Using Conceptual Models to Shape Healthy Sustainable Cities

  • George Morris
  • Brigit Staatsen
  • Nina van der Vliet


In the context of relentless global urbanisation, and with most of the world’s population already living in cities, the urban environment retains its historic status as a key arena for public health policy and action. The concept of Ecological Public Health emphasises the interconnections between humans and the natural world and the reality that health, wellbeing, equity and indeed humanity’s survival rely on natural systems and processes. This chapter discusses conceptual models to support policy and action in environmental health but, especially, to deliver ecological public health in the urban context. One ‘family’ of conceptual models, the DPSEEA model and its derivatives, is particularly suited to this role as it offers an integrated and policy-relevant conceptualisation of the relationship between human activity, the physical environment, and health. The chapter illustrates a number of conceptual models and emphasises their utility as tools with which to think, communicate and deliver when addressing public health and societal challenges of unprecedented complexity. Only by developing and applying the correct tools can we confront the challenges of the urban context and design policies that create a healthier, more sustainable and more equal world.


  1. Agenda Stad. (2016). Verslag Werkconferentie Agenda Stad. Retrieved from
  2. Arsenio E, Martens K, Di Ciommo F. (2016) Sustainable urban mobility plans: Bridging climate change and equity targets? Res Transp Econ (55):30-9. In: Staatsen B, van der Vliet N, Kruize H, et al. (2017) INHERIT: Exploring triple-win solutions for living, moving and consuming that encourage behavioural change, protect the environment, promote health and health equity. EuroHealthNet, BrusselsCrossRefGoogle Scholar
  3. Box, G. E. P. (1979). Robustness in the strategy of scientific model building. In R. L. Launer & G. N. Wilkinson (Eds.), Robustness in statistics (pp. 201–236). New York: Academic Press.CrossRefGoogle Scholar
  4. Braubach, M., Jacobs, D. E., & Ormandy, D. (2011). Environmental burden of disease associated with inadequate housing. Copenhagen: WHO Regional Office Europe. Retrieved from Scholar
  5. Briggs, D., Corvalan, C., & Nurminen, M. (1996). Linkage methods for environmental health analysis: General guidelines. Geneva: World Health Organisation.Google Scholar
  6. Carmichael, L., Racioppi, F., Calvert, T., & Sinnett, D. (2017). Environment and health for European cities in the 21st century: Making a difference. Geneva: WHO.Google Scholar
  7. Corvalán, C., Briggs, D., Briggs, D. J., & Zielhuis, G. (2000). Decision-making in environmental health: From evidence to action. New York: Taylor & Francis.CrossRefGoogle Scholar
  8. Coutts, C., Forkink, A., & Weiner, J. (2014). The portrayal of natural environment in the evolution of the Ecological Public Health Paradigm. International Journal of Environmental Research and Public Health, 11(1), 1005–1019.CrossRefGoogle Scholar
  9. Dahlgren, G., & Whitehead, M. (1991). Policies and strategies to promote social equity in health. Stockholm (Mimeo): Institute for Future Studies.Google Scholar
  10. Egan, J. (2004). The Egan review: Skills for sustainable communities. London: Office of the Deputy Prime Minister.Google Scholar
  11. European Environmental Agency (EEA). (2015). The European Environment - State and Outlook (SOER) 2015. A comprehensive assessment of European environment’s state, trends, prospects, in a global context. Copenhagen: EEA.Google Scholar
  12. European Commission. (2015). The EU Urban Agenda [Factsheet]. Retrieved from
  13. European Commission. (2016). Urban agenda for the EU ‘Pact of Amsterdam’. Brussels: EU. Retrieved from Scholar
  14. Evans, R. G., & Stoddart, G. L. (1990). Producing health, consuming health care. Social Science & Medicine, 31(12), 1347–1363.CrossRefGoogle Scholar
  15. FRESH Consortium. (2014a). Climate change leaflet. Copenhagen: EEA. Retrieved from Scholar
  16. FRESH Consortium. (2014b). Housing leaflet. Copenhagen: EEA. Retrieved from Scholar
  17. FRESH Consortium. (2015a). FRESH brochure. Copenhagen: EEA. Retrieved July, 2017, from Scholar
  18. FRESH Consortium. (2015b). A Europe to thrive in – Environment, health and well-being. Copenhagen: EEA. Retrieved from Scholar
  19. FRESH Consortium. (2015c). Transport leaflet. Copenhagen: EEA. Retrieved from Scholar
  20. Gee, G. C., & Payne-Sturges, D. C. (2004). Environmental health disparities: A framework integrating psychosocial and environmental concepts. Environmental Health Perspectives, 112(17), 1645–1653.CrossRefGoogle Scholar
  21. Hartig, T., Mitchel, R., de Vries, S., & Frumkin, H. (2014). Nature and health. Annual Review of Public Health, 35, 207–228.CrossRefGoogle Scholar
  22. Kjellstrom, T., & Corvalan, C. (1995). Framework for the development of environmental health indicators. World Health Statistics Quarterly, 48, 144–154.Google Scholar
  23. Lalonde, M. (1974). A conceptual framework for health. RNAO News, 30(1), 5–6.Google Scholar
  24. McIntosh, B. S., Seaton, R. A., & Jeffrey, P. (2007). Tools to think with? Towards understanding the use of computer-based support tools in policy relevant research. Environmental Modelling and Software, 22(5), 640–648.CrossRefGoogle Scholar
  25. Millennium Ecosystem Assessment. (2005). Ecosystems and human well-being: Synthesis. Washington: Island Press.Google Scholar
  26. Morris, G. P., Beck, S. A., Hanlon, P., & Robertson, R. (2006). Getting strategic about the environment and health. Journal of Public Health, 120(10), 889–903.CrossRefGoogle Scholar
  27. Morris, G., Reis, S., Beck, S., Fleming, L. E., Adger, W. N., Benton, T. G., et al. (2015). Health Climate Change impacts report card technical paper No.10. Climate change and health in the UK. Scoping and communicating the longer-term “distal” dimensions. Swindon: Natural Environment Research Council. Retrieved January 5, 2017, from Scholar
  28. Morris G, Saunders P (2017) The environment in health and well-being. Oxford Research Encyclopedia of Environmental Science. Retrieved January 5, 2017, from Scholar
  29. Michie, S., et al. (2011). The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implementation Science, 6, 42.CrossRefGoogle Scholar
  30. Platform Healthy Design/Platform Gezond Ontwerp. (2013). Magazine Gezond Ontwerp. Eindhoven: Technische Universiteit Eindhoven.Google Scholar
  31. Pruss Ustun, A., Wolf, J., Corvalan, C., et al. (2016). Diseases due to unhealthy environments: An updated estimate of the global burden of disease attributable to environmental determinants of health. Journal of Public Health, 1–12.
  32. Rayner, G., & Lang, T. (2012). Reshaping the conditions for good health. Oxford: Routledge Publishers.Google Scholar
  33. Reis, S., Morris, G., Fleming, L. E., et al. (2015). Integrating health and environmental impact analysis. Journal of Public Health, 129(10), 1383–1389.CrossRefGoogle Scholar
  34. Rockström, J., Steffen, W., Noone, K., et al. (2009). A safe operating space for humanity. Nature, 461(7263), 472–475.CrossRefGoogle Scholar
  35. Steffen, W., Richardson, K., Rockström, J., et al. (2015). Planetary boundaries: Guiding human development on a changing planet. Science, 347(6223), 1259855.CrossRefGoogle Scholar
  36. Schram-Bijkerk, D., Kruize, H., Staatsen, B., & van Kamp, I. (2016). Modellen plaveien de weg naar een gezonde stad. Tijdschrift Milieu-Dossier, 22(6), 43–47. Retrieved from Scholar
  37. Staatsen, B., van der Vliet, N., Kruize, H., et al. (2017). INHERIT: Exploring triple-win solutions for living, moving and consuming that encourage behavioural change, protect the environment, promote health and health equity. Brussels: EuroHealthNet.Google Scholar
  38. Scottish Government. (2008). Good places, better health. A new approach to environment and health in Scotland. Edinburgh: Scottish Government.Google Scholar
  39. Scottish Government. (2012). Good places better health for Scotland’s children. Edinburgh: Scottish Government.Google Scholar
  40. Susser, M., & Susser, E. (1996). Choosing a future for epidemiology: I. Eras and paradigms. American Journal of Public Health, 86(5), 668–673.CrossRefGoogle Scholar
  41. United Nations. (2015). Sustainable development goals. New York: United Nations. Retrieved from Scholar
  42. United Nations (UN). (2016). The New Urban agenda. Adopted at the United Nations Conference on Housing and sustainable urban development on 20 October 2016 (Habitat III). Nairobi: Habitat. Retrieved from
  43. World Health Organization (WHO). (2017). Environment and health in Europe: Status and perspectives. Copenhagen: WHO Regional Office Europe. Retrieved from Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • George Morris
    • 1
  • Brigit Staatsen
    • 2
  • Nina van der Vliet
    • 2
  1. 1.European Centre for Environment and Human HealthUniversity of ExeterExeterUK
  2. 2.National Institute for Public Health and the EnvironmentBilthovenThe Netherlands

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