City Know-hows

Heart-healthy neighbourhoods: An urban obesity index for planning and design

This is a photo of an urban green space in the city of Madrid, Spain. These spaces are vital components for promoting and protecting the physical and mental well-being of citizens. They have an impact in many dimensions: thermal comfort, clean air, carbon capture, restorative affect. Cities, with their constant activity and sensory overload, can cause stress. Green spaces are key to improving cardiovascular health. Source: Ester Higueras, 2024

Living in modern cities can increase cardiovascular disease risk. This study analyzes the association between urban design and obesity, proposing a simplified index to assess how the built environment impacts heart health. Our “Urban-Obesity-Index” helps local authorities and planners design healthier neighbourhoods.

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Target audience

  • Urban health actors: Academics, researchers, and professionals working at the intersection of health and the urban environment, seeking to understand and improve cardiovascular health in cities.
  • Local authorities: Mayors, councillors, and municipal government officials with responsibilities in urban planning, public health, the environment, and sustainable development.

The problem

Rapid urbanization, especially in developing countries, challenges public health by creating environments that hinder healthy lifestyles. These urban environments, often lacking green spaces and access to fresh food, while facing high pollution and insecurity, contribute to increased obesity and cardiovascular diseases. This complex problem, involving multiple factors, makes evaluating and designing effective interventions difficult. Understanding how these factors contribute to obesity is crucial for planning cities that promote cardiovascular health.

What we did and why

Based on a comprehensive review that analyzed 63 documents with data from 56 countries and 102 cities. A total of 145 indicators were identified and classified to optimize their use and adaptability, with a holistic view to address the problem. This allowed the definition of 23 key characteristics of the built environment that form a practical and simplified “Urban Obesity Index” for planners and local authorities to assess neighbourhoods and identify priority areas for intervention.

Our study’s contribution

For understanding the association between the urban environment and cardiovascular health:
• We developed the “Urban Obesity Index,” a practical tool for assessing how the built environment influences cardiovascular health.
• This index incorporates health determinants and planning strategies to provide a holistic view.
• We emphasize the neighbourhood scale to identify priority intervention areas.
This allows local authorities to integrate cardiovascular health into urban planning and contribute to achieving the goals of SDGs 3 and 11.

Impacts for city policy and practice

The “Urban Obesity Index” provides a practical tool for authorities and planners to:
• assess cardiovascular risk associated with the built environment; integrate cardiovascular health into urban planning; design heart-healthy neighborhoods that promote active lifestyles and access to healthy food;
• promote equity by identifying and addressing inequalities, helping to target interventions to the most vulnerable areas and populations;
• encourage citizen participation in creating healthier cities, raising awareness of the problems and fostering community involvement; and,
• monitor progress to improve interventions, establishing evidence-based criteria for more effective actions and allowing for adjustments and improvements in intervention strategies.
The index is a tool for local decision-making, policy implementation, indicator monitoring, and the inclusion of cardiovascular health in urban planning.

Further information

Full research article:

The weight of place: a relational framework for urban obesity and heart health in diverse contexts by Manuel Antonio Medrano-Blanco, Emilia Román López, Jose Alí Porras-Salazar and Ester Higueras García

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