Conceptualizing the nexus of human and nature health in cities: A spatial multidimensional assessment framework for urban planetary health

Urban areas lie at the center of global environmental change. As planetary boundaries are increasingly being breached and social foundations remain unmet, both human and nature's wellbeing are under threat. The health of humans and the environment on which they depend –increasingly recognized as planetary health—requires urgent attention, particularly within cities. However, achieving improvements in planetary health within urban areas requires a comprehensive assessment of its current state. This remains a challenge, due to the multidimensional nature of planetary health and the complexity of urban systems. This study aims to address this gap by developing a spatial multidimensional framework for assessing the state of urban planetary health that considers human and nonhuman natural systems as equals. To achieve this, a combined approach was followed. Building on planetary health literature synthesis and conceptual work to identify the critical aspects required for assessing urban planetary health, the framework was conceptualized based on 54 ecological and socioeconomic attributes that reflect two overarching dimensions: nature's wellbeing and human wellbeing. To operationalize the framework, a strategy based on Multi-Criteria Decision Analysis and conceptual categories to capture the attributes' feasibility and relevance to the interconnections between human and nature's wellbeing within planetary health was developed. This strategy ensures applicability, flexibility, and an equal representation of human and ecological dimensions across different spatial contexts. Overall, the urban planetary health assessment framework aims to support urban development, governance, and planning towards healthier and more sustainable cities for all living beings. As such, it contributes to addressing the gap in providing a comprehensive, evidence-based assessment of the state of planetary health within complex urban systems.