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


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          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.

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          Most cited references46

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          City planning and population health: a global challenge

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            Urban as a Determinant of Health

            Cities are the predominant mode of living, and the growth in cities is related to the expansion of areas that have concentrated disadvantage. The foreseeable trend is for rising inequities across a wide range of social and health dimensions. Although qualitatively different, this trend exists in both the developed and developing worlds. Improving the health of people in slums will require new analytic frameworks. The social-determinants approach emphasizes the role of factors that operate at multiple levels, including global, national, municipal, and neighborhood levels, in shaping health. This approach suggests that improving living conditions in such arenas as housing, employment, education, equality, quality of living environment, social support, and health services is central to improving the health of urban populations. While social determinant and multilevel perspectives are not uniquely urban, they are transformed when viewed through the characteristics of cities such as size, density, diversity, and complexity. Ameliorating the immediate living conditions in the cities in which people live offers the greatest promise for reducing morbidity, mortality, and disparities in health and for improving quality of life and well being.
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              Urban health in developing countries: what do we know and where do we go?

              The world became mainly urban in 2007. It is thus timely to review the state of knowledge about urban health and the current priorities for research and action. This article considers both health determinants and outcomes in low-income urban areas of developing countries. The need to study urban health in a multi-level and multi-sectoral way is highlighted and priorities for research are identified. Interventions such as the Healthy Cities project are considered and obstacles to the effective implementation of urban health programmes are discussed. Concepts such as the double burden of ill health and the urban penalty are re-visited. Finally, a call for a shift from 'vulnerability' to 'resilience' is presented.

                Author and article information

                Int J Environ Res Public Health
                Int J Environ Res Public Health
                International Journal of Environmental Research and Public Health
                07 March 2019
                March 2019
                : 16
                : 5
                : 836
                [1 ]Centre of Studies in Geography and Spatial Planning, University of Coimbra, 3004-530 Coimbra, Portugal; paