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Green cities and health: a question of scale?
  1. Elizabeth A Richardson1,
  2. Richard Mitchell2,
  3. Terry Hartig3,
  4. Sjerp de Vries4,
  5. Thomas Astell-Burt5,
  6. Howard Frumkin6
  1. 1Institute of Geography, School of GeoSciences, University of Edinburgh, Edinburgh, UK
  2. 2Public Health and Health Policy Section, University of Glasgow, Glasgow, UK
  3. 3Institute for Housing and Urban Research, Uppsala University, Uppsala, Sweden
  4. 4Landscape Centre, Alterra, Wageningen University and Research Centre, Wageningen, The Netherlands
  5. 5Social and Public Health Sciences Unit, Medical Research Council, Glasgow, UK
  6. 6School of Public Health, University of Washington, Seattle, USA
  1. Correspondence to Dr Elizabeth A Richardson, School of GeoSciences, University of Edinburgh, Drummond Street, Edinburgh EH8 9XP, UK; e.richardson{at}


Background Cities are expanding and accommodating an increasing proportion of the world's population. It is important to identify features of urban form that promote the health of city dwellers. Access to green space has been associated with health benefits at both individual and neighbourhood level. We investigated whether a relationship between green space coverage and selected mortality rates exists at the city level in the USA.

Methods An ecological cross-sectional study. A detailed land use data set was used to quantify green space for the largest US cities (n=49, combined population of 43 million). Linear regression models were used to examine the association between city-level ‘greenness’ and city-level standardised rates of mortality from heart disease, diabetes, lung cancer, motor vehicle fatalities and all causes, after adjustment for confounders.

Results There was no association between greenness and mortality from heart disease, diabetes, lung cancer or automobile accidents. Mortality from all causes was significantly higher in greener cities.

Conclusions While considerable evidence suggests that access to green space yields health benefits, we found no such evidence at the scale of the American city. In the USA, greener cities tend also to be more sprawling and have higher levels of car dependency. Any benefits that the green space might offer seem easily eclipsed by these other conditions and the lifestyles that accompany them. The result merits further investigation as it has important implications for how we increase green space access in our cities.

  • Green space
  • urban health
  • USA
  • environmental epidemiology
  • GIS
  • environmental epidem

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  • Funding This study was funded by the UK Forestry Commission. Forest Research, Alice Holt Lodge, Farnham, Surrey GU10 4LH, UK.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.