Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Influence of urban and transport planning and the city environment on cardiovascular disease

Abstract

This Review describes the relationship between urban and transport planning and the city environment, the main cardiovascular risk factors (including physical activity, hypertension, and obesity), and cardiovascular disease and mortality. Good evidence exists for a relationship between built environment measures (such as mixed land use, connectivity and walkability, and physical activity), environmental exposures (such as green space, air pollution, and noise), and cardiovascular disease and mortality. Some good evidence exists for a link between transport mode and cardiovascular disease, but evidence is inconsistent for an association between built environment measures and weight status, and between green space and either weight status or physical activity. Further research is needed into the influence of built environment measures on cardiovascular disease and mortality. Urban and transport planning has an important effect on cardiovascular health and its risk factors. Cardiovascular disease and mortality could be reduced by better urban and transport planning that promotes physical activity; reduces levels of air pollution, noise, and heat island effects; and increases green space.

Key points

  • Urban and transport planning affects cardiovascular health and its risk factors, including hypertension, physical activity, and obesity.

  • Good evidence exists for a relationship between built environment measures (mixed land use, connectivity and walkability, and physical activity), environmental exposures (green space, air pollution, and noise), and cardiovascular disease and mortality.

  • Cardiovascular disease and mortality could be reduced by improved urban and transport planning that promotes physical activity; reduces levels of air pollution, noise, and heat island effects; and increases green space.

  • A move away from car-centric sprawling cities towards more compact, less car-dependent cities, and greener cities with mixed land use, more public and active transport, and greener infrastructure is needed.

  • Health impact assessment tools have become available to estimate the health effects of healthy urban and transport planning and should be used to promote further healthy development.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

Fig. 1: A simplified framework of urban and transport planning, environment, and cardiovascular disease and mortality.

References

  1. 1.

    United Nations. World urbanization prospects. UN Economic and Social Affairs 2014 revision. http://esa.un.org/unpd/wup/Highlights/WUP2014-Highlights.pdf (2014).

  2. 2.

    Bettencourt, L. M., Lobo, J., Helbing, D., Kühnert, C. & West, G. B. Growth, innovation, scaling, and the pace of life in cities. Proc. Natl Acad. Sci. USA 104, 7301–7306 (2007).

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  3. 3.

    Nieuwenhuijsen, M. J. Urban and transport planning, environmental exposures and health-new concepts, methods and tools to improve health in cities. Environ. Health 15, S38 (2016).

    Article  Google Scholar 

  4. 4.

    GBD 2016 Causes of Death Collaborators. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 390, 1151–1210 (2017).

    Article  Google Scholar 

  5. 5.

    Nichols, M., Townsend, N., Scarborough, P. & Rayner, M. Cardiovascular disease in Europe 2014: epidemiological update. Eur. Heart J. 35, 2929–2939 (2014).

    Article  PubMed  CAS  Google Scholar 

  6. 6.

    Chokshi, D. A. & Farley, T. A. The cost-effectiveness of environmental approaches to disease prevention. N. Engl. J. Med. 367, 295–297 (2012).

    Article  PubMed  CAS  Google Scholar 

  7. 7.

    Ewing, R. & Cervero, R. Travel and the built environment: a meta-analysis. J. Am. Plann. Assoc. 76, 265–294 (2010).

    Article  Google Scholar 

  8. 8.

    Grasser, G., Van Dyck, D., Titze, S. & Stronegger, W. Objectively measured walkability and active transport and weight-related outcomes in adults: a systematic review. Int. J. Publ. Health 58, 615–625 (2013).

    Article  Google Scholar 

  9. 9.

    Wang, Y., Chau, C. K., Ng, W. Y. & Leung, T. M. A review on the effects of physical built environment attributes on enhancing walking and cycling activity levels within residential neighborhoods. Cities 50, 1–15 (2016).

    Article  CAS  Google Scholar 

  10. 10.

    Ewing, R. & Cerverom, R. “Does compact development make people drive less?” The answer is yes. J. Am. Plann. Assoc. 83, 19–25 (2017).

    Article  Google Scholar 

  11. 11.

    Malambo, P., Kengne, A. P., De Villiers, A., Lambert, E. V. & Puoane, T. Built environment, selected risk factors and major cardiovascular disease outcomes: a systematic review. PLoS ONE 11, e0166846 (2016).

