THE URBAN EXPOSOME

BUILDING HEALTHIER, AGE-FRIENDLY URBAN AREAS THROUGH EXPOSOME RESEARCH

Written by Claire Webster, Andrea Piano Mortari and Jeroen Lakerveld

Over 55% of the population currently resides in urban areas—a figure expected to rise to 68% by 2050.¹ Understanding the relationship between increasingly urbanised environments and health is therefore crucial. While living in an urban area offers many advantages, such as having easier access to social and functional amenities within walking distance, it also presents unique health challenges, particularly for more vulnerable populations, including older people.

WHAT IS AN URBAN AREA?

An urban area is a city or town and its surrounding areas e.g., the suburbs. Urban areas are very developed and include houses, commercial buildings, roads, bridges, and railways, as well as high population density.²

Urban Living and Healthy Ageing

The built environment is thought to play an important role in healthy ageing. Older adults may experience physical and psychological barriers to interacting with their environments such as frailty, fear of falls, distances to destinations, and concerns around safety.³ As people age, they may rely more on their immediate neighbourhood and public transport. In 2006, the World Health Organization developed its Age-friendly Cities initiative by identifying key elements of the urban environment that support active and healthy ageing. Taking research from 33 cities, they confirmed the factors most important to older people. These included access to public transport, outdoor spaces and buildings, appropriate housing, community support and health services.⁴ These exposome related factors all have a role to play in whether people age well or not.

Understanding the Exposome

The human exposome refers to the totality of environmental exposures that we are exposed to throughout our lifetime, starting from conception and pregnancy⁵. This includes not only exposures such as air pollution, noise and temperature, but also factors like access to green spaces, mobility, neighbourhood facilities and even social and digital environments. Socioeconomic factors such as education status, occupation and housing are also important. Since more than half of humanity lives in cities, a large part of our exposome is now urban.

These factors interact with each other and may change over time, shaping habits, lifestyles, and biological processes, and play a significant role in healthy ageing.

Urban exposures, such as air and noise pollution, are associated with an increased risk of chronic diseases such as diabetes⁶, cardiovascular disease, respiratory and mental health disorders. European studies show that neighbourhoods rich in amenities and easily walkable promote important factors for ageing well, including physical activity, social connections, and better metabolic and cognitive health. One study in the US revealed that those living in more walkable areas take an average of 1,100 more steps per day⁷, with lasting benefits on well-being and the mind, especially for older and vulnerable people.

Climate change is adding another dimension to the urban exposome. Europe is the fastest-warming WHO region, with extreme heat posing a growing risk to health.⁸ In cities, the urban heat island effect, where densely built environments and limited vegetation contribute to higher temperatures, can intensify this risk. Older people can be particularly vulnerable to extreme heat, with chronic health conditions, reduced mobility and social isolation further increasing the risk.⁹

Challenges in Studying the Urban Exposome

Exposomics, the systematic study of how environmental factors influence health, potentially offers a transformative, data-driven, and more proactive approach to disease prevention. However, there are several challenges involved in urban exposome research. These include:

Data Complexity

Vast and diverse data related to exposure factors in urban environments are becoming available. Gathering, integrating, calibrating, and interpreting this data requires advanced analytical tools and interdisciplinary collaboration.

Context

Exposure levels can vary greatly within a city and over time. What people are exposed to in a city can change a lot depending on where they are and why and when they are there.

Health Inequities

Health inequities are more evident in urban areas, often varying between neighbourhoods and sometimes even between adjacent streets. Vulnerable populations in these areas often face disproportionate exposure to environmental risks, exacerbating health disparities. Addressing this inequity requires targeted interventions and policies.

Whilst the challenges remain, advances in exposome science, allow us to now analyse not just a single exposure factor, but a mosaic of exposures. Thanks to high-resolution maps, personal sensors, and big data analysis, we can now more precisely monitor exposures such as pollution, noise, heat, the food environment and the presence of green spaces, and their impact on health. These data can also help identify where urban interventions are most needed and monitor their impact over time.

The TALEA project in Bologna, for example, uses data from sensors, remote sensing and citizen science to support the development and monitoring of a network of ‘Green Cells’.¹⁰ These use vegetation and nature-based solutions to provide relief during heatwaves, while also supporting biodiversity, sustainable mobility and social interaction.

Tools such as the NEXI Proximity Index¹¹, inspired by the 15-minute city model, and the new high-resolution European Walkability Index¹² help measure urban quality and design healthier, more accessible, and more sustainable cities.

In the STAGE project, we are developing AI-powered risk prediction models that account for a wide range of exposure factors in relation to health outcomes, such as multi morbidity in older adults. The models bring together medical history, lifestyle habits, and a wide variety of environmental exposures. This rich combination of data will allow us to paint a fuller picture of an individual’s health, predict how multiple diseases might progress together, and facilitate personalised care. The goal is to generate evidence that can help healthcare providers, policymakers, researchers and citizens better understand health risks, act earlier and support healthy ageing.

Initiatives Tackling Urban Health Challenges

Amid the complexities and varied challenges of enhancing urban health, numerous global and regional initiatives are forging paths towards more sustainable and healthier urban living.

The WHO Healthy Cities Network works to elevate health on the political and social agendas of cities, focusing on equity, participatory governance, and local-level public health movements while emphasising intersectoral collaboration to address determinants of health.

The Green City Accord, an initiative by the European Commission, represents a commitment by European mayors to promote cleaner and healthier cities, aiming to enhance the quality of life for all Europeans and accelerate the implementation of relevant EU environmental laws.

Meanwhile, Eurocities fosters a platform for cities across Europe to exchange insights and strategies, addressing urban challenges with key aims such as establishing healthy, prosperous, and inclusive cities, mitigating air, water, and noise pollution, promoting clean mobility, and amplifying citizen engagement.

These initiatives highlight the vital role of policy, community involvement, and city collaboration in moving toward healthier urban living, which complements and aligns with exposome research.

There are also environmental initiatives dedicated to healthy ageing. The Global Network of Age-friendly Cities and Communities, which involves more than 1,800 cities and communities in 60 countries working to improve their physical and social environments to become better places in which to grow old, has seen a rapid growth in membership. One of the four enablers in the UN Decade of Healthy Ageing (2021–2030) is creating age-friendly environments. The WHO European Region Ageing is Living Strategy (2026–2030) is expected to be adopted in October 2026, with one of the four core areas focused on creating enabling environments.

Despite the many initiatives, monitoring and evaluating the outcomes and impact remains challenging and understudied.¹³

Shaping Healthier Urban Environments

The path toward understanding and improving urban health challenges is a shared endeavour beginning with recognising the role of research, policy, and collaboration. Healthy urban environments cannot be created in silos and stakeholders must work together to implement strategic, multisectoral and coordinated approaches to the challenges involved.

At the European level, exposome science is increasingly recognised as a pillar of a preventive health policy. The European Parliament, through the Panel for the Future of Science and Technology (STOA), estimates that up to 90% of the risk of chronic diseases is linked to environmental exposures.¹⁴ However, despite many of these diseases often associated with ageing, the risks for developing them are most likely influenced in early life. Exposomics can track early-life environmental exposures that influence long-term health, and therefore healthy ageing outcomes.

The STAGE project is one example of how European research is redefining the way we understand the link between cities, the environment, and health. One key output which will support that understanding is an Age-Friendly Neighbourhood Atlas. Under development, this online, Europe-wide map will enable users to visualise, examine and compare the healthy and active ageing potential of areas.

The urban exposome reminds us that health is associated with many aspects of our environment. Translating exposome research into effective urban health policies can be challenging yet hugely powerful. By combining science, public policies, and democratic data management, we can build cities that not only reduce disease but also generate health, equity, and sustainability for all.

RESOURCES

¹ World Health Organization, Urban Health Fact Sheet https://www.who.int/news-room/fact-sheets/detail/urban-health
² National Geographic https://education.nationalgeographic.org/resource/urban-area/
³ Fear of Falling and Environmental Factors: A Scoping Review. Ann Geriatr Med Res (2022) 26(2):83–93. https://doi.org/10.4235/agmr.22.0016
⁴ World Health Organization News Release https://www.who.int/news/item/11-12-2010-who-launches-global-network-of-age-friendly-cities
⁵ The International Human Exposome Network https://humanexposome.net/
⁶ Mette Sørensen, Ulla Arthur Hvidtfeldt, Aslak Harbo Poulsen et al. Long-term exposure to transportation noise and risk of type 2 diabetes: A cohort study. Environmental Research, Volume 217, 2023, 114795, ISSN 0013-9351. https://doi.org/10.1016/j.envres.2022.114795.
⁷ Althoff, T., Ivanovic, B., King, A.C. et al. Countrywide natural experiment links built environment to physical activity. Nature 645, 407–413 (2025). https://doi.org/10.1038/s41586-025-09321-3
⁸ World Health Organization Regional Office for Europe. Heatwaves. WHO Europe. https://www.who.int/europe/health-topics/heatwaves
⁹ Fastl, C., Arnberger, A., Gallistl, V., Stein, V.K. & Dorner, T.E. (2024). Heat vulnerability: health impacts of heat on older people in urban and rural areas in Europe. Wiener Klinische Wochenschrift, 136, 507–514. https://doi.org/10.1007/s00508-024-02419-0
¹⁰ European Urban Initiative. TALEA – Green Cells Leading the Green Transition: Bologna. https://www.urban-initiative.eu/ia-cities/bologna/about-projects
¹¹ Beatrice Olivari, Piergiorgio Cipriano, Maurizio Napolitano, Luca Giovannini. Are Italian cities already 15-minute? Presenting the Next Proximity Index: A novel and scalable way to measure it, based on open data. Journal of Urban Mobility, Volume 4, 2023, 100057, ISSN 2667-0917, https://doi.org/10.1016/j.urbmob.2023.100057.
¹² Nishit Patel, Hoang-Ha Nguyen, Jet van de Geest, Alfred Wagtendonk, Mohan J.S. Raju, Payam Dadvand, Kees de Hoogh, Marta Cirach, Mark Nieuwenhuijsen, Thao Minh Lam, Jeroen Lakerveld. A Walk across Europe: Development of a high-resolution walkability index. Health & Place, Volume 96, 2025, 103544, ISSN 1353-8292, https://doi.org/10.1016/j.healthplace.2025.103544.
¹³ Xu, W., Zechner, M., Viknaraj Sivabalan, T., Low, L. L., Shon, C., Chen, H., Reuter, A., Turner, D., Tiilikainen, E., Kiyota, E., & Iwarsson, S. (2025). Towards evidence-based approaches to monitoring and evaluating age-friendly cities and communities: Reflections from the Western Pacific and Nordic Regions. Urban Studies, 0(0). https://doi.org/10.1177/00420980251375852
¹⁴ Scientific Foresight Unit (STOA) EPRS | European Parliamentary Research Service. Human exposome research – Potential, limitations and public policy implications.
https://www.europarl.europa.eu/RegData/etudes/STUD/2025/765791/EPRS_STU(2025)765791_EN.pdf