Health and the City, Literature Review 2020-2023
Two major projects led by Sustainable Calgary — The Playbook for Healthy Communities and the Neighbourhood Streets Pilot Policy Evaluation Kit — reviewed research published between 2000 and 2020 on how city design affects health. To build on that foundation, we conducted a new review of research published from 2020 to 2023.
Recent global research shows that the way cities are built has a powerful influence on people’s health. Much of the literature looks at how common features of city life — density, traffic, access to nature, air quality, noise, and heat — affect both individual health and entire populations. The studies include large, long-term investigations that track how exposure to healthy or unhealthy environments influences people at all stages of life, from before birth through old age.
Researchers have linked urban environments to a wide range of physical health issues, including sleep problems, heart and lung disease, kidney disease, bowel diseases, and cognitive decline. Mental health is also a major focus, with studies connecting city design to anxiety, depression, stress, and even creativity.
A significant portion of the research deals with environmental racism. These studies show clear patterns: racialized and lower-income communities are more likely to be exposed to pollution, noise, and dangerous transportation conditions, and less likely to have access to parks, transit, and clean air. This unequal distribution of risk and protection contributes directly to health disparities.
Canada plays a leading role in studying social determinants of health, which examine how socioeconomic conditions shape health outcomes. Canadian researchers also contribute strongly to discussions about building “healthy cities” in the era of climate change and biodiversity loss.
Most of the research in this field is correlational — showing strong relationships between city conditions and health outcomes — but some studies do demonstrate cause-and-effect relationships. Researchers use a wide range of methods, including epidemiological studies, modelling, GIS mapping, qualitative interviews, and systematic reviews that synthesize dozens of studies at once.
Although cities in Canada are not responsible for running hospitals or the healthcare system, they play a critical role in preventing disease. Since the 1974 Lalonde Report, prevention has been recognized as the most cost-effective way to improve health and reduce suffering. Yet health systems still focus mostly on treatment. Cities, however, have control over many of the factors that shape prevention: housing, transportation, urban design, parks, air quality, and access to daily needs.
When cities are designed well, they reduce the conditions that lead to illness — and lower the economic and social costs associated with poor health. When they are designed poorly, they contribute to avoidable disease, injury, and early death.
Key Findings
• Exposure to polluted air, noise, extreme heat, car-dependent sprawl, and lack of nature increases illness and early death across all life stages, including before birth.
• These risks decrease when cities add more green space, reduce car dependence, and build compact, mixed-use, and socio-economically diverse neighbourhoods.
• Marginalized communities face higher exposure to harmful environments and reduced access to health-promoting spaces and infrastructure.
• Cars significantly harm health through pollution, noise, collisions, and the spread of low-density development.
• When healthy city design is applied equitably, it improves health for everyone — and has the largest impact for those who currently face the greatest environmental burdens.