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Copyright: © 2022 by the authors.Urban green spaces provide environmental, economic, societal and health benefits to cities. However, policy and planning interventions aiming to improve usage have often led to unintended consequences, including, in some circumstances, an actual decline in usage. Previous research has identified factors influencing the use of urban green space, more often with a focus on the ‘quality’ and physical features of the space, rather than on the broader social factors. This study aims to unpack the complexity of factors that influence the use of urban green space through the application of Systems Thinking. A qualitative mixed-method approach integrating System Dynamics with rapid ethnography was adopted to elicit the views of local residents in Thamesmead, London. A thematic analysis of interviews was undertaken to systematically map the causal relations between factors, which were compared to wider stakeholders’ views. Our findings highlight the relevance of dynamics and social influences on the use of green space, which include social interactions and stewardship, health conditions, availability of services and amenities. These are factors that are underexplored in the literature and, sometimes, overlooked in urban green space policy by decision-makers. We infer that attendance of urban green spaces requires time, which may be occupied in other practices determined by local conditions and needs. Expanding the spatial and temporal boundaries of investigation, wider than debates on ‘quality’, should, in our view, increase the chances of identifying critical influences and foster an increased use of green space. Wellcome Trust (CUSSH project, ref. no. 209387/Z/17/Z); U.K. Natural Environment Research Council (CAMELLIA project, ref. no. NE/S003495/1).

Indoor heat and air pollution pose concurrent threats to human health and wellbeing, and their effects are more pronounced for vulnerable individuals. This study investigates exposures to summertime indoor overheating and airborne particulate matter (PM2.5) experienced by low-income seniors and explores the potential of natural ventilation on maintaining good indoor thermal conditions and air quality (IAQ). Environmental and behavioural monitoring and a series of interviews were conducted during summer 2017 in 24 senior apartments on three public housing sites in NJ, USA (1930s’ low-rise, 1960s’ high-rise and LEED-certified 2010s’ mid-rise). All sites had high exposures to overheating and PM2.5 concentrations during heat waves and on regular summer days, but with substantial between-site and between-apartment variability. Overheating was higher in the 30s’ low-rise site, while pollutant levels were higher in the 60s’ high-rise. Mixed linear models indicated a thermal and air quality trade-off with window opening (WO), especially in some ‘smoking’ units from the older sites, but also improved both thermal and PM2.5 concentration conditions in 20% of the apartments. Findings suggest that with warmer future summers, greater focus is needed on the interdependencies among (1) thermal and IAQ outcomes and (2) technological and behavioural dimensions of efforts to improve comfort for vulnerable occupants.

Written by Radha Jagannathan and Ioanna Tsoulou, this chapter begins with a discussion of the economic turmoil Greece has experienced in recent history and takes us through the debt crisis, the austerity measures that followed, and the cash-for-reform deal with the EU. Focusing principally on the supply side and on the Greek society’s tendency for over-educating its young, the chapter describes the rise of the precariat as a direct consequence of the labor market’s inability to absorb the high-educated/high skilled labor, and focuses attention on the prevailing norms of clientelism, nepotism and non-meritocracy that have earned Greece a rather dubious distinction as one of the most corrupt western democracies. After an overview of the Greek education system and the rather poor reputation of its VET, the chapter provides a comparative discussion of the active labor market policies in Greece and Portugal and why similar reforms in the two countries led to divergent results. The chapter explores Greece’s capacity to adopt an entrepreneurship pathway to curbing youth unemployment and presents results from a survey of 30 Greek youth who opined on the issues of youth labor market.

Background: Environmental improvement is a priority for urban sustainability and health and achieving it requires transformative change in cities. An approach to achieving such change is to bring together researchers, decision-makers, and public groups in the creation of research and use of scientific evidence. Methods: This article describes the development of a programme theory for Complex Urban Systems for Sustainability and Health (CUSSH), a four-year Wellcome-funded research collaboration which aims to improve capacity to guide transformational health and environmental changes in cities. Results: Drawing on ideas about complex systems, programme evaluation, and transdisciplinary learning, we describe how the programme is understood to “work” in terms of its anticipated processes and resulting changes. The programme theory describes a chain of outputs that ultimately leads to improvement in city sustainability and health (described in an ‘action model’), and the kinds of changes that we expect CUSSH should lead to in people, processes, policies, practices, and research (described in a ‘change model’). Conclusions: Our paper adds to a growing body of research on the process of developing a comprehensive understanding of a transdisciplinary, multiagency, multi-context programme. The programme theory was developed collaboratively over two years. It involved a participatory process to ensure that a broad range of perspectives were included, to contribute to shared understanding across a multidisciplinary team. Examining our approach allowed an appreciation of the benefits and challenges of developing a programme theory for a complex, transdisciplinary research collaboration. Benefits included the development of teamworking and shared understanding and the use of programme theory in guiding evaluation. Challenges included changing membership within a large group, reaching agreement on what the theory would be ‘about’, and the inherent unpredictability of complex initiatives.

