Abstract
Background: About 2/3 of the Europeans reside in cities. Thus, we must expand our knowledge on how city characteristics affect health and well-being. Perceptions about cities' resources and functioning might be related with health, as they capture subjective experiences of the residents. We characterized the health status of 74 European cities, using all-cause mortality as indicator, and investigated the association of mortality with residents' dissatisfaction with key domains of urban living.Methods: We considered 74 European cities from 29 countries. Aggregated data on residents' dissatisfaction was obtained from the Flash Eurobarometer, Quality of life in European cities (2004–2015). For each city a global dissatisfaction score and a dissatisfaction score by domain (environment, social, economic, healthcare, and infrastructures/services) were calculated. Data on mortality and population was obtained from the Eurostat. Standardized Mortality Ratios, SMR, and 95% Confidence Intervals (95% CI) were calculated. The association between dissatisfaction scores and SMR was estimated using Generalized Linear Models.Results: SMR varied markedly (range: 73.2–146.5), being highest in Eastern Europe and lowest in the South and Western European cities. Residents' dissatisfaction levels also varied greatly. We found a significant association between city SMR and residents' dissatisfaction with healthcare (β = 0.334; IC 95% 0.030–0.639) and social environment (β = 0.239; IC 95% 0.015–0.464). No significant association was found with the dissatisfaction scores related with the physical and economic environment and the infrastructures/services.Conclusions: We found a significant association between city levels of mortality and residents' dissatisfaction with certain urban features, suggesting subjective assessments can be also used to comprehend urban health.
Highlights
Urbanization is probably one of the most important demographic phenomena of our times (Galea and Vlahov, 2005)
In Model 0, we looked for the bivariate associations between each dissatisfaction score, region and Standardized Mortality Ratios (SMR) and we found that only the dissatisfaction score with healthcare (β = 0.286; 95% Confidence Intervals (95% Confidence Intervals (CI)) 0.065, 0.507) was significantly associated with the SMR, all other regression coefficients were positive, indicating that increased dissatisfaction with cities’ attributes was associated with increased mortality
We found profound differences in mortality across 74 cities in Europe, with the highest risk of death generally found in Eastern and Northern Europe and the lowest in the South and Western European cities
Summary
Urbanization is probably one of the most important demographic phenomena of our times (Galea and Vlahov, 2005). An. Dissatisfaction and Mortality in Europe healthy city is “one that is continually creating and improving those physical and social environments and expanding those community resources which enable people to mutually support each other in performing all the functions of life and developing to their maximum potential” (WHO-EUROPE, 1995), which, promotes human health and urban sustainability (Portney and Sansom, 2017). Dissatisfaction and Mortality in Europe healthy city is “one that is continually creating and improving those physical and social environments and expanding those community resources which enable people to mutually support each other in performing all the functions of life and developing to their maximum potential” (WHO-EUROPE, 1995), which, promotes human health and urban sustainability (Portney and Sansom, 2017) This multifaceted definition implies that cities must offer health-supportive physical and socioeconomic environments and adequate access to infrastructures and services, which, according to several conceptual models, represent the main determinants of population health within urban contexts (Galea and Vlahov, 2005). We characterized the health status of 74 European cities, using all-cause mortality as indicator, and investigated the association of mortality with residents’ dissatisfaction with key domains of urban living
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