More and more people are living in cities, scientists predict that noncommunicable diseases will account for 77% of the global burden of disease by 2030, and now research from the University Medical Center in Mainz, Germany, shows that urbanization exacerbates the risks of such diseases.

The Mainz study synthesizes the existing evidence on the impact of several urban environmental risks. These include air pollution (more than half of the global deaths from air pollution are due to cardiovascular disease); transportation noise (which contributes to the risk of metabolic disease by raising stress hormone levels, heart rate, and blood pressure); and light pollution at night (associated with changes to the circadian rhythm, which is linked to conditions including obesity and heart disease).

As more people realize that humans and our cities are enmeshed with nature, and thus our health, reasons for differently designed cities are multiplying.

Research has shown, for instance, that 20% of all deaths could be prevented if cities were designed to meet the recommendations for physical activity, air pollution, noise, heat, and green space.

The Mainz authors have identified four models of cities that they consider healthy: the compact city, the superblock city (Barcelona), the 15-minute city (Paris), and of course the car-free city model (Vauban neighbourhood of Freiburg in Germany).

All four models are designed to promote active transportation and to minimize car use. This in turn reduces air pollution, noise, and heat and increases physical activity, which improves heart health.

But not all cities have the structure, leadership, or budgets to transition so sharply, so ideas like designing cities by shifting time can help.

Cities, how we live and them, and how they affect health, are complex systems, so the authors also looked at the exposome approach.

[The approach considers] things like air pollution, green space, and housing are obviously all interconnected. Thinking about them as contributing in different, interlinked ways to our urban exposures can help to understand how, together, they cause ill health, and how socioeconomic status influences the extent of their impact.

As the linked article mentions, the study is very western-centric and thus ignores both models in place elsewhere, and perhaps solutions or useful insights which could be found in those same places. Still, a good read and multiple links throughout, so readers can dig deeper.