• Air pollution: Cities experience greater air pollution due to traffic within and into cities, industrial activity, and the concentration of buildings. Traffic congestion is a major contributor to air pollution, and prolonged exposure to pollutants has been linked to both physical and mental health problems, including cognitive decline and heightened risk of psychiatric disorders. 
• Noise pollution: Cities are often louder than non-urban areas. Chronic exposure to urban noise pollution disrupts sleep, raises blood pressure, and activates the body’s stress response, leading to higher risks of cardiovascular disease, hypertension, and metabolic disorders. It also aggravates mental health conditions, increasing anxiety, depression, and psychological distress. Children may experience impaired cognitive development, lower reading comprehension, and behavioral problems. 
• Extreme weather: Urban infrastructure often has inadequate drainage systems and is particularly vulnerable to heavy rain and flooding, which are becoming more frequent and intense with climate change. The high population density and reliance on critical infrastructure in cities heightens the risks of disruption to power, water, food, sanitation, safety, economic vitality, and healthcare.
• Urban Heat Island Effect: Cities are often several degrees warmer than surrounding rural areas because of heat-absorbing surfaces like asphalt and concrete. The effect, intensified by climate change, increases the risk of heat-related illnesses, mortality, and psychiatric illness.

• Urban populations have higher prevalence rates of anxiety, depression, schizophrenia, and substance use disorders. 
• Noise from traffic, construction, and dense human activity contributes to stress and sleep disturbances, which can worsen mental health outcomes.
• Increased risk of traffic accidents and violence contributes to higher rates of trauma and chronic stress.
• Many urban residents have limited access to green spaces (parks, trees, and natural environments), which results in higher stress levels, reduced well-being, and psychological distress. Communities with fewer green spaces often experience higher temperatures, worse air quality, and greater psychological stress. Green amenities are unequally distributed, typically favoring wealthier neighborhoods. These disparities reinforce existing health inequities, as marginalized groups are less likely to have the protective benefits of urban greenery.
• Cities often have stark inequalities, with higher concentrations of unhoused and low socioeconomic status populations. They may lack adequate housing, healthcare, and social support. High density does not guarantee social cohesion, and segregation by race or income can result in isolation.

• Access to services: Urban residents typically have better access to healthcare, mental health services, and social support networks than those living in rural areas.
• Opportunities for connection: Proximity to cultural, recreational, and social activities can foster community and belonging.
• Cities may provide employment and educational opportunities that can buffer some of the negative impacts of urban stressors.

• Unhoused individuals: Cities have a higher prevalence of homelessness compared to rural areas due to the services and economic opportunities available. Unhoused individuals are at extreme risk of illness and death during heat waves due to hot asphalt, limited shelter and air conditioning, poor air quality, and violence. Estimates on the association between daily heat and mortality are 10 to 100 times higher for unhoused individuals compared to the general population. 
• Migrants and refugees: Both international and rural migrants often settle in cities in search of jobs, education, and better living conditions. Refugees and internally displaced persons, such as Syrian refugees in Beirut and Rohingya refugees in Bangladesh, are examples of urban migration. However, migrants may lack social support or urban job skills, leading to economic insecurity and vulnerability to mental health and climate risks. Moreover, the process of migration and displacement impact mental health and well-being. In India, as one example, climate-induced rural-to-urban migration further aggravates urban poverty and leads to challenging outcomes.
• People with mental illness may face barriers to mental health care, housing, and safety, especially in disaster situations. People with mental illness are also more susceptible to heat-related illness and more vulnerable in climate-driven disasters.

• Socioeconomic inequities: Lower-income and racial minority groups are disproportionately exposed to environmental hazards, crowded living conditions, and insufficient access to mental health services. 
• Limited access to nature: Disparities in green space and tree cover contribute to both physical and psychological stress since access to parks and natural environments is associated with improved well-being. 
• Inequities in exposure and response: The susceptibility to climate events and ability to respond (ie., access necessary services) is not evenly distributed, leaving the most vulnerable at greater risk.

The legacy of redlining and bluelining:

Originating in the 1930s, redlining was a policy in the United States that denied mortgages and investment to Black communities, creating segregated neighborhoods. The legacy of redlining persists today, resulting in disinvestment, limited access to green spaces, poor infrastructure, and lower social cohesion. Over time, redlined urban areas decay, and residents experience congested housing and a lack of cooling technology. Historically redlined areas experience compounded mental health burdens, and are correlated with higher rates of anxiety, depression, and emergency mental health visits, particularly among black residents and other marginalized groups. Recent bluelining practices, where finance and insurance companies restrict or withdraw services from neighborhoods deemed at high risk for climate disasters, have heightened vulnerability in these same urban communities. Bluelined areas often overlap with redlined neighborhoods, therefore disproportionately affecting low-income and communities of color. Residents in these areas thus face less access to resources and infrastructure to adapt to climate risks, and greater exposure to the mental and physical impacts of climate change.

What can we do to create equitable, sustainable cities and improve the health of urban populations?

Tackling the urban intersection of climate change and mental health requires integrating nature-based, technological, and social solutions. Effective implementation demands inclusive community participation, a strong emphasis on social justice, and tailored approaches specific to local urban contexts.

1. Urban design and nature-based solutions: Urban design serves as a foundational strategy that shapes how cities can adapt and mitigate the impacts of climate change and its effects on mental health.

• Implement biophilic design: Integrating green space, ecological restoration, and natural light into urban planning promotes environmental sustainability and psychological well-being. Expanding parks, green roofs, rain gardens, and tree coverage can significantly reduce the urban heat island effect, manage stormwater runoff, filter pollution, and improve community well-being. Biophilic design has been shown to lower stress, blood pressure, heart rate, chronic pain, fatigue, aggression and sadness, and improve cognitive functioning.
  • The Smart Surfaces program is an example of the benefits of improved urban design. Smart Surfaces are lighter in color to reflect sunlight, more porous to soak up rainfall, and involve more plants to improve air quality and heat.
• Create walkable neighborhoods: Urban design that encourages walking and social interaction, rather than car dependency, improves physical and mental health, fosters resilience, and reduces pollution.

2. Technological innovations: Cities can leverage technology to bolster resilience to climate change and improve mental health.

• Smart Climate Sensors monitor air quality and temperature, enabling timely interventions during extreme weather or pollution events.
• Energy-efficient infrastructure, such as energy-efficient appliances, reduces carbon emissions and improves urban health by lowering air pollution, respiratory illnesses, heat-related health risks, and stress on vulnerable populations.  
• Sustainable transportation, such as electric public transit, bike-sharing, and pedestrian-friendly streets reduces pollution and traffic. Transportation is needed both within and into cities and it should be accessible, safe, affordable, reliable, and frequent. Effective transportation reduces social isolation and improves access to resources for residents.

3. Social and policy approaches: Comprehensive policy measures and community-driven initiatives are essential for sustainable urban living.

• Sustainable land-use policy encourages compact, mixed-use development that can buffer cities from climate and health crises.
• Partnerships between local organizations and healthcare systems can ensure effective, locally-driven solutions. For example, during heat waves, safety areas such as malls, libraries, community centers, places of worship, and theaters have acted as “resilience hubs” to provide protection to dense populations. Publicly funded spaces often extend their hours during heat emergencies, and encouraging privately owned venues to do the same could greatly increase community protection.
• “Integrated Behavioral Health Models” links urban practitioners with mental health experts through tele-education, expanding the local capacity to manage complex psychiatric cases, especially for at-risk community members. One example is Project ECHO, which provides mentorship and training in health care, education, climate change.
• Enhanced case management provides greater outreach for vulnerable populations during heat waves and disasters. 
• Improving public health communications (ie., alert systems, awareness campaigns, and community storytelling) can foster broader policy changes and systems-level behavioral shifts. Developing alert systems that reach people with minimal technological access, such as for impoverished, elderly, or homeless populations, may require greater resources, but is necessary for keeping vulnerable populations safe and healthy. 
• Supporting community resilience: Resilience refers to the capacity of communities to anticipate, prepare, respond, and recover from adverse situations. Some examples include:
  • Community gardens foster food security, social cohesion, and mental well-being by providing green spaces and opportunities for engagement. 
  • Local programs and third spaces foster a sense of belonging and create resilience among residents. For example, the San Francisco Community Empowerment Center provides local residents with education, resources, and activities to foster health in their community.
  • Mutual aid and disaster response networks, such as local organizations and community-driven initiatives, support vulnerable neighbors during extreme weather, pandemics, or economic hardship. After Hurricane Katrina in New Orleans, local organizations and residents mobilized to provide food, shelter, and support, demonstrating the strength of community networks. Similarly, flooding in Bangladesh was met with community strength with the construction of raised homes and local warning systems, which have mitigated the impacts of recurrent flooding. 

The role of health professionals: Health professionals, including mental health and public health, are central to resilience-building. They must have climate change education integrated into their training, as they can:

• Implement trauma-informed care and support groups after disasters;
• Proactively screen for heat-related risks in psychiatric patients;
• Engage vulnerable populations in behavioral protective actions, such as how to survive extreme heat;
• Provide or promote nature prescriptions – prescribed time in parks and natural areas, resulting in improved mood, reduced stress, and increased physical activity among participants in places like Scotland and British Columbia. However, these only work where green spaces are available and accessible. 

Blog Post: Bluelining: How Climate Change is Driving an Insurance Crisis, published in Americans for Financial Reform on February 22, 2024, by Jessica Garcia

Hot temperatures will disrupt classes at Baltimore schools that lack air conditioning, published in CBS News on September 1, 2023, by Mike Hellgren

Extreme Heat May Substantially Raise Mortality Risk for People Experiencing Homelessness, published in Boston University School of Public Health, published on October 11, 2024 by Jillian McKoy

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Heat-Health Plans Overlook Mental Health Risks, published in Columbia Mailman School of Public Health on May 28, 2025 by Robbie Parks.

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How traffic noise hurts children’s brains, published in BBB on June 23, 2024, by Olivia Howitt

Is Bluelining the ‘New’ Redlining? How Insurance Discrimination Deepens Climate Disparities, published in Center for International Environmental Law by Lindsay Fenlock, on August 9, 2024.

Refugee and migrant mental health, published by the World Health Organization on September 1, 2025.

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Published: October 21, 2025

Author: Essence Roark, MPH Candidate at the Yale School of Public Health
LinkedIn: https://www.linkedin.com/in/essence-roark/ 

Editor: Colleen Rollins, PhD