Balanced spatial distribution of green areas creates healthier urban landscapes.
The benefits of green infrastructure on human well-being in urban areas are already well-established, with strong evidence of the positive effects of the amount and proximity to green areas. However, the understanding of how the spatial distribution and type of green areas affect health is still an open question. Here, through a land sharing and sparing framework, we explore how different spatial configurations of green and built-up areas and how different types of green areas can affect cardiovascular and respiratory hospitalizations in São Paulo city, Brazil. Sharing/sparing indicators were selected as the main explanatory factors in the control of all groups of diseases. Land sharing appeared as a favourable spatial condition to prevent cardiovascular hospitalization, while land sparing and arboreal vegetation were relevant to reduce hospitalization by lower respiratory diseases. For upper respiratory diseases, forests seem to provide a disservice, once they were associated with increased rates of hospitalization by respiratory allergies causes. Considering that hospitalization rates and severity of cardiovascular diseases are substantially higher than those of upper respiratory ones, dense vegetation tends to provide more services than disservices. The land sharing configuration, which is characterized by green areas spread throughout the urban network (in streets, gardens, small squares or parks), should lead to higher exposure and use of the benefits of green areas, which may then explain the greater prevention of cardiovascular diseases. These novel results indicate that a more balanced distribution of green areas across built-up areas creates healthier urban spaces, and thus can be used as an urban planning strategy to leverage the health benefits provided by green infrastructure. Policy implications: Aiming to reduce hospitalizations by cardiovascular and pulmonary causes, urban planning should promote the spreading of green areas across the cities, in order to increase daily contact with natural attributes, giving preference to distribution over total quantity of green in urban landscape.