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  12. 12.

    Mayne, S. L., Auchincloss, A. H. & Michael, Y. L. Impact of policy and built environment changes on obesity-related outcomes: a systematic review of naturally occurring experiments. Obes. Rev. 16, 362–375 (2015).

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  13. 13.

    Sallis, J. F. et al. Physical activity in relation to urban environments in 14 cities worldwide: a cross-sectional study. Lancet 387, 2207–2217 (2016).

    Article  PubMed  Google Scholar 

  14. 14.

    Hirsch, J. A. et al. Changes in the built environment and changes in the amount of walking over time: longitudinal results from the Multi-Ethnic Study of Atherosclerosis. Am. J. Epidemiol. 180, 799–809 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

  15. 15.

    Mackenbach, J. D. et al. Obesogenic environments: a systematic review of the association between the physical environment and adult weight status, the SPOTLIGHT project. BMC Public Health 14, 233 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

  16. 16.

    Chiu, M. et al. Moving to a highly walkable neighborhood and incidence of hypertension: a propensity-score matched cohort study. Environ. Health Perspect. 124, 754–760 (2016).

    PubMed  CAS  Article  Google Scholar 

  17. 17.

    Müller-Riemenschneider, F. et al. Neighborhood walkability and cardiometabolic risk factors in Australian adults: an observational study. BMC Public Health 13, 755 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  18. 18.

    Li, F., Harmer, P., Cardinal, B. J. & Vongjaturapat, N. Built environment and changes in blood pressure in middle aged and older adults. Prev. Med. 48, 237–241 (2009).

    Article  PubMed  PubMed Central  Google Scholar 

  19. 19.

    Griffin, B. A. et al. The relationship between urban sprawl and coronary heart disease in women. Health Place 20, 51–61 (2013).

    Article  PubMed  Google Scholar 

  20. 20.

    Stevenson, M. et al. Land use, transport, and population health: estimating the health benefits of compact cities. Lancet 388, 2925–2935 (2016).

    Article  PubMed  PubMed Central  Google Scholar 

  21. 21.

    Mueller, N. et al. Health impacts related to urban and transport planning: a burden of disease assessment. Environ. Int. 107, 243–257 (2017).

    Article  PubMed  Google Scholar 

  22. 22.

    Audrey, S., Procter, S. & Cooper, A. R. The contribution of walking to work to adult physical activity levels: a cross sectional study. Int. J. Behav. Nutr. Phys. Act. 11, 37 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

  23. 23.

    Saelens, B. E., Vernez Moudon, A., Kang, B., Hurvitz, P. M. & Zhou, C. Relation between higher physical activity and public transit use. Am. J. Public Health 104, 854–859 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

  24. 24.

    Donaire-Gonzalez, D. et al. The added benefit of bicycle commuting on the regular amount of physical activity performed. Am. J. Prev. Med. 49, 842–849 (2015).

    Article  PubMed  Google Scholar 

  25. 25.

    Wanner, M., Götschi, T., Martin-Diener, E., Kahlmeier, S. & Martin, B. W. Active transport, physical activity, and body weight in adults: a systematic review. Am. J. Prev. Med. 42, 493–502 (2012).

    Article  PubMed  Google Scholar 

  26. 26.

    Laverty, A. A., Mindell, J. S., Webb, E. A. & Millett, C. Active travel to work and cardiovascular risk factors in the United Kingdom. Am. J. Prev. Med. 45, 282–288 (2013).

    Article  PubMed  Google Scholar 

  27. 27.

    Flint, E., Cummins, S. & Sacker, A. Associations between active commuting, body fat, and body mass index: population based, cross sectional study in the United Kingdom. BMJ 349, g4887 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

  28. 28.

    Sugiyama, T., Ding, D. & Owen, N. Commuting by car: weight gain among physically active adults. Am. J. Prev. Med. 44, 169–173 (2013).

    Article  PubMed  Google Scholar 

  29. 29.

    Martin, A., Panter, J., Suhrcke, M. & Ogilvie, D. Impact of changes in mode of travel to work on changes in body mass index: evidence from the British household panel survey. J. Epidemiol. Community Health 69, 753–761 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  30. 30.

