Introduction
The built environment – where we live, work, travel and play – is an important determinant of our health. How our environment is constructed and used influences our exposure to harmful health hazards, such as air pollution, and our uptake of health-promoting behaviours, such as physical activity[i].
This briefing provides an overview of the evidence for the health and wellbeing benefits, and impacts on health inequalities, which can be achieved through greener, healthier streets initiative.
Mechanisms for health improvement
The primary mechanisms for health improvement targeted through these interventions are:
Reduced exposure to air pollution
Air pollution increases the risk of multiple diseases, including cardiovascular disease, respiratory disease (including asthma) and cancer[ii]. These are the three major causes of death, including early preventable deaths, and a major source of health inequity.
Particulate air pollution (PM2.5) levels (9.1µg/m3) is higher than average across both London (8.3 µg/m3) and England (7.0 µg/m3) (2023 figures) – but is falling faster than the national average[iii].
Across London, we know this burden is distributed inequitably, with those in ethnic minority groups and those in low-income areas exposed to the highest pollution levels[iv]. Road traffic is a major source of air pollution in the borough, accounting for high proportions of local emissions: 41% of nitrogen oxides, 25% of large particulates (PM10) and 24% of fine particulates (PM2.5)[v].
Greener, healthier streets aims to reduce air pollution-related harm by lowering the activity of, and people’s proximity to, pollutant-emitting vehicles.
Increased physical activity
Doing more physical activity significantly reduces the risk of many physical and mental health conditions, including cardiovascular disease, cancer, diabetes, dementia and depression[vi]. These are conditions which are important drivers of inequalities in Islington[vii]. Recent research shows that even small increases in physical activity can have an effect – as few as 2,400 steps per day reduces risk of cardiovascular disease[viii]. Other research has found that structured physical activity can significantly reduce the risk of cancer returning and death after chemotherapy for bowel cancer[ix].
There is scope to increase activity levels. Only 78% of adults[x] are physically active, falling to 55% for children and young people[xi] (adults need 150mins of activity per week and younger children need up to 180mins per day). In addition, 43% of adults in the borough are living with overweight or obesity[xii], and 37% of children leaving primary school live with overweight or obesity[xiii]. As with exposure to air pollution, minoritised and low-income groups are disproportionately likely to be inactive, with many facing major barriers to being active. Older people and those with long-term conditions and disabilities are also less likely to be active than others[xiv].
Greener, healthier streets aims to increase physical activity uptake by reducing barriers to active travel options and increasing barriers to motor vehicle travel. This is consistent with the Mayor of London’s Transport Strategy that by 2041 all Londoners do at least 20 minutes of active travel every day. The Mayor’s team estimates that if every Londoner walked or cycled for 20 minutes every day we would prevent one in six early (premature) deaths in the city[xv].
Reduced road traffic injuries
An analysis of self-reported road injuries found that disabled people, people on low incomes and Londoner pedestrians have higher rates of road injuries than the national average[xvi]. Research has also shown that older people are at particular risk from road injuries, both as pedestrians and cyclists[xvii].
Transport for London data for 2022 shows that people in London are twice as likely to be killed or seriously injured on streets in the most deprived 30% of areas compared with the least deprived 30% of areas[xviii].
Greener, healthier streets aim to reduce the volume of, and proximity to, traffic, thereby reducing the risk of injury.
Other health and wellbeing impacts
We expect our greener, healthier streets initiatives to contribute to other health and wellbeing outcomes, including:
- reduced social isolation and improved mental well-being due to increased social interaction opportunities in neighbourhood settings[xix][xx] and physical activity[xxi]
- reduced harm from climate change due to reductions in greenhouse gas emissions and improvements to the built environment to make them more resilient to a changing climate[xxii]
- reductions in health inequalities, as we know that groups who are most adversely impacted by traffic injuries, air pollution and barriers to being active are people on low incomes and people from minoritised groups
- increased freedom of movement for children and young people as parents perceive streets to be safer
Do greener, healthier streets interventions improve health or predictors of good health?
Liveable neighbourhoods
In neighbouring Islington, areas within and around Low Traffic Neighbourhoods (LTNs) have experienced greater reductions in traffic volumes and air pollution (nitrogen dioxide) than in other neighbourhoods in the borough[xxiii].
In February 2024, Transport for London (TfL) published an overview of the impacts of LTN schemes[xxiv]. This found:
- A 50% reduction in road casualties within LTNs, with no increase on boundary roads
- A 46% reduction in daily motor vehicle traffic in LTNs, with no change on boundary roads
In July 2025, new research was published analysing road casualties across the whole of London, and comparing roads within LTNs, those on the boundary of an LTN and those without LTNs. This demonstrated that across 113 LTNs there was a 35% reduction in all injuries, and a 37% reduction in deaths and serious injuries compared to areas without LTNs. At the same time, on boundary roads cyclists and motorcyclists experienced lower injury rates, while pedestrian and other motor vehicle users showed no change in injury rates[xxv].
Research by the same team at the University of Westminster found that pedestrians experienced the largest reduction in road casualties (85% reduction compared to non-LTN areas)[xxvi]..
In a study covering 14 cities across the world, including Stoke-on-Trent in the UK, components of the liveable neighbourhoods initiative, such as increased street connectivity, public transport availability and access to parks within walking distance, were found to be associated with increased physical activity levels. The findings of this study were highly consistent across settings and socio-economic groups. They suggested that physical activity linked to living in neighbourhoods with such features could contribute to 30-60% of the 150 minutes of moderate physical activity per week recommended by the WHO[xxvii].
Another study, performed across England in 2015, examined the impact of improving, and promoting awareness of, walking infrastructure in low-income areas with low physical activity levels and high levels of obesity. Examples of infrastructure improvements included new street lighting, removal of bollards and community-led environment changes, such as bulb planting. This study found a 15% increase in the use of walking routes by pedestrians in intervention areas 14-20 months after the intervention compared to usage before interventions, occurring after a transient reduction in use[xxviii].
A review published in 2024 found that certain features of the built environment could increase “psychological restoration” and contribute to improved mental health for residents. These include [xxix]:
Natural features:
- Diverse vegetation / planting, especially flowers and trees
- The sight and sound of water
Landscape characteristics:
- Slopes / topographical variation
- Natural (grass or wood decking) ground cover, or hard surfaces painted green
- Away from traffic, especially traffic noise
- Provision of seating
Research in London found that younger people, those in less skilled occupations, those with poor health and those from minoritised communities are disproportionately affected by high land surface temperatures (a feature of the urban heat island)[xxx]. Initiatives to add shade and green infrastructure have the potential to reduce land surface temperatures and tackle inequalities.
For older adults in particular, proximity to local resources and recreational facilities, access to public transport and neighbourhood safety are facilitators of mobility and social activity[xxxi]. Research for Transport for London found that improving London’s high streets for walking and cycling led to a 216% increase in people stopping, sitting or socialising[xxxii]. Research in America found that increased walkability in neighbourhoods was associated with increased social interactions with neighbours[xxxiii].
For children and young people there is evidence that car-centred design restricts opportunities for children to engage in active travel and outdoor free play as a result of safety concerns. Both these activities are critical to children’s health and wellbeing[xxxiv]. Research has shown that parents who are more concerned about street safety are less likely to allow outdoor play[xxxv] and independent travel[xxxvi].
Cycleways
An evaluation of Waltham Forest’s “Mini Holland” scheme found that after it was implemented, vehicle ownership and road traffic reduced[xxxvii]. Follow on research by the same team found that after five years of the Mini Holland scheme (in Enfield, Waltham Forest and Kingston) rates of active travel increased, especially among those living in LTN areas. Most of the increase was in time spent walking, but the evaluation also found strong evidence that more people in LTNs were taking up cycling[xxxviii]. These are consistent with findings linked to traffic calming measures from a government-commissioned review in 2018[xxxix].
Cycling in inner London has increased in recent years, with 1.26 million cycle journeys made every day on London roads (up 20% compared with 2019). While cycling rates remain lower among people from minoritised ethnic groups, participation is rising in all groups (e.g. 15% of Black Londoners reported having cycled in the last year in 2022/23 compared with 12% in 2019/20)[xl].
Although a picture of inequitable uptake of cycling is apparent in London, there is evidence that infrastructure improvement may increase cycling amongst those who are currently underserved. A systematic review published in 2021 found that access to bike lanes is linked to increased physical activity levels among children and adolescents[xli].
A review completed by TfL in 2011 found that the main barriers to cycling amongst those in minoritised ethnic groups and those living on low incomes relate to safety concerns, lack of facilities and poor weather, suggesting that improvements in local infrastructure may serve to improve equity of uptake[xlii].
A more recent review by TfL has found increased use of cycling routes after improvement work and an increased perception of cycle safety[xliii].