This article is included in Complex Urban Systems for Sustainability and Health: CUSSH collection. Data availability: No data are associated with this article. Copyright: © 2021 Davies M et al. This paper describes a global research programme on the complex systemic connections between urban development and health. Through transdisciplinary methods the Complex Urban Systems for Sustainability and Health (CUSSH) project will develop critical evidence on how to achieve the far-reaching transformation of cities needed to address vital environmental imperatives for planetary health in the 21st Century. CUSSH’s core components include: (i) a review of evidence on the effects of climate actions (both mitigation and adaptation) and factors influencing their implementation in urban settings; (ii) the development and application of methods for tracking the progress of cities towards sustainability and health goals; (iii) the development and application of models to assess the impact on population health, health inequalities, socio-economic development and environmental parameters of urban development strategies, in order to support policy decisions; (iv) iterative in-depth engagements with stakeholders in partner cities in low-, middle- and high-income settings, using systems-based participatory methods, to test and support the implementation of the transformative changes needed to meet local and global health and sustainability objectives; (v) a programme of public engagement and capacity building. Through these steps, the programme will provide transferable evidence on how to accelerate actions essential to achieving population-level health and global climate goals through, amongst others, changing cities’ energy provision, transport infrastructure, green infrastructure, air quality, waste management and housing.

The Complex Urban Systems for Sustainability and Health (CUSSH) project is a global research programme on the complex systemic connections between urban development and health. Through transdisciplinary methods it will develop critical evidence on how to achieve the far-reaching transformation of cities needed to address vital environmental imperatives for planetary health in the 21st century. CUSSH’s core components include: (i) a review of evidence on the effects of climate actions (both mitigation and adaptation) and factors influencing their implementation in urban settings; (ii) the development and application of methods for tracking the progress of cities towards sustainability and health goals; (iii) the development and application of models to assess the impact on population health, health inequalities, socio-economic development and environmental parameters of urban development strategies, in order to support policy decisions; (iv) iterative in-depth engagements with stakeholders in partner cities in low-, middle- and high-income settings, using systems-based participatory methods, to test and support the implementation of the transformative changes needed to meet local and global health and sustainability objectives; (v) a programme of public engagement and capacity building. Through these steps, the programme will provide transferable evidence on how to accelerate actions essential to achieving population-level health and global climate goals through, amongst others, changing cities’ energy provision, transport infrastructure, green infrastructure, air quality, waste management and housing.

We explore methodological issues core to the cost-benefit evaluation of building adaptations designed to protect against heat risks to residents of care homes in England in the context of the uncertainties relating to the loss of life expectancy in heat death. We used building physics modelling to quantify the impact of external window shading on indoor temperatures. We calculated associated heat mortality and loss of life expectancy under three sets of assumptions of life-shortening based on: (Method 1) an England & Wales (E&W) life-table, (Method 2) E&W life-table scaled to match observed average survival of care home residents and (Method 3) assuming that those dying of heat have a life expectancy of six months. External window shading was estimated to reduce mean indoor temperatures by 0.9 °C in a ‘warm’ summer and 0.6 °C in an ‘average’ summer. In a care home of 50 residents, the heat deaths and years of life lost (YLL) averted by such shading were estimated by the three life-expectancy assumptions (Methods 1, 2, 3) to be: 0.07, 0.47 and 0.28 heat deaths and 0.29, 0.76 and 0.14 YLL for the warm year and 0.05, 0.31 and 0.19 heat deaths and 0.20, 0.51 and 0.10 YLL for the average year. Over a 20-year time horizon and assuming an annual discount rate of 3.5%, the monetized benefit of reduced YLL would be around £90,000, £230,000 and £44,000 with the three life-expectancy assumptions. Although this range represents appreciable uncertainty, it appears that modest cost adaptations to heat risk may be justified in conventional cost-benefit terms even under conservative assumptions about life expectancy.

