Promoting a healthy cities agenda through indicators: development of a global urban environment and health index

Helen Pineo*, Nici Zimmermann, Ellie Cosgrave, Robert W. Aldridge, Michele Acuto, Harry Rutter

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

12 Citations (Scopus)


There is a growing awareness among city leaders and policy-makers of the impact of the urban environment on health outcomes and inequalities. Increasingly, practitioners in built environment city departments, such as housing, planning, transport and regeneration, seek new tools and guidance to understand how their respective policies and decisions can support the creation of healthier cities. This paper presents the development of a global index to help city leaders and practitioners understand their role in delivering health outcomes through urban environment policies and programmes. The Building Research Establishment’s international Healthy Cities Index (BRE HCI) contains 10 environment categories and 58 indicators, supported by a causal pathways framework. This was achieved through an iterative process including: stakeholder engagement, evaluating research evidence, selecting indicators and identifying data sources. We tested the index and causal pathways approach on two case study cities: Dubai and London. We found that they contributed to: raising awareness of the links between the environment and health; identifying shared responsibilities and the need to work across departmental silos; and uncovering the competing demands faced by some departments (and private sector stakeholders) as they seek to deliver health promoting environments alongside other objectives.

Original languageEnglish
Pages (from-to)27-45
Number of pages19
JournalCities and Health
Issue number1
Publication statusPublished - 2018
Externally publishedYes

Bibliographical note

Funding Information:
This work was supported by the Building Research Establishment Trust. A commercial contract between BRE and Dubai Land Department helped fund some of the research described here. HR was supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) North Thames at Bart?s Health NHS Trust. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. The authors would like to acknowledge Dubai Land Department and Southwark Council for their kind permission to publish findings from working with those cities. We would also like to thank the academic experts who were commissioned to attend the weighting workshop in London on January 27, 2017. Their candid feedback was instrumental in determining the final approach for the BRE Healthy Cities Index. Participants included: Dr Jo Barnes, Senior Research Fellow: Air Quality Management Resource Centre, University of the West of England (UWE); Prof Steven Cummins, Professor of Population Health, London School of Hygiene and Tropical Medicine (LSHTM); Dr Danielle Sinnett, Senior Research Fellow, FET - Architecture and the Built Environment, UWE; Dr Marcella Ucci, Senior Lecturer, Bartlett School Environment, Energy & Resources, University College London; Dr Melvyn Hillsdon, Associate Professor Sport and Health Sciences, University of Exeter; Dr Charlotte Clark, Reader in Environmental & Mental Health Epidemiology, Queen Mary University of London; Prof Sir Andy Haines, Professor of Public Health & Primary Care, LSHTM; Dr Russell Jones, Public Health Programme Manager, Glasgow Centre for Population Health; Dr Harry Rutter, Senior Clinical Research Fellow, LSHTM; and Dr Wolf-Peter Schmidt, Assistant Professor in Epidemiology, LSHTM.

Publisher Copyright:
© 2018 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.


  • healthy cities
  • index
  • indicators
  • Urban health
  • urban planning
  • urban policy


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