    Flint, E., Webb, E. & Cummins, S. Change in commute mode and body-mass index: prospective, longitudinal evidence from UK Biobank. Lancet Public Health 1, e46–e55 (2016).

    Article  PubMed  PubMed Central  Google Scholar 

  31. 31.

    Grøntved, A. et al. Bicycling to work and primordial prevention of cardiovascular risk: a cohort study among Swedish men and women. J. Am. Heart Assoc. 5, e004413 (2016).

    Article  PubMed  PubMed Central  Google Scholar 

  32. 32.

    Murtagh, E. M. et al. The effect of walking on risk factors for cardiovascular disease: an updated systematic review and meta-analysis of randomised control trials. Prev. Med. 72, 34–43 (2015).

    Article  PubMed  Google Scholar 

  33. 33.

    Hamer, M. & Chida, Y. Active commuting and cardiovascular risk: a meta-analytic review. Prev. Med. 46, 9–13 (2008).

    Article  PubMed  Google Scholar 

  34. 34.

    Celis-Morales, C. A. et al. Association between active commuting and incident cardiovascular disease, cancer, and mortality: prospective cohort study. BMJ 357, j1456 (2017).

    Article  PubMed  Google Scholar 

  35. 35.

    Lachowycz, K. & Jones, A. P. Greenspace and obesity: a systematic review of the evidence. Obes. Rev. 12, e183–e189 (2011).

    Article  PubMed  CAS  Google Scholar 

  36. 36.

    Nieuwenhuijsen, M. J., Khreis, H., Triguero-Mas, M., Gascon, M. & Dadvand, P. Fifty shades of green: pathway to healthy urban living. Epidemiology 28, 63–71 (2017).

    Article  PubMed  Google Scholar 

  37. 37.

    Bancroft, C. et al. Association of proximity and density of parks and objectively measured physical activity in the United States: a systematic review. Soc. Sci. Med. 138, 22–30 (2015).

    Article  PubMed  Google Scholar 

  38. 38.

    Triguero-Mas, M. et al. Living close to natural outdoor environments in four European cities: adults’ contact with the environments and physical activity. Int. J. Environ. Res. Public Health 14, E1162 (2014).

    Article  Google Scholar 

  39. 39.

    Astell-Burt, T., Feng, X. & Kolt, G. S. Green space is associated with walking and moderate-to-vigorous physical activity (MVPA) in middle-to-older-aged adults: findings from 203 883 Australians in the 45 and Up Study. Br. J. Sports Med. 48, 404–406 (2014).

    Article  PubMed  Google Scholar 

  40. 40.

    Grazuleviciene, R. et al. The influence of proximity to city parks on blood pressure in early pregnancy. Int. J. Environ. Res. Public Health 11, 2958–2972 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

  41. 41.

    Liang, R. et al. Effect of exposure to PM2.5 on blood pressure: a systematic review and meta-analysis. J. Hypertens. 32, 2130–2141 (2014).

    Article  PubMed  CAS  Google Scholar 

  42. 42.

    Olsson, D., Mogren, I. & Forsberg, B. Air pollution exposure in early pregnancy and adverse pregnancy outcomes: a register-based cohort study. BMJ Open 5, e001955 (2013).

    Article  Google Scholar 

  43. 43.

    Jerrett, M. et al. Traffic-related air pollution and obesity formation in children: a longitudinal, multilevel analysis. Environ. Health 13, 49 (2014).

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  44. 44.

    McConnell, R. et al. A longitudinal cohort study of body mass index and childhood exposure to secondhand tobacco smoke and air pollution: the Southern California Children’s Health Study. Environ. Health Perspect. 123, 360 (2015).

    PubMed  Article  Google Scholar 

  45. 45.

    Van Kempen, E. & Babisch, W. The quantitative relationship between road traffic noise and hypertension: a meta-analysis. J. Hypertens. 30, 1075–1086 (2012).

    Article  PubMed  CAS  Google Scholar 

  46. 46.

    Pyko, A. et al. Exposure to traffic noise and markers of obesity. Occup. Environ. Med. 72, 594–601 (2015).

    Article  PubMed  Google Scholar 

  47. 47.

    Christensen, J. S. et al. Long-term exposure to residential traffic noise and changes in body weight and waist circumference: a cohort study. Environ. Res. 143, 154–161 (2015).