Indoor air quality (IAQ) is an important consideration for health and well-being as people spend most of their time indoors. Multi-disciplinary interest in IAQ is growing, resulting in more empirical research, especially in affordable housing settings, given disproportionate impacts on vulnerable populations. Conceptually, there is little coherency among these case studies; they traverse diverse spatial scales, indoor and outdoor environments, and populations, making it difficult to implement research findings in any given setting. We employ a social-ecological systems (SES) framework to review and categorize existing interventions and other literature findings to elucidate relationships among spatially and otherwise diverse IAQ factors. This perspective is highly attentive to the role of agency, highlighting individual, household, and organizational behaviors and constraints in managing IAQ. When combined with scientific knowledge about the effectiveness of IAQ interventions, this approach favors actionable strategies for reducing the presence of indoor pollutants and personal exposures.

Background: Environmental improvement is a priority for urban sustainability and health and achieving it requires transformative change in cities. An approach to achieving such change is to bring together researchers, decision-makers, and public groups in the creation of research and use of scientific evidence. Methods: This article describes the development of a programme theory for Complex Urban Systems for Sustainability and Health (CUSSH), a four-year Wellcome-funded research collaboration which aims to improve capacity to guide transformational health and environmental changes in cities. Results: Drawing on ideas about complex systems, programme evaluation, and transdisciplinary learning, we describe how the programme is understood to “work” in terms of its anticipated processes and resulting changes. The programme theory describes a chain of outputs that ultimately leads to improvement in city sustainability and health (described in an ‘action model’), and the kinds of changes that we expect CUSSH should lead to in people, processes, policies, practices, and research (described in a ‘change model’). Conclusions: Our paper adds to a growing body of research on the process of developing a comprehensive understanding of a transdisciplinary, multiagency, multi-context programme. The programme theory was developed collaboratively over two years. It involved a participatory process to ensure that a broad range of perspectives were included, to contribute to shared understanding across a multidisciplinary team. Examining our approach allowed an appreciation of the benefits and challenges of developing a programme theory for a complex, transdisciplinary research collaboration. Benefits included the development of teamworking and shared understanding and the use of programme theory in guiding evaluation. Challenges included changing membership within a large group, reaching agreement on what the theory would be ‘about’, and the inherent unpredictability of complex initiatives.

Copyright: © 2021 The Author(s). Contemporary challenges linked to public health and climate change demand more effective decision-making and urban planning practices, in particular by taking greater account of evidence. In order to do this, trust-building relationships between scientists and urban practitioners through collaborative research programmes is required. Based on a policy-relevant research project, Complex Urban Systems for Sustainability and Health (CUSSH), this project aims to support the transformation of cities to meet environmental imperatives and to improve health with a quantitative health impact assessment. A case study in Rennes, France, focuses on the role of a policy decision-support tool in the production and use of knowledge to support evidence-informed decision-making. Although the primary objective of informing decision-making through evidence-based science is not fulfilled, the use of a decision-making support tool can lay the foundations for relationship-building. It can serve as a support for boundary-spanning activities, which are recognised for their effectiveness in linking science to action. This case study illustrates that the path of knowledge transfer from science to policy can be challenging, and the usefulness of using models may not be where it was thought to have been. Practice relevance The requirements for an effective policy-relevant research programme depend on the establishment of trust. An analysis of the evolution of relationships between cities’ practitioners and scientists shows the need to establish relationships between stakeholders involved in this kind of research. Even if it does not directly support the implementation of transformational policies for health and sustainability, the use of a decision-making support tool can become essential in building trust relationships and later have ripple effects to achieve its primary goals. Moreover, a dedicated team has a key role to facilitate the links between scientists and cities practitioners—to boundary span. Finally, this paper adds to a growing body of work reflecting upon the success of policy–research partnerships. Wellcome Trust (grant number 209387/Z/17/Z).

Summertime overheating in care settings has been identified as a key risk and research priority for the health and social care system. This paper examines the current and future risk of summertime overheating in two London-based care homes occupying modern and older buildings. Continuous monitoring of outdoor and indoor temperature in bedrooms, communal areas and offices in summer 2019 helped to establish the prevalence and intensity of overheating. Dynamic thermal simulation (EnergyPlusV8.9) of the two care settings assessed the potential for avoiding active cooling in future climate using passive solutions. In both care settings, indoor temperatures were observed to exceed 30 °C during daytime hours, significantly higher than the recommended 26 °C threshold of Public Health England. Although severity of overheating was lower in the older building, overheating was found to be prevalent and prolonged across both care settings with bedroom temperatures higher than lounges especially at night. Thermal simulation analysis showed that, with regards to temperature reduction and cooling load, nighttime ventilation was the single most effective passive solution for both buildings for the current climate, while a combination of night ventilation, external shading and high-albedo external walls was the most effective package solution. By the 2080s, air-conditioning was the most effective solution for reducing temperature, but also had the highest cooling load, highlighting the importance of balancing passive with active measures to improve thermal comfort and reduce cooling loads.

