Background: Urban environments provide both restorative natural areas (e.g., greenspace, bluespace) and exposure to stressors (e.g., air and noise pollution) yet these have typically been studied in isolation. Understanding their differential impact on mental and physical health is crucial for public health and urban planning as these decisions create both health-promoting and -damaging environments. Methods: Using a longitudinal epidemiological dataset (2011-2020) from 835 residents of Leipzig, Germany, we investigate the impact of surrounding green and blue space, along with exposure to air and noise pollution, on four key indicators of mental and physical health, i.e., symptoms of anxiety and depression as well as systolic blood pressure and body mass index over time. We compare five Bayesian mixed models to assess the differentiated effects of urban environmental exposure on health outcomes. Results:  Greater cover of nearby green space (within 100m radius of a person’s residence) was associated with reduced symptoms of depression and body mass index (BMI) over time. Increased tree canopy cover was associated with reduced symptoms of anxiety in participants, but only for those with higher socioeconomic status. Sociodemographic factors, particularly older age, female sex and lower socioeconomic status, were consistently associated with worse mental and physical health outcomes. Conclusions: Results indicate that natural and urban environmental exposures can impact mental and physical health with pronounced effects accruing over time. These findings highlight that to improve public health, nature-based solutions should be addressed together with urban stressors. Improving surrounding natural greenspace for urban residents is not sufficient without also addressing long-term exposure to noise pollution.