    Article  PubMed  CAS  Google Scholar 

  48. 48.

    Madaniyazi, L. et al. Outdoor temperature, heart rate and blood pressure in Chinese adults: effect modification by individual characteristics. Sci. Rep. 6, 21003 (2016).

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  49. 49.

    Wang, S. et al. Outdoor temperature and temperature maintenance associated with blood pressure in 438,811 Chinese adults. Blood Press. 26, 246–254 (2017).

    Article  PubMed  Google Scholar 

  50. 50.

    Yang, H. K. et al. Ambient temperature and prevalence of obesity: a nationwide population-based study in Korea. PLoS ONE 10, e0141724 (2015).

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  51. 51.

    Pereira, G. et al. The association between neighborhood greenness and cardiovascular disease: an observational study. BMC Public Health 12, 466 (2012).

    Article  PubMed  PubMed Central  Google Scholar 

  52. 52.

    Valdés, S. et al. Ambient temperature and prevalence of obesity in the Spanish population: the Di@bet.es Study. Obesity 22, 2328–2332 (2014).

    Article  PubMed  Google Scholar 

  53. 53.

    Tamosiunas, A. et al. Accessibility and use of urban green spaces, and cardiovascular health: findings from a Kaunas cohort study. Environ. Health 13, 20 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

  54. 54.

    Gascon, M. et al. Green space and mortality: a systematic review and meta-analysis. Environ. Int. 2, 60–67 (2016).

    Article  Google Scholar 

  55. 55.

    Donovan, G. H. et al. The relationship between trees and human health: evidence from the spread of the emerald ash borer. Am. J. Prev. Med. 44, 139–145 (2013).

    Article  PubMed  Google Scholar 

  56. 56.

    Forouzanfar, M. H. et al. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013: a systematic analysis for the global burden of disease study 2013. Lancet 386, 2287–2323 (2015).

    Article  PubMed  Google Scholar 

  57. 57.

    Cohen, A. et al. Estimates and 25-year trends of the global burden of disease attributable to ambient air pollution: an analysis of data from the Global Burden of Diseases. Lancet 389, 1907–1918 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  58. 58.

    Shah, A. S. et al. Global association of air pollution and heart failure: a systematic review and meta-analysis. Lancet 382, 1039–1048 (2013).

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  59. 59.

    Bhaskaran, K. et al. The effects of air pollution on the incidence of myocardial infarction–a systematic review. Heart 95, 1746–1759 (2009).

    Article  PubMed  CAS  Google Scholar 

  60. 60.

    Cesaroni, G. et al. Long term exposure to ambient air pollution and incidence of acute coronary events: prospective cohort study and meta-analysis in 11 European cohorts from the ESCAPE Project. BMJ 348, f7412 (2014).

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  61. 61.

    Brook, R. D. et al. Particulate matter air pollution and cardiovascular disease an update to the scientific statement from the American Heart Association. Circulation 121, 2331–2378 (2010).

    Article  PubMed  CAS  Google Scholar 

  62. 62.

    Héroux, M. E. et al. Quantifying the health impacts of ambient air pollutants: recommendations of a WHO/Europe project. Int. J. Public Health 60, 619–627 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  63. 63.

    Hoek, G. et al. Long term air pollution exposure and cardio-respiratory mortality: a review. Environ. Health 12, 43 (2013).

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  64. 64.

    Dominici, F. et al. Fine particulate air pollution and hospital admission for cardiovascular and respiratory diseases. JAMA 295, 1127–1134 (2006).

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  65. 65.

    Basner, M. et al. Auditory and non-auditory effects of noise on health. Lancet 383, 1325–1332 (2014).

    Article  PubMed  Google Scholar 

  66. 66.

    Halonen, J. I. et al. Road traffic noise is associated with increased cardiovascular morbidity and mortality and all-cause mortality in London. Eur. Heart J. 36, 2653–2661 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  67. 67.

    Ndrepepa, A. & Twardella, D. Relationship between noise annoyance from road traffic noise and cardiovascular diseases: a meta-analysis. Noise Health 13, 251 (2011).

    Article  PubMed  Google Scholar 

  68. 68.

    Babisch, W. et al. Associations between traffic noise, particulate air pollution, hypertension, and isolated systolic hypertension in adults: the KORA study. Environ. Health Perspect. 122, 492 (2014).

