,3
,5
]. Since 1970 it
has responded to the environmental impacts of rapid
urban growth on human health and well-being [4
]. After
1995 it began to move away from empirical studies of
patterns in urban ecosystems towards understanding how
multiple physical, social and biotic components interact
to form urban ecosystems and to become highly involved
in urban planning and management [6
].
The ecology in cities interpretation examines how human
contact with specic urban green areas, such as sports
grounds or remnant woodlands, affects human health
[7
].
Some commentators on the impacts of urbanization dis-
cuss them at the national scale, but in environmental
reality, the diversity of size of nation states, from city
states and small island states like Singapore and Kiribati,
to subcontinental sized countries like Russia, China,
Brazil and India makes this somewhat inappropriate.
That is not to deny the very real role that national policies
and administrative systems play in urban development
and environmental management. For example, the uni-
ed governments of Chinese municipalities like
Chongqing [18
].
In terms of understanding the links between urban
ecology and urban ecosystems and human health, this
paper concentrates on the rst two scales, those of the
green infrastructure mosaic and the built-up areas as a
human habitat. The latter implies considering the city as
a public health realm. This involves exploring whether
cities or rural areas are healthier places in which to live. It
also examines the risks to health and well-being that
occur in the diverse built-up areas and communities
found within the great cities of the modern world. The
former involves the exploration of the role of urban
greenspaces, nature, plants and wildlife in human health
and well-being in cities.
Urban ecosystems as public health realms
Human beings, like other organisms, are inuenced by
the selective action of the urban environment. Social
structure and interactions, physiology and health,
morphology (e.g. increased obesity), and even long-term
changes in genetics of human urban residents, may be
associated with urban living [20,4
]. The diversity of
conditions within built-up areas creates many risk factors
possibly affecting human health and well-being. The risk
factors include four interrelated sets of hazards [21]:
(1) Environmental risk factors including ambient air
quality, ambient noise levels, soil and water con-
tamination, and solid waste disposal.
(2) Economic risk factors comprising the lack of afford-
able housing, food and water for poor households,
permanent unemployment and inequalities of access
to diverse kinds of resources and services including
affordable primary health care.
(3) Technological risk factors including trafc accidents,
industrial and chemical disasters, and contamination
from mass produced foods and synthetic products.
(4) Social and individual risk factors including crime,
violence and social exclusion, inadequate education
and training.
These factors apply across the scales of urban ecosystem
study (Table 1).
There are constant interactions between all the factors,
affecting both human and urban ecosystem health. Sus-
tainability requires a full awareness of both direct and
indirect human interventions affecting ecological pro-
cesses and ecosystem sates at all levels (Figure 1).
Different groups (e.g. children, ethnic communities, the
elderly and the employed) will have varying exposure to
these risks, but globally their effects are telling. In low-
income countries urban accident rates and pollution
levels are much higher than in more prosperous regions
[22
]. Of the
total 59 million deaths in 2008, crashes accounted for over
386 Human settlements and industrial systems
Current Opinion in Environmental Sustainability 2012, 4:385392 www.sciencedirect.com
Urban ecology and urban ecosystems Douglas 387
Table 1
Multi-level ecosystem risk factors and impacts affecting urban populations.
Urban ecosystem scale Ecosystem components/drivers Socio-economic factors
Patches with the urban mosaic
(neighbourhoods and households)
Urban greenspaces (parks/gardens, derelict land) Social networks, social capital, segregation,
social support, population density, security,
access to health and social services,
wealth/poverty, violence, crime
Urban infrastructure: water supply, sanitation,
waste disposal, housing, noise
Disease vector habitats
Built-up areas (municipal level) Provisioning and regulating ecosystem services,
local (urban heat island) and regional climate,
soil and water contamination
Municipal government actions
Market conditions and employment
opportunities
Technological risks, accidents
Civil society
Urban region (peri-urban and urban) Land use and land cover change, ecological impacts
of urban expansion, geophysical disasters (oods,
earthquakes, among others)
Security of local food supply, inuence of
regional and national government, land
ownership and access to land for food and
recreation
Global Climate change; inter-annual and seasonal climatic
variability, invasive species (disease vectors)
Threats to food supplies and costs, impact
of globalization, immigration and emigration;
market instability; resource competition
Figure 1
Human Health and
Well-being
Urban Design
Planning and
Management
Urban Ecosystem
Health
Industrial
processes and
releases to the
environment
Urban ecosystem
services and urban
quality of life
Ecological Processes
Urban
growth
Health
risks
Political, corporate and
socio-economic-strategies
Current Opinion in Environmental Sustainability
Simple diagram of key factors in the relationship between urban ecology and human health and well-being.
www.sciencedirect.com Current Opinion in Environmental Sustainability 2012, 4:385392
1.4 million (2%). This is more than tuberculosis and
almost 50% more than malaria, and over 60% of the
deaths by HIV/AIDS. The burden of road trafc injuries
on vulnerable road users differs substantially across
income levels. Some 228,000 pedestrians die in low-
income countries, as opposed to 162,000 in middle-
income countries and 23,000 in high-income countries
each year [24
]. While
social isolation and little mobility are key risk factors
during heat waves, no access to an air-conditioned
environment, living in homes that retain heat or on the
upper oors of high rise buildings are also important
factors. Elderly people in hospital and residential homes
are at increased risk because of their frailty and therefore
need particular attention from carers [29
].
Health benets of the urban green
infrastructure: patch scale urban ecosystems
Urban green infrastructure comprises managed and
natural green areas such as remnant woodlands; gardens;
formal parks; green corridors such as bridleways, railway
and road verges and cycle paths; golf courses; sports
grounds; street trees; green roofs; waterways and lakes
with surrounding vegetation; and derelict land with inva-
sive plants, both privately and publicly owned. Since 2000
much has been done by local and regional governments to
map the green infrastructure of their areas and consider its
roles in adaptation to climate and delivering ecosystem
services including health benets [30
,31
].
In 2005 evidence [32] suggested that living in areas with
walkable green spaces, as opposed to living in areas
without walkable green spaces, was associated with
greater likelihood of physical activity [33], higher func-
tional status, lower cardiovascular disease risk [34], and
longevity among the elderly, independent of personal
characteristics [35]. More multidisciplinary work on urban
health since then has begun to clarify the role of green
space and urban planning in promoting health. The
scientic evidence broadly conrms that there are
positive benets to be gained from both active and
passive involvement with natural areas in towns and cities
[36
].
Living in environments with vegetation and greenspace
may reduce incivilities, aggression and violence [37
],
gun assaults, vandalism and criminal mischief being low-
ered after urban greening in Philadelphia [38].
Compared with exercising indoors, exercising in natural
environments is associated with greater feelings of revi-
talization and positive engagement, decreases in tension,
confusion, anger, and depression, and increased energy
[39
].
Green patches in urban areas have multiple values, being
multifunctional greenspaces providing a range of ecosys-
tems services. People may see them as having a specic
purpose, such as a sensory garden or a golf course, but
they all provide, to varying degrees, such ecosystem
services as biodiversity, local climate modication, and
388 Human settlements and industrial systems
Current Opinion in Environmental Sustainability 2012, 4:385392 www.sciencedirect.com
sustainable drainage. This multifunctionality turns such
parks and other open spaces into hubs of community
activity [40
].
Many governments are actively promoting urban green
infrastructure, emphasising its health benets [42,43,44
].
Nevertheless, despite the apparent benets, there is great
variability in the use of urban greenspaces by individuals.
Some depends on the character of the open space. For
some people shrubbery or woodland is unsafe and unat-
tractive, for other it is a place of adventure to explore [36].
Social connections are important for gaining health
benets, especially having friends who encourage exer-
cise, and having at least one friend with whom to explore
greenspaces [45]. Neighbourhood characteristics, in-
cluding the presence of footpaths (sidewalks), enjoyable
scenery, hills, and water spaces may be positively associ-
ated with physical activity [46
].
