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JustGreen: Health impact assessment of urban vegetation across the 200 most populated US cities
Journal article   Peer reviewed

JustGreen: Health impact assessment of urban vegetation across the 200 most populated US cities

David Rojas-Rueda, Michelle C. Kondo and Daniel Carver
Landscape and urban planning, v 277, 105764
01 Jan 2027
DOI: https://doi.org/10.1016/j.landurbplan.2026.105764
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Abstract

Environmental Sciences & Ecology Geography, Physical Life Sciences & Biomedicine Regional & Urban Planning Science & Technology Ecology Environmental Studies Geography Physical Geography Physical Sciences Public Administration Social Sciences Urban Studies
Urban vegetation provides substantial health benefits in US cities, yet the protection that existing green cover delivers has not been quantified across a broad national sample. We conducted a census-tract-level health impact assessment across the 200 most populated US cities, estimating premature deaths, stroke cases, and dementia cases attributable to current greenness and the additional burden preventable through a 10% greenness increase. Using peak-greenness Normalized Difference Vegetation Index (NDVI) values derived from Sentinel-2 satellite imagery at 10 m resolution, population attributable fractions applied to county- and state-level baseline disease rates, and dose-response functions from published cohort studies and meta-analyses, we estimated that existing urban vegetation is associated with 133,698 fewer premature deaths annually (95% uncertainty interval [UI]: 97,056 to 214,462), 24,721 fewer stroke cases (95% UI: 11,700 to 31,784), and 16,349 fewer dementia cases (95% UI: 10,609 to 22,403). A 10% vegetation increase would be associated with an additional 18,100 fewer deaths, 3,288 fewer strokes, and 2,125 fewer dementia cases. Per-capita benefits vary 14-fold across cities, driven principally by vegetation level. Equity analysis using the CDC Social Vulnerability Index across 28,620 census tracts shows that the most socially vulnerable neighborhoods have 18% lower vegetation and receive 20% fewer mortality benefits per 100,000 adults than the least vulnerable. These estimates represent the statistical burden attributable to current vegetation exposure rather than individually identifiable prevented events, and they quantify what is at risk when existing urban green space is removed. We identify 4,185 doubly burdened tracts as priority targets for equitable greening investment.

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