Is a liveable city a healthy city? Health impacts of urban and transport planning in Vienna, Austria.

Each year, The Economist Intelligence Unit (EIU) computes the Global Liveability Index and determines the most liveable cities around the world. Vienna, Austria, was ranked by the EIU as the most liveable city worldwide in 2018 and 2019. However, the relationship between a liveable as well as healthy and environmentally-just city has not been previously explored. To explore whether the most liveable city is also a healthy and environmentally-just one, we estimated the premature mortality burden related to non-compliance with international exposure level recommendations for physical activity (PA), air pollution (PM and NO), road traffic noise, green space and heat for Vienna, as well as its distribution by socioeconomic status (SES). We applied the Urban and TranspOrt Planning Health Impact Assessment (UTOPHIA) methodology and estimated the annual mortality, life expectancy (LE) and economic impact of non-compliance with exposure guidelines for the Viennese adult population ≥ 20 years. We compared current with recommended exposure levels, quantified the association between exposures and mortality and calculated attributable health impact fractions. Eight percent of premature mortality (i.e. 1239 deaths, 95% CI: 679-1784) was estimated to be attributable to non-compliance with the recommended exposure levels. Seventy-six percent of the attributable premature mortality was due to PM exposure and insufficient PA. Non-compliance also resulted in an average of 199 days of LE lost for the adult population (95% CI: 111-280) and an economic impact of 4.6 (95% CI: 2.5-6.7) billion 2015€ annually. Overall, residents of lower SES neighbourhoods faced higher risk of premature mortality due to higher exposure to NO, road traffic noise, heat and less green space. Despite high liveability standards according to EIU definition, a considerable premature mortality burden was attributable to non-compliance with exposure recommendations, and socioeconomic inequalities were estimated. Although the exposure attributable mortality burden was lower than in other European cities and local Viennese policies favour the reduction of motorized traffic, alongside the promotion of active and public transport and urban greening, there is room for further alignment of liveability, environmental health and justice objectives.