Sprawl often characterizes unsustainable, car-dependent, and low-density urban development at the edges of cities. Much research has documented the relationship among sprawl and air pollutant concentrations and many studies have addressed sprawl���s social implications, especially for low-income and minority groups. However, limited research has investigated the links between areas with increased levels of sprawl and air pollution, where vulnerable populations reside. This paper brings together the refined sprawl dataset from Smart Growth America and selected environmental justice indicators on air pollution-ozone and air toxics- from the US Environmental Protection Agency���s Environmental Justice Screening and Mapping Tool (EJSCREEN), in a national-level analysis of U.S. territories. Through Pearson correlations and a series of logistic regressions, the significant connection of sprawl and ozone concentrations is shown, in areas with more low-income, and less educated groups with higher percentages of children. On the other hand, while air toxics cancer risk is higher in areas with low-income, and linguistically isolated racial minorities, it has lower levels in more sprawled areas. Upon a closer look, it is shown that only selected dimensions of compactness link to higher cancer risk, while aspects such as a higher mix of jobs may have a reverse effect on it. These findings provide new directions in the ongoing discussion of sustainable urban development patterns and suggest that the focus should be on development that can promote better air quality, while simultaneously reducing social vulnerability to environmental challenges, with additional benefits for local innovation and community building.

This paper addresses the challenge of incorporating occupant behavior into building performance simulation models used during the design process—that is, before the actual occupants are known. It proposes the use of synthetic population data, an approach that is novel in building performance modeling although common in urban planning and public health. A simpler approach embodied in the ASHRAE Fundamentals volume is to report standard distributions of values for behavioral variables, assuming that parameters vary independently of one another when in fact many co-vary or are interdependent. An alternative approach calibrates models of occupant behavior against actual occupants in specific existing buildings, but this raises questions of transferability. Needed is a database of “generic” occupants that designers can use prospectively during the design process. This paper documents a process of combining disparate field studies of commercial buildings into a larger occupant behavior database and generating a statistically similar synthetic data set that can be shared without compromising confidentiality requirements associated with field studies. The synthetic data set successfully incorporates much of the covariance structure of the underlying field data and supports multivariate modeling. Its scope and structure necessarily serve the needs of the associated modeling framework. Cooperative and systematic sharing of data by field researchers is crucial for building large enough data sets to serve as a behaviorally-robust basis for building design.

The goal of this chapter is to convey a novel approach to overcoming the limitations of case study research of building occupant behavior in workplace settings by pooling samples and creating a synthetic population of building occupants and behaviors. Synthetic populations can be used by researchers and designers of buildings to develop more accurate models of performance and behavior (Andrews et al. 2016). In the example presented here, three disparate field studies of workplace settings are combined into a larger database that is enhanced through the generation of a statistically similar synthetic data set.

As heat waves become more extreme, there is a growing concern for the health of elderly city dwellers who have poor living conditions and limited access to resources. Much research has documented socioeconomic links to heat vulnerability, but limited studies have investigated the detailed living conditions of vulnerable populations, despite increasing requests from local communities. In this paper, we examine the summertime thermal performance of 24 senior apartments within 3 public housing sites (2 conventional multifamily and 1 LEED-rated building), and the seniors' adaptive responses in Elizabeth, NJ, USA. Time-series data were collected from sensors, interviews and observations on the thermal environment and behavior, from May–October 2017. Our multi-level, occupant-centric approach utilizes the indoor heat index as a proxy for heat stress, against site and building characteristics, and environmental and personal variables. Panel regressions show thermal variations among sites/apartments and illustrate the significant effect of actions, such as window opening and air conditioner use. Results also show how the seniors' adaptive responses vary by site; residents with central air-conditioning use it, while residents from the two older sites engage in a wider range of adaptive actions, and in some cases achieve similar indoor heat indexes as apartments from the green building. Indoor heat stress experienced by low-income seniors can be greatly reduced through cost-effective strategies that target individual behaviors and outdoor amenities. This implies the need for integrated solutions to the heat waves problem across scales; including changes to residents' habits, building envelopes, building operations, and outdoor spaces.