Population Health Inequalities Across and Within European Metropolitan Areas through the Lens of the EURO-HEALTHY Population Health Index.

Claudia Costa,Paula Santana,Evangelia Samoli,Nicolás Zangarini,Klea Katsouyanni,Carme Borrell,Diana Corman,Patrick Deboseree,Sotiris Vardoulakis,Christina Mitsakou,Marc Marí Dell’Olmo,Giuseppe Costa,Dagmar Dzurova,Sani Dimitroulopoulou,Jürgen Schweikart,Michala Lustigova,Ângela Freitas,Mercè Gotsens,Bo Burstrom

doi:10.3390/ijerph16050836

Abstract

The different geographical contexts seen in European metropolitan areas are reflected in the uneven distribution of health risk factors for the population. Accumulating evidence on multiple health determinants point to the importance of individual, social, economic, physical and built environment features, which can be shaped by the local authorities. The complexity of measuring health, which at the same time underscores the level of intra-urban inequalities, calls for integrated and multidimensional approaches. The aim of this study is to analyse inequalities in health determinants and health outcomes across and within nine metropolitan areas: Athens, Barcelona, Berlin-Brandenburg, Brussels, Lisbon, London, Prague, Stockholm and Turin. We use the EURO-HEALTHY Population Health Index (PHI), a tool that measures health in two components: Health Determinants and Health Outcomes. The application of this tool revealed important inequalities between metropolitan areas: Better scores were found in Northern cities when compared with their Southern and Eastern counterparts in both components. The analysis of geographical patterns within metropolitan areas showed that there are intra-urban inequalities, and, in most cities, they appear to form spatial clusters. Identifying which urban areas are measurably worse off, in either Health Determinants or Health Outcomes, or both, provides a basis for redirecting local action and for ongoing comparisons with other metropolitan areas.

Highlights

Health is a critical global development issue, especially in urban areas where the majority of the world’s population lives [1,2,3,4]
When the EURO-HEALTHY Population Health Index (PHI) was applied to the metropolitan areas, a geographical variation in the distribution of the value-scores was revealed across metropolitan areas in both components
Regardless of the above-mentioned limitations, the strength of this study is to show that geographical analysis is needed when investigating health inequalities

Summary

Introduction

Health is a critical global development issue, especially in urban areas where the majority of the world’s population lives [1,2,3,4]. The United Nations Sustainable Development Goals (SDG) put a focus on health promotion through a number of interconnected health-related targets like SDG-3 (good health and well-being), SDG-10 (reduced inequalities) and SDG-11 (sustainable cities and communities). These goals are achievable through multisectoral approaches, as stated in the New Urban Agenda [5,6,7]. The determinants of health are shaped by individual and political decisions and can be either positive health factors (e.g., economic security, adequate housing), protective (e.g., social support, healthy diet) or risk factors (e.g., pollution, smoking) [17]. The recent study on environmental public health indicators in European urban areas, within the framework of the EURO-HEALTHY project, explored this through the association between the health impacts and the physical and built environmental risks in order to support the prioritisation of interventions that improve public health and reduce avoidable deaths [18]

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