Research, Urban Planning, Environment and Health

The European Urban Burden of Disease Project

Cycling in Utrecht
Photo: Mark Nieuwenhuijsen
Mark Nieuwenhuijsen (on behalf the consortium)

Cities have long been known to be society’s predominant engine of innovation and wealth creation, yet they are also hotspots of pollution and disease partly due to current urban and transport planning practices. The aim of the European Urban Burden of Disease (UBD) project is to:

  1. evaluate the health burden and its determinants related to current and future potential urban and transport planning practices and related exposures (e.g, air pollution, noise, islands, green space, physical activity) in European cities and
  2. make this evidence available for policy and decision making for healthy and sustainable futures (Nieuwenhuijsen et al 2022).

Cities provide good opportunities for policy change as city councils have direct local accountability and have more agile governance structures compared to national governments. However, they often lack the expertise and resources to conduct quantitative health impact assessments to quantify the health impacts of their current urban and transport planning practices, or alternative or future scenarios. The urban burden of disease project will provide exposure and health estimates for around 1000 cities in Europe and publish these on a publicly accessible website: 




Appropriate and efficient urban planning and transport systems are essential for cities to thrive, but evidence suggests that current urban and transport planning practices can cause increased exposure to air pollution and noise, heat islands and a lack of green space and physical inactivity that have detrimental effects on health such as increasing morbidity and premature mortality. A recent health impact assessment study in Barcelona found that suboptimal urban and transport planning practices may be responsible for nearly 3,000 premature deaths annually or around 20% of the total of number of deaths (Mueller et al 2017).

The Urban Burden of Disease Project will provide exposure and health estimates for around 1000 cities in Europe.

The UBD project draws on an established comparative risk assessment methodology (i.e. Urban and Transport Planning Health Impact Assessment UTOPHIA tool). The project has only recently become possible because of the availability of new data on city boundaries, exposures, and mortality data for such a large number of cities and new exposure response functions. Unfortunately, city specific morbidity data and data on other determinants of health such as physical activity or transport mode are lacking and/or not available in easy accessible format for most of the cities, but may become available in the future. Please contact the UBD project team if you know of good available data sources.

Furthermore, the UBD project will conduct an in-depth assessment of current status of urban and transport planning and develop alternative, sustainable and healthy scenarios for a number of cities (e.g. Barcelona, Paris, Utrecht, Kiev). It will conduct an in-depth evaluation of current land use and transport practices in the cities and linkages between urban and transport planning, environment, physical activity and health. It will assess the health burden of current and alternative urban and transport planning practices. The work will be conducted with local stakeholders.

The UBD project will provide many European cities with burden of disease estimates that can be used to inform policies to reduce this burden.

So far the UBD project team conducted quantitative burden of disease assessments for the year 2015 to estimate the effect of air pollution exposure (PM2.5 and NO2) and lack of green space on natural-cause mortality for adult residents (aged ≥20 years) in 969 cities and 47 greater cities in Europe (Khomenko et al 2021) We found that the reduction of air pollution to the lowest measured concentrations could prevent nearly 125,000 deaths per year for PM2.5 exposure and 80,000 deaths per year for NO2 exposure. Increasing green space in the cities could prevent around 40,000 premature deaths annually (Pereira et al 2021).

The UBD project will provide many European cities with burden of disease estimates that can be used to inform policies to reduce this burden. Improved urban and transport practices are needed to reduce the current related burden of disease. New urban models such as the Barcelona Superblocks, the Paris 15-minute city or the Car free city/neighbourhood such as Vauban Freiburg (Nieuwenhuijsen 2021) and/or a shift in private car use towards public and active transportation and greening of cities are urgently need to make our cities more sustainable, liveable and healthier (Nieuwenhuijsen 2020).


