Is a Liveable City a Healthy City?

Photo: Vienna, Austria. Samuel Elias on Unsplash

The majority of urban dwellers are used to living with high traffic volumes, busy streets, high noise levels and reduced accessibility to open and green spaces, which decreases the opportunities to do physical activity and relax from the busyness of urban life. Poor environmental quality and the associated adverse health impacts are generally taken as unfortunate burdens of city life, and, thus, rarely questioned in terms of how they relate to urban liveability.

Additionally, it is very common that more vulnerable groups commonly reside in areas with the worst adverse environmental conditions. However, what if environmental, health and social justice factors were considered as fundamental aspects of liveability in cities?

What if environmental, health and social justice factors were considered as fundamental aspects of liveability in cities?

The Global Liveability Index

The most well-known urban liveability ranking is the Global Liveability Index, published annually by The Economist Intelligence Unit (EIU). The EIU computes the Global Liveability Index based on 30 indicators that evaluate the five broad themes: stability, access to healthcare, culture and environment, education and infrastructure.

Nevertheless, only a few of the EIU liveability indicators consider the link between urban environment and health. The six healthcare indicators refer only to the availability/quality of public and private healthcare, availability of over-the-counter drugs and other, not further specified, general healthcare indicators.

The most well-known urban liveability ranking is the Global Liveability Index, published annually by The Economist Intelligence Unit (EIU)

There are only three cultural and environment indicators relevant in the discussion of urban health (i.e. humidity/temperature rating, discomfort of climate to travellers and sporting availability) and only two relevant infrastructure indicators (i.e. quality of public transport and availability of good quality housing). Similarly, the presence of socioeconomic inequalities in cities is not discussed in the EIU's liveability definition.

In this way, the EIU’s liveability indicators do not comprehensively account for environmental quality and social justice in cities and seem to miss out on key indicators necessary to build truly liveable and healthy communities that matter to citizens.

Is a liveable city a healthy city?

In our recently published paper, we decided to further explore the relationship between urban liveability, environment, health and social justice. We chose Vienna as our case study, given that the city was ranked by the EIU as the most liveable city worldwide in 2018 and 2019, reaching top scores across all categories evaluated.

In our recently published paper, we decided to further explore the relationship between urban liveability, environment, health and social justice. We chose Vienna as our case study given that the city was ranked by the EIU as the most liveable city worldwide in 2018 and 2019

First, we gathered exposure data for five environmental and lifestyle exposures related to urban and transport planning, which included air pollution and road traffic noise levels, green space, heat and physical activity levels.

Next, we collected the relevant population and mortality data and estimated the annual premature mortality burden that could be attributed to non-compliance with international recommendations for the five studied exposures. To do so, we compared current with recommended exposure levels, retrieved the associations between exposures and mortality from the best available evidence and calculated the attributable mortality fractions.

Additionally, we evaluated how the mortality impacts varied by socioeconomic status. We built a socioeconomic index based on the population’s educational level, unemployment and income and repeated the analyses by socioeconomic group.

Source: Sasha Khomenko et al. Environmental Research. doi.org/10.1016/j.envres.2020.109238. Figure 3. Map of Vienna. Multiple environmental burdens by socioeconomic status at the sub-district level. The quintile distribution of the environmental exposures (PM2.5, NO2, noise, green space and heat) was used.

We estimated that 8% of annual premature mortality in Vienna could be attributed to non-compliance with international exposure recommendations for the five studied exposures. Both higher socioeconomic status groups that lived in the city centre and lower socioeconomic groups faced higher adverse exposure levels for the studied exposures. However, overall lower socioeconomic groups faced higher risk for mortality due to the exposures.

8% of annual premature mortality in Vienna could be attributed to non-compliance with international exposure recommendations for the five studied exposures: air pollution, road traffic noise, green space, heat and physical activity

The results indicate that a considerable percentage of premature mortality in Vienna was attributable to high air pollution and noise levels, insufficient physical activity, heat and lack of green space, and socioeconomic inequalities were present, evidencing that the current EIU’s liveability definition does not comprehensively consider the health, environmental and social justice perspectives.

Our results emphasize the mismatch between the current liveability definition and urban health, leaving room for further alignment of liveability, environmental health and social justice objectives to not only provide liveable cities but also healthy and just ones.

How should we define urban liveability?

Previous studies on urban liveability have advocated for the inclusion of indicators that consider environmental, health and justice aspects. For instance, the urban liveability definition could include more transport indicators, such as the distance to public transport or active transport mode share; walkability indicators, based on neighbourhood density, diversity and street connectivity; green infrastructure indicators, such as distance to and size of public open green spaces; environmental indicators, such as air pollution and noise levels; health indicators, such as road trauma, respiratory conditions, physical activity levels, diet or obesity; and equity indicators, such as the distribution of infrastructure, services, environmental exposures and health outcomes among neighbourhoods, helping to create cities that promote health and equity.

We encourage the liveability definition to go beyond the EIU's definition of liveability, and we call for the health and well-being, as well as the environmental and social justice perspectives to be considered more holistically

Thus, we encourage the liveability definition to go beyond the current EIU's definition, and we call for health and well-being, as well as environmental and social justice perspectives to be considered more holistically. Poor environmental quality and the associated adverse health outcomes should not be accepted as unfortunate burdens of urban life, and must be addressed through adequate policy measures that focus on the reduction of motorized traffic, promotion of active transport and greater availability of green and public space. A liveable city should also be a healthy and socially just city.