Urban aquatic ecosystems for human health and well-being - a scoping review

Identifying relevant, measurable health indicators is essential for targeting interventions and monitoring outcomes. Urban aquatic ecosystems (UAEs) provide ecosystem services, e.g. water-quality regulation, flood and temperature buffering, and contact with nature that are known to support physical and mental health. However, most articles focusing on UAEs examine environmental risks instead of human health outcomes. The aim of this scoping review was therefore to identify human health and well-being indicators associated with UAEs as reported in the literature and to map them to the WHO Global Reference List of Core Health Indicators.

A scoping review was conducted, including complementary desk research, following the Joanna Briggs Institute nine-phase method, from defining the objective to summarising the results. A literature search in three databases returned N = 5,099 records. Screening was done independently by the authors in two iterations; title/abstract and then full text using predefined inclusion and exclusion criteria. Thirty-two articles were selected.

Three health indicator domains within the health status category, one health status indicator group, and two risk related indicators associated with UAEs were identified. Within WHO's health status indicator category, health indicator domains mental health, physical health, well-being, as well as the indicator group cause-specific mortality were found. Within WHO's risk factor indicator category, the health indicators "age-standardised prevalence of insufficiently physically active persons aged 18+ years" and "age-standardised prevalence of overweight and obesity in persons aged 18 + years" were identified. Mental and physical health and well-being were mainly assessed through self-report, whereas disease-specific indicators (e.g. prevalence, mortality) were predominantly based on registry or clinical data.

This scoping review indicates that the available literature generally reports beneficial associations between UAEs and the identified health indicators, indicator group and domains; for example, improved mental and physical health, greater well-being, increased physical activity, and reduced mortality. The mapping points to several WHO-aligned indicators that merit further investigation, including those capturing potential negative impacts, such as water-related morbidity and mortality. To better assess hazards and causal pathways, future research should not only link environmental and health metrics, but do so using standardised, comparable indicators across studies and settings.