  • Khomenko S, Cirach M, Pereira-Barboza E, et al. Premature mortality due to air pollution in European cities: a health impact assessment. Lancet Planet Health 2021;S2542-5196(20):30272-2.
  • Mueller N, Rojas-Rueda D, Basagaña X, et al. Urban and Transport Planning Related Exposures and Mortality: A Health Impact Assessment for Cities. Environ Health Perspect 2017;125(1):89-96.
  • Nieuwenhuijsen MJ. Urban and transport planning pathways to carbon neutral, liveable and healthy cities; A review of the current evidence. Environ Int. 2020 Apr 6:105661.
  • Nieuwenhuijsen MJ. New urban models for more sustainable, liveable and healthier cities post covid19; reducing air pollution, noise and heat island effects and increasing green space and physical activity. Environ Int. 2021 Sep 6:106850. 
  • Nieuwenhuijsen MJ, Barrera-Gómez J, Basagaña X, Cirach M, Daher C, Pulido MF, Iungman T, Gasparrini A, Hoek G, de Hoogh K, Khomenko S, Khreis H, de Nazelle A, Ramos A, Rojas-Rueda D, Pereira Barboza E, Tainio M, Thondoo M, Tonne C, Woodcock J, Mueller N. Study protocol of the European Urban Burden of Disease Project: a health impact assessment study. BMJ Open. 2022 Jan 20;12(1):e054270.
  • Pereira Barboza E, Cirach M, Khomenko S, Iungman T, Mueller N, Barrera-Gómez J, Rojas-Rueda D, Kondo M, Nieuwenhuijsen M. Green space and mortality in European cities: a health impact assessment study. Lancet Planet Health. 2021 Oct;5(10):e718-e730.

Consortium Members

Mark Nieuwenhuijsen1-4 (lead), Jose Barrera-Gomez1-3, Xavier Basagaña1-3, Marta Cirach1-3, Carolyn Daher1-3, Maria Foraster Pulido1-3, 5, Tamara Iungman1-3, Antonio Gasparrini6, Gerard Hoek7, Kees de Hoogh8,9, Sasha Khomenko1-3, Haneen Khreis10,11, Audrey de Nazelle12, Ana Ramos1-3, David Rojas-Rueda13, Evelise Pereira Barboza1-3, Marko Tainio14,15, Meelan Thondoo1-3, Cathryn Tonne1-3, James Woodcock1-3, 11, Natalie Mueller1-3

1. ISGlobal, Barcelona, Spain
2. Universitat Pompeu Fabra (UPF), Barcelona, Spain
3. CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
4. Mary MacKillop Institute for Health Research, Melbourne, Australia
5. PHAGEX Research Group, Blanquerna School of Health Science, Universitat Ramon Lull (URL), Barcelona, Spain
6. London School of Hygiene & Tropical Medicine
7. Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
8. Swiss Tropical and Public Health Institute, Basel, Switzerland
9. University of Basel, Basel, Switzerland
10. TTI, Texas A&M
11. Centre for Diet and Activity Research, MRC Epidemiology Unit, University of Cambridge
12. Imperial College London, UK
13. Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, USA
14. Sustainable Urbanisation Programme, Finnish Environment Institute SYKE, Helsinki, Finland
15. Systems Research Institute, Polish Academy of Sciences, Warsaw, Poland

Funding Statement

This project receives funding and support from:

  • SURREAL through the European Union’s Horizon 2020 research and innovation programme under grant agreement No 956780,
  • GoGreenRoutes through the European Union’s Horizon 2020 research and innovation programme under grant agreement No 869764,
  • EXPANSE through the European Union’s Horizon 2020 research and innovation programme under grant agreement No 874627, and
  • A Fellowship from the Spanish Ministry of Science and Innovation through the "ayudas para la formación de profesorado universitario 2020–24" doctoral funding.

Our Team

Coordinator (on behalf the consortium)

  • Mark J Nieuwenhuijsen
    Mark J Nieuwenhuijsen Research Professor, Director of the Urban Planning, Environment and Health Initiative, and Director of the Air pollution and Urban Environment Programme

Consortium Members at ISGlobal

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