    PubMed  PubMed Central  Article  Google Scholar 

  69. 69.

    Münzel, T., Gori, T., Babisch, W. & Basner, M. Cardiovascular effects of environmental noise exposure. Eur. Heart J. 35, 829–836 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

  70. 70.

    Turner, L. R., Barnett, A. G., Connell, D. & Tong, S. Ambient temperature and cardiorespiratory morbidity: a systematic review and meta-analysis. Epidemiology 23, 594–606 (2012).

    Article  PubMed  Google Scholar 

  71. 71.

    Ye, X. et al. Ambient temperature and morbidity: a review of epidemiological evidence. Environ. Health Perspect. 120, 19–28 (2012).

    Article  PubMed  Google Scholar 

  72. 72.

    Cheng, J. et al. Impact of diurnal temperature range on human health: a systematic review. Int. J. Biometeorol. 58, 2011–2024 (2014).

    Article  PubMed  Google Scholar 

  73. 73.

    Laaidi, K. et al. The impact of heat islands on mortality in Paris during the August 2003 heat wave. Environ. Health Perspect. 120, 254 (2012).

    Article  PubMed  Google Scholar 

  74. 74.

    Mueller, N. et al. Urban and transport planning related exposures and mortality: a health impact assessment for cities. Environ. Health Perspect. 125, 89 (2017).

    PubMed  Article  Google Scholar 

  75. 75.

    Nieuwenhuijsen, M. J. & Khreis, H. Car free cities: pathway to healthy urban living. Environ. Int. 94, 251–262 (2016).

    Article  PubMed  CAS  Google Scholar 

  76. 76.

    Khreis, H. et al. The health impacts of traffic-related exposures in urban areas: understanding real effects, underlying driving forces and co-producing future directions. J. Transp. Health 3, 249–267 (2016).

    Article  Google Scholar 

  77. 77.

    Khreis, H., van Nunen, E., Mueller, N., Zandieh, R. & Nieuwenhuijsen, M. J. How to create healthy environments in cities. Epidemiology 28, 60–62 (2017).

    Article  PubMed  Google Scholar 

  78. 78.

    Scheepers, C. E. et al. Shifting from car to active transport: a systematic review of the effectiveness of interventions. Transport Research Part A 70, 264–280 (2014).

    Google Scholar 

  79. 79.

    Heinen, E., Panter, J., Mackett, R. & Ogilvie, D. Changes in mode of travel to work: a natural experimental study of new transport infrastructure. Int. J. Behav. Nutr. Phys. Act. 12, 81 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  80. 80.

    Giles-Corti, B. et al. City planning and population health: a global challenge. Lancet 388, 2912–2924 (2016).

    Article  PubMed  Google Scholar 

  81. 81.

    Mueller, N. et al. Health impact assessment of active transportation: a systematic review. Prev. Med. 76, 103–114 (2015).

    Article  PubMed  Google Scholar 

  82. 82.

    Nieuwenhuijsen, M. J. et al. Participatory quantitative health impact assessment of urban and transport planning in cities: a review and research needs. Environ. Int. 103, 61–72 (2017).

    Article  PubMed  Google Scholar 

Download references

Review criteria

PubMed, Web of Science, Science Direct, and reference lists from relevant articles were searched for English language articles published between 1 January 1980 and 1 December 2017, using the search terms “city” and “urban” in combination with “air pollution”, “noise”, “temperature”, “green space”, “heat island”, “built environment”, “mixed land use”, “walkability”, “density”, “connectivity”, “physical activity”, “obesity”, “overweight”, “cardiovascular mortality”, “cardiovascular disease”, “hypertension”, and “blood pressure”. I focused on systematic reviews, meta-analyses, and articles published in the past 5 years; however, I used older articles if they represented seminal research or were necessary to understand more recent findings. I gave priority to systematic reviews and meta-analyses in the reporting because they provide overall summaries of the current state of work.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Mark J. Nieuwenhuijsen.

Ethics declarations

Competing interests

The author declares no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Nieuwenhuijsen, M.J. Influence of urban and transport planning and the city environment on cardiovascular disease. Nat Rev Cardiol 15, 432–438 (2018). https://doi.org/10.1038/s41569-018-0003-2

Download citation

Further reading

Search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing