decades, to unhealthy and overcrowded cities. Some urban planners plan their projects based on economic and political interests, without thinking about the aesthetics and physical constructs of the building itself. The author therefore emphasizes a "new collective mind" that integrates health impact assessments into the built environment, making urban health a priority.

The author also critisises past urban planning strategies, because considered as "too rigid and anti-health". Some planning projects solely focus on the interests of the private sector, and not on the overall benefits of the entire population. The built environment is therefore often driven by socioeconomic factors that influence urban planning strategies, which often leads to segregation, social exclusion, and ultimately health inequities. As socioeconomic-driven policies are mostly influenced by industries and market-driven incentives, and less by locally-driven interests, this can lead to:
- city fragmentation
- unsustainable behavior patterns (e.g.: exclusion, isolation, violence)
- barriers to activity (e.g.: less spatial fluidity, less communication)
- industrial and grey buildings, freight pollution and traffic

In some cities, social issues and equity are therefore put aside, since cultural and health models are not prioritized. I find this paper extremely well done because it critically discusses how socioeconomic-policies are main drivers of the city's economy and governance, which in turn lead to economic prosperity and success, thus not always being seen as negative drivers. Nevertheless, he also mentions how there is another side of the same coin, which is urban health, community engagement and social equity, which he defines as "urban ecology and ecological landscaping". All in all, socioeconomic-policies are seen both negatively and positively. However, they tend to exclude urban health as key priority.

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The environmental determinant: social and climate inequities

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The environmental determinant: social and climate inequities

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I wanted to add this article to the Padlet as it takes into account the environmental determinants of urban health. More specifically, it focuses on the social and climate inequities in urban environments.

The City of Delhi, India, is given as an example. Delhi has been shown to be a hot spot for heat waves in the past decades, with temperatures rising above 50°C. The urban heat island effect affects mostly socially vulnerable groups. Low income neighborhoods are most likely to be confronted with poor quality housing, poor sanitation facilities and inaccessibility to freshwater. These conditions feed into the vulnerability to climate. The study also states that poorer populations of Delhi have less accessibility to green spaces.

Also, the geographical determinants of Delhi are taken into account. In fact, during the post-monsoon months, some neighborhoods and green spaces become flooded, hence limiting accessibility to urban public spaces, overall walkability and increasing the risk of communicable diseases. Physical health in these situations is therefore hindered by climatic conditions as well.

It was interesting to read about these aspects, as environmental and geographical factors are usually less considered when talking about health inequities. I think that a lot of cities suffer from low urban health caused by environmental inequities. Variables such as the coast, altitude, tropical storms, equatorial temperatures are all determinants to urban health.

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What grasped most my attention was reading about the urban heat island effect, a phenomenon that in my opinion is not addressed enough. Vulnerable groups and elderly people are in fact mostly affected by it. My research topic should therefore be closely linked to the environmental realm of sustainable development, since climate change will increasingly be an underlying issue to urban health.

Moreover, what came up often in these papers is the problem of segregation and living in poorer neighborhoods, as these can influence a person's physical and mental state. This problem will be addressed in the next section, which will focus on the determinants of urban health and how the latter is influenced by different variables.

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In this section, I examined the different variables that influence urban health.

Social disparities within cities are still to this day one of the main drivers of health inequities. Living standards across neighborhoods can be very different, and the lack of unified, coherent urban strategies throughout the city causes even more disparities amongst the population. As we have seen before, urban policies can be socially and economically driven, prioritizing some neighborhoods instead of others, thus feeding into disparities, social injustice and health inequities. Dirty and polluted streets can indeed disincentivize people to practice physical activity, socialize or even take a walk through the neighborhood, hence causing a vicious cycle of physical inactivity, social exclusion, and depression.

One of my main takeaways that I found interesting is that some determinants can be more controlled than others. Socioeconomic inequities can for example be limited thanks to new, efficient and modern urban planning policies, which we will examine in the following section. On the other hand, environmental determinants, especially the geographical context of a city, are less controlled due to climatic and geomorphological conditions. Some cities are for example more exposed to heat waves and extreme weather conditions than others due to their geographical position, as we have seen in Delhi. Nevertheless, climate change policies and land use policies can be supporting tools that mitigate this issue.

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Although there is a lack of policies specifically on managing physical and mental health in cities, this section provided information about cross-sectoral and overlapping policies, both from the EU and from the UN.

The European Green Deal is across all policies the most influential policy tool in Europe, due its multifaceted and cross-sectoral policies on climate change mitigation and adaptation, sustainable development, energy efficiency and social inclusion and coherence.

The Sustainable Development Goals within the UN 2030 Agenda are also to be considered as important tools for urban health, especially since SDG 11 is dedicated to transforming cities into sustainable environments by 2030.

On a more practical level, what grasped mostly my attention was the effects that blue and green spaces have on public health. Although these are very good and effective solutions to improving well-being, they are of course not a definitive and one size fits all solutions, since not all cities are located on the coast or crossed by a river. One can therefore state that not living in proximity to water bodies can be a health inequity, determined by geographical factors. Nevertheless, I have used green and blue spaces as an inspiration for developing potential new solutions (i.e.: urban nature-based solutions), that mimic nature and provide similar benefits to health.

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The key to sustainable development: the economic, social and environmental dimensions 

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The key to sustainable development: the economic, social and environmental dimensions 

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I think this paper gives the best conclusion to this Padlet, as it puts emphasis on the sustainability of the proposed solution and views urban NBS as a key component to reaching better urban health. It therefore puts NBS into perspective and gives the reader a clear picture on the long-term success of NBS.

I really liked this paper because it acknowledges what I mentioned before about EU policies, and that there is a gap in EU law-making specifically about nature based solutions. However, the paper grasps this opportunity to build on best practices and local projects carried out in the EU that could set the example for future policy-making. The paper also supports research and innovation, technological development and stakeholder engagement, which are all extremely important tools for future policy-making.

A major strength of the paper is that it critically evaluates the EU's policies and sets out clear recommendations on what EU policy makers should do to integrate NBS in effective regulations. The paper conducted a survey stating that more than 28,000 citizens across all Member States are willing to implement NBS into their countries through effective regulations, making urban health a key priority. The primary reason for their willingness to implement NBS into their countries derives from wanting a better quality of life, improved aesthetics, better health and cleaner water and air.

The paper supports economic sustainability, stating that urban NBS bring tourism, business opportunities, jobs and property values. It also acknowledged financial resources as an important limitation to reaching NBS, mentioning lack of political will as an obstacle to NBS. Nevertheless, what I like about this paper is that it values civil society and their needs, stating that there is a high willingness from citizens to promote NBS as urban health solutions.

I would like to focus more on social sustainability. The paper emphasizes co-implementation and social engagement as key components in implementing urban NBS. Civil society, citizen's of a particular neighborhoods, local policy-makers, experts and academics are all relevant stakeholders to NBS. Innovative thinking, collaborations between experts and better knowledge are all assets that can be promoted by creating a network of actors made of experts, citizens and law makers. Together, they should work in the best interest of urban health and address societal challenges.

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UH HABITAT & World Health Organization, 2020, p. 19

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The key to success: links between the SDGs and urban health

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The key to success: links between the SDGs and urban health

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I wanted to add this map to the Padlet as it gives a clear picture on the interlinkages between NBS, urban health and the SDGs. I think it beautifully concludes this journey, as it emphasizes sustainable development. More specifically, it takes into account two key SGDs, SDG 11 "Sustainable Cities" and SDG 3 "Good health and well-being". I would consider this map as a key figure for success. It highlights the effectiveness, sustainability and successfulness of the proposed solution, and gives my research a firm evidence-based structure.

When we merge health with cities, through the implementation of urban NBS, we achieve good urban health. As the map shows, urban health can help achieve all SDGs of the UN Agenda for 2030, showing that every goal is interdependent and connected to one another.

We focused a lot on reducing climate change to promote better health for people, especially for vulnerable groups.
- The map shows that indeed, urban health can promote SDG 13, by improving climate change mitigation and adaptation strategies, and climate resilience.
- Urban health also helps to achieve SDGs 1, 2 and 6, which are the main drivers of health inequities, as we have seen in the previous sections. In fact, better urban health through nature based solutions will provide safe and universal access to clean water, food and sanitation facilities.
- SDG 10, which specifically aims to reduce inequalities, will be strengthened through reduced environmental exposures and stronger infrastructures.

This map adopts a holistic approach to nature based solutions, as it takes into account all aspects of sustainable development and all 17 SDGs. In the end, that is what sustainability and long-term effectiveness are all about.

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This section is the pillar of my research, as it looks at nature-based solutions and how they can be adopted into cities. Depending on the urban planning strategy of a city, urban NBS can be the essence of sustainable development, as they promote environmental sustainability (e.g.: rich biodiversity, rewilding initiatives, clean air), social sustainability (e.g.: community engagement, bottom-up approaches, inclusiveness) and economic sustainability (e.g.: lower risks of illness treatment, less hospitalizations).

The research also shows that urban NBS are long-term sustainable solutions that can be interlinked with all SDGs. They are indeed beneficial to achieving sustainable development overall. SDG 11 and 3 are the key tools to implementing urban NBS, and once integrated into cities, they will lead to the achievement of the remaining SDGs.

Overall, looking at my research, I believe that these are the most common and successful urban NBS:
-  Green walls, green rooftops, green buildings.
- Revitalising and cleaning abandoned buildings, dirty water canals and ponds.
- Rewilding urban parks, planting peri-urban forests, green corridors and trees along streets.
- Creating community gardens, water and bee reservoirs, and permaculture.

The most involved stakeholders are:
- citizens (local level)
- experts (e.g.: engineers, architects, urban planners)
- policy-makers (local level and EU level)
- academia

In terms of results, urban NBS promote:
- increased mood swings, less stress and anxiety levels
- decreased chronic depression symptoms
- better quality of life, more life satisfaction and happiness
- more connection and appreciation to life and nature
- lower heart beat
- decreased risk of non-communicable diseases, like cancer and cardiovascular, respiratory diseases
- increased physical activity, more sports and outdoor activities
- increased social engagement, going out, socializing
- increased restorative practices and care for the environment

Any limitations? With my research, I wanted to address the issue of urban health in cities and how urban NBS can be used as coping mechanisms. The evidence shows that NBS are effective, working and sustainable solutions that promote well-being for all citizens. I don't think that urban NBS have any limitations when it comes to improving health, as the facts and figures show that all NBS succeed in the same manner. However, I do believe that urban NBS can be influenced by the tools and implementation methods used in each city. These implementation tools are indeed heavily influenced by political and economic drivers, and local urban planning strategies, thus limiting the successfulness and sustainability of NBS. Therefore, not all cities will have the same types of NBS, and not all neighborhoods will be part of NBS planning strategies. Spatial inequities can thus persist over time, feeding into more health inequalities.

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