From Urban Planning to Respiratory Health: Why Weighting Risk Factors Matters 🏙️➡️🫁⚖️

I did not begin this research in a laboratory, I began it in cities. As an economist and urban planner working at territorial governance and public health, I have been confronted with a recurring reality: the form of our cities quietly determines who breathes clean air and who does not
From Urban Planning to Respiratory Health: Why Weighting Risk Factors Matters 🏙️➡️🫁⚖️
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Environmental urban and socioeconomic risk factors for respiratory diseases a systematic review with quantitative weighting analysis - Discover Public Health

Background Rapid urbanization, environmental degradation, and socioeconomic inequalities are reshaping exposure patterns and vulnerability profiles for respiratory diseases worldwide. Although extensive literature documents individual urban and environmental determinants, decision-makers still lack integrated, transparent, and reproducible frameworks to synthesize heterogeneous evidence and prioritize risk factors in a policy-relevant manner. Methods A PRISMA-aligned review (2014–2024) synthesized 43 studies, extracting and NLP-harmonizing 211 risk-factor entries into 29 standardized factors across seven categories using rule-based cleaning and semantic similarity checks. Factors were scored through a multi-criteria framework (Frequency, Impact, Applicability, Contextuality), with within-study normalization ensuring weights summed to 100%, followed by cross-study aggregation, LOCO robustness analyses, and descriptive profiling. Quality-control checks addressed duplicate factor labeling and consistency across studies, while a cluster-robust OLS model was applied as an ex-post validation of internal coherence, not for causal inference. Results Pollution-related exposures, urban form and green-space conditions, and climate-related determinants emerged as the most consistently prioritized configurations, while living conditions showed lower weights. Rankings were highly stable across robustness checks (Spearman ρ ≈ 0.96–0.99). Leave-one-criterion-out (LOCO) analyses further confirmed this stability, showing only limited rank shifts when each scoring dimension was removed sequentially. Top-k overlap remained high across LOCO scenarios, indicating that prioritization was not driven by any single criterion. Ex-post cluster-robust OLS validation indicated that Impact and Contextuality were the main drivers of prioritization, whereas Frequency was marginal and Applicability was not statistically significant. Discussion This study presents a reproducible prioritization framework that emphasizes severity and contextual relevance rather than causal estimation. The resulting patterns align with established urban health frameworks highlighting the combined roles of the built environment, environmental hazards, and social inequalities. Conclusions This study presents a reproducible decision-support framework for prioritizing urban health determinants, integrating systematic review, NLP-assisted harmonization, multi-criteria weighting, and econometric validation, with potential extensions toward predictive modeling, economic evaluation, and dynamic policy monitoring.

Whenever I attended conferences and academic seminars, public health impacts were explained differently each time through urban, environmental, or socioeconomic dimensions. Each discipline offered its own lens, its own framework.

But one question kept returning: 🔁❓

If respiratory diseases are the result of multiple interacting configurations  urban, environmental, and socioeconomic  how much weight should be assigned to each ? And why do we still struggle to translate scientific evidence into clear territorial priorities ? ⚖️📊

Cities are expanding rapidly. Pollution levels are rising. Climate change is reshaping exposure patterns. Social inequalities are deepening. And respiratory diseases  from asthma and COPD to tuberculosis and COVID-19  continue to affect millions of people worldwide. We already know many individual risk factors: air pollution, housing overcrowding, traffic-related emissions, heat waves, lack of green spaces. The literature is abundant.

Yet something was missing.

What was lacking was a structured and transparent method to prioritize these factors  to assign weight to each dimension and to validate findings through quantitative and econometric analysis, both for academic researchers and, especially, for policymakers who must decide where to intervene first.

It was precisely this gap that inspired the research titled “Environmental Urban and Socioeconomic Risk Factors for Respiratory Diseases: A Systematic Review with Quantitative Weighting Analysis.” 

The Challenge of Fragmented Knowledge 🧩

We produce studies.
We accumulate data.
We publish analyses.

The literature in urban health is vast. Air pollution. Housing. Urban heat. Social inequalities. Daily mobility.

Each study adds a piece to the puzzle.

But the city is not a static puzzle.
It breathes. It moves. It amplifies.

Pollution circulates according to urban morphology.
Climate change alters the dispersion of particles and intensifies heat waves.
Social inequalities determine who lives near congested highways and who benefits from tree-lined parks.
Transport infrastructures shape, every single day, the air our lungs absorb.

Everything is interconnected.

And yet, our scientific syntheses remain fragmented. They isolate determinants as if the city could be understood by slicing it into separate compartments.

It was this fragmentation that deeply challenged me.

How Urban Form and Mobility Patterns Shape Respiratory Health Risks 🏙️🚦

This research demonstrates that urban form and mobility patterns are key determinants of population exposure to air pollution and heat-related health risks, directly influencing respiratory health outcomes.

Based on a systematic review of 43 studies published between 2014 and 2024, the analysis identified 211 occurrences of risk factors associated with respiratory diseases in urban settings. The study applied a rigorous, multi-layered methodological framework combining PRISMA-based literature selection, structured data extraction, Natural Language Processing (NLP), multi-criteria weighting, statistical normalization, and validation through ANOVA and OLS models.

By integrating environmental, urban, and socioeconomic dimensions, the research provides a structured and reproducible approach to understanding urban health dynamics.

A key finding is that specific urban configurations can either exacerbate or mitigate respiratory risks. In other words, city design is not neutral: spatial organization and mobility systems directly shape exposure patterns and vulnerability.

The study ultimately highlights that urban planning is not only an infrastructural discipline but a fundamental component of public health strategy.

Breathing is a territorial act. 🌍🫁

This study does not claim to establish definitive causal relationships. Instead, it offers a framework for thinking differently.

To think of the city as an active determinant of health.
To see prioritization as a strategic tool.
To understand research as a bridge between disciplines.

Health is not built solely in hospitals.
It is built in neighborhood density.
In air quality.
In planning decisions.
In public policies.

Breathing is a biological act.

But breathing is also a territorial act.

And if we want healthier cities, we must accept a simple truth:

📐What we plan today will determine who breathes freely tomorrow. 🌍🌱

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Urban Politics
Humanities and Social Sciences > Politics and International Studies > Political Science > Comparative Politics > Urban Politics
Public Health
Life Sciences > Health Sciences > Public Health
Risk Factors
Life Sciences > Health Sciences > Public Health > Health Promotion and Disease Prevention > Risk Factors
Air Pollution and Air Quality
Physical Sciences > Earth and Environmental Sciences > Environmental Sciences > Pollution > Air Pollution and Air Quality
Econometrics
Humanities and Social Sciences > Economics > Quantitative Economics > Econometrics
Climate-Change Impacts
Life Sciences > Biological Sciences > Plant Science > Plant Ecology > Climate-Change Impacts

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