Environmental determinants of population health in urban settings. A systematic review

Abstract

Background: Population health is influenced by interactions between environmental determinants, which are captured by dimensions and indicators. This study aims to systematically review key environmental determinants and respective dimensions and indicators, relevant to evaluate population health in urban settings, and to understand their potential implications into policies.

Methods: A search of literature published between 2008 and 2018 was conducted in PubMed, Web of Science, Scopus and SciELO Portugal databases, on studies with evidence on association between an environmental determinant and a health outcome in urban contexts. Health determinants, dimensions and indicators researched in the selected studies were synthetized, and associations analyzed. An independent assessment of quality of the studies was performed. Key conclusions and policy recommendations were extracted to build a framework to analyze environment related population health and policies in urban settings.

Results: Ninety four studies of varied methodological approaches and quality met the inclusion criteria. The review identified positive associations between all environmental determinants -socioeconomic, built environment, natural environment, healthcare, behaviors, and health outcomes - overall mortality and morbidity, in urban settings. Improvements in income, education, air quality, occupation status, mobility and smoking habits indicators have positive impact in overall mortality and chronic diseases morbidity indicators. Initiatives to improve population health in which policymakers can be more evidence-informed include socioeconomic, natural environment and built environment determinants.

Conclusions: There is scope and need to further explore which environmental determinants and dimensions most contribute to population health to create a series of robust evidence-based measures to better inform urban planning policies.

Keywords: Environmental determinants; Population health; Systematic review; Urban settings.

Fig. 1

Illustrative representation of environmental determinants to evaluate population health in urban settings, adapted from [–30]. The common dimensions were organize within the considered determinants with differences in: i) education and racial segregation are included in socioeconomic determinants; ii) physical environment is named natural environment, and the dimensions divided in air quality, water quality, noise and soil instead of natural resources; iii) built environment included green spaces and iv) behaviors included physical activity

Fig. 2

PRISMA flow chart with literature search

Fig. 3

Sankey diagram of studies exploring relationships between environmental determinants and health outcomes (N = 94 studies)

Fig. 4

Summary of environmental determinants and dimension based upon the review, deemed as relevant for urban contexts, and synthesis of preventive recommendations to promote population health in urban contexts