Economic analysis of greener, healthier streets initiatives
A report published in 2024 concluded that Low Traffic Neighbourhoods can be highly cost effective, estimating 20-year returns in terms of improved health outcomes at 50 to 200 times the cost of the schemes. The study focused on two main health outcomes – reduced premature mortality and reduced sick days – to quantify the economic benefits of increased physical activity in LTN areas[xliv].
Emerging evidence from London’s Ultra Low Emission Zone (ULEZ) has found increases in labour productivity, an 18.5% reduction in sick leave and a 10% reduction in respiratory issues compared to the period before the first emissions restrictions were introduced in 2008[xlv].
Recent studies in Scotland and Finland found that cycle commuting was associated with better health outcomes, higher wellbeing scores and fewer sick days than other methods (with the benefits outweighing the increased risk of injury)[xlvi], and that cycle commuting is associated with a 47% lower risk of death from any cause, and significant reductions in hospitalisation, cardiovascular disease, mental health conditions and death from cancer[xlvii]. In the same study, pedestrian commuting also had significant, but smaller, benefits in terms of cardiovascular disease hospitalisation and mental health conditions.
Transport for London’s research has found that high street walking, cycling and public realm improvements can increase retail sales by up to 30% and increase retail rental values by 7.5%[xlviii].
A report commissioned by the Department for Transport found international evidence that LTNs are good for local economies, creating destinations that are attractive for residents and retail, although it concluded there was insufficient UK-based evidence to draw conclusions on their overall economic impact[xlix].
Potential harms of greener, healthier streets initiatives
Some residents have raised concerns about potential harms of our transport initiatives. This review of the evidence has not identified significant harms:
Emergency response times
A 2021 study found that the London Fire Brigade reported more delays due to traffic calming measures after the introduction of Covid-19 LTNs, but that response times were unchanged – primarily because of reductions in delays for other reasons, especially “traffic” [l].
Crime levels
An evaluation of the Waltham Forest “Mini Holland” programme found total street crime decreased by around 10% after the introduction of the LTN compared to other areas, and by 18% three years after – with no evidence that crime has been displaced to neighbouring areas[li].
Harms to disabled people
In depth qualitative research with 84 people with disabilities (including 11 Islington residents) found mixed experience of LTNs. Participants identified benefits including more pleasant journeys and benefits to physical health but also problems including longer journey times for themselves and their carers. A key finding was that consultation and engagement with disabled residents is essential to ensure they can fully benefit from any changes made[lii].
Increase in inequalities, especially exposure to air pollution
Boundary roads are more likely to be home to lower-income residents, due to the nature of the housing and the drawbacks (noise, pollution) of living on a main road meaning such housing is cheaper[liii]. On average, LTNs have not increased traffic on boundary roads (in some cases it has done, but in others it has reduced boundary road traffic)[liv]. Interventions such as the Ultra Low Emission Zone can reduce the air pollution impact of continued traffic on boundary roads[lv].
What makes an effective greener, healthier streets initiative?
A report by the Centre for London summarises the key features of effective Low Traffic Neighbourhoods[lvi]:
- Good scheme design
- Joined up schemes which enable residents to see improvements on their whole journey
- Improving the whole streetscape, including trees, planters, benches and wider pavements
- Careful consideration of any exemptions offered
- Include support to address barriers to active travel to enable all residents to benefit from new schemes
- Make plans to mitigate any potential negative impacts
- Significant engagement
- Early engagement
- Ensuring engagement reaches different groups within the local community, including those whose voices are less often heard
- Be honest about any potential downsides
- Consider using innovative approaches such as deliberative democracy
- Communications
- Be clear and honest about the goals of any new schemes
- Share the stories of local residents and professionals to communicate the benefits of schemes
- Be clear about any rules and exemptions
- Recognise that some residents will be worse off and thank them for their contribution to changes which will benefit their wider community
- Build the local evidence base to demonstrate the impact of schemes
The Healthy Streets framework is another useful guide when considering how the design of our streets can contribute to health outcomes. It covers ten domains, as shown in the diagram below:
Discussion
Overall, there is evidence for the link between each of the main components of the greener, healthier streets initiative and health-promoting factors (or proxies for them). The positive associations in the literature mainly relate to increased physical activity and reduced pollution levels. Most reports do not go on to assess the direct impacts on health (or ill health) status, although evidence for reduced risk of road traffic incidents is available for some components.
Geographically targeted area-based measures can reduce population inequalities[lvii],
This paper is based on a report by Fran Bury, Islington Public Health
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