Abstract
Across the United States, cities are creating sustainability and climate action plans (CAPs) that call to increase local vegetation. These greening initiatives have the potential to not only benefit the environment but also human health. In epidemiologic literature, greenness has a protective effect on mortality through various direct and indirect pathways. We aimed to assess how an increase in greenness could decrease mortality in the largest urban areas in the United States. We conducted a nationwide quantitative health impact assessment to estimate the predicted reduction in mortality associated with an increase in greenness across two decades (2000, 2010, and 2019). Using a recently published exposure-response function, Landsat 30 m 16-day satellite imagery from April to September, and publicly available county-level mortality data from the CDC, we calculated the age-adjusted reduction in all-cause mortality for those 65 years and older within 35 of the most populated metropolitan areas. We estimated that between 34,000 and 38,000 all-cause deaths could have been reduced in 2000, 2010, and 2019 with a local increase in green vegetation by 0.1 unit across the most populated metropolitan areas. We found that overall greenness increased across time with a 2.86% increase from 2000 to 2010 to 11.11% from 2010 to 2019. These results can be used to support CAPs by providing a quantitative assessment to the impact local greening initiatives can have on mortality. Urban planners and local governments can use these findings to calculate the co-benefits of local CAPs through a public health lens and support policy development.