Toward integrating subjective well-being in environmental health impact assessments for healthy urban living: a conceptual and methodological exploration

INTRODUCTION: Environmental Health Impact Assessments (HIAs) can inform decisions about the health effects of policy-related changes in environmental exposures. Conventional health impact metrics, focusing on mortality, morbidity, and disability, neglect subjective well-being. We explored the need and feasibility of integrating well-being indicators such as happiness and life satisfaction into quantitative environmental HIAs. METHODS: Building on a multidisciplinary expert workshop and existing literature, we addressed (1) definitions and indicators of well-being, (2) pathways linking environmental exposures (air pollution, noise, extreme temperatures, and green space) to well-being, and (3) the strength of epidemiological evidence for these associations. We evaluated the challenges of integrating well-being indicators into environmental HIAs, and provided an exploratory example. RESULTS: We argue that including well-being in HIAs offers a more comprehensive view of health, aligning with policy goals focused on enhancing citizen's well-being. The literature identifies plausible pathways linking exposures to well-being, whilst epidemiological evidence for associations between environmental exposures and well-being is limited, but suggestive. We propose conducting exploratory HIAs integrating well-being, especially for green space (n = 16 epidemiological studies) and air pollution (n = 18). We outline two practical integration strategies: (1) report well-being impacts separately as Well-being-Adjusted Life Years, and (2) incorporate well-being into existing health indicators such as Quality-Adjusted Life Years or Disability-Adjusted Life Years. CONCLUSIONS: Inclusion of well-being into quantitative environmental HIAs presents a more comprehensive representation of health and well-being beyond indicators focusing on morbidity and mortality. However, the epidemiological evidence base regarding environmental exposures and well-being warrants further expansion.