Negative impacts on mental and physical health can be
associated with urban nature, especially in informal
settlements (slums) in low income megacities. In slums
in Dhaka, Bangladesh, the few green areas are low-lying
and regularly ooded. Combined with poor sanitation,
open waste water drainage and garbage disposal, such
vegetation patches increase the risk for infectious dis-
eases (e.g. diarrhoea) [47]. In this instance urban nature
provides environmental disservices [48
,52
]. However,
many poor urban farmers use sewage wastes to fertilizer
their crops. From Zimbabwe, Ghana and Kenya to the
Philippines and Vietnam [53
,54
,55
] examples of
severe health risks are well-documented. Use of urban
greenspace has its risks.
Attitudes and responses to urban nature and greenspaces
vary. Seeing nature through a window can have great
benets for human health and well-being, but not for
every one. Positive benets from being able the see trees
and green landscapes have been found in studies of
prisoners and hospital patients [56
]. A negligible interest in or
afnity for nature among young Singaporeans was also
attributed to growing up in a dense high-rise urban
environment, but also to over-protective parents and
an abundance of other recreational and entertainment
options [59]. It would be dangerous to assume that all
Hong Kong or Singapore residents share these attitudes,
just as in Philadelphia, it is likely that cultural or social
norms related to residents experience with greenspace
nature will differ according to the location within the city,
family circumstances and social and economic opportu-
nities. Natures potential for providing a more satisfying
existence may be less apparent among the poor and urban
than the rich and rural [60
]. In
view of the urgency of improving the health of slum
populations, curtailing malaria, cholera, HIV-Aids, and
related disease risks and improving human well-being,
that research will have to be accelerated. The simple task
of reducing trafc accidents still seems to be beyond
society in nearly all countries. The slightly more proble-
matic issue of avoiding chemical contamination of our
environment could be dealt with if monitoring of emis-
sions and dumping was improved; if law enforcement was
more effective; if both individual operatives and man-
agers took greater care; and if corporations exercised
greater moral responsibility for the impacts of their oper-
ations on their neighbours and on the human environ-
ment more generally. The health risks associated the
ever-increasing array of chemical compounds being
invented and inadvertently released in to the urban
environment will remain difcult until detection methods
and monitoring systems are able to keep pace with that
inventiveness and commercial production. While many
health risks associated with industrial systems have been
greatly reduced, for many people and many cities, the old
problems linger on and new ones arrive apace. This
situation will continue to handicap our efforts to make
both cities more sustainable and urban living tolerable for
all, rather than just for the wealthier minority of the
worlds urban population.
References and recommended reading
Papers of particular interest, published within the period of review,
have been highlighted as:
of special interest
of outstanding interest
1.
Pickett STA, Burch WR, Dalton SE, Foresman TW, Grover JM,
Rowntree R: A conceptual framework for the study of human
ecosystems in urban areas. Urban Ecosyst 1997, 1:185-199.
One of the key papers of modern urban ecology.
16. Douglas I: The analysis of cities as ecosystems. In Routledge
Handbook of Urban Ecology. Edited by Douglas I, Goode D, Houck
M, Wang R. London: Routledge; 2011:17-25.
17.
Gill SE, Handley JF, Ennos AR, Pauleit S: Adapting cities for
climate change: the role of the green infrastructure. Built
Environ 2007, 33:115-133.
Signicant for the analysis of the green infrastructure and assessment of
the way it modies the urban climate.
32. Galea S, Vlahov D: Urban health; evidence, challenges, and
directions. Annu Rev Public Health 2005, 26:341-365.
33. Booth ML, Owen N, Bauman A, Clavisi O, Leslie E: Social-
cognitive and perceived environment inuences associated
with physical activity in older Australians. Prev Med 2000,
31:15-22.
34. Latkin CA, Curry AD: Stressful neighborhoods and depression:
a prospective study of the impact of neighborhood disorder.
J Health Soc Behav 2003, 4:34-44.
35. Takano T, Nakamura K, Watanabe M: Urban residential
environments and senior citizens longevity in megacity areas:
the importance of walkable greenspaces. J Epidemiol
Community Health 2002, 56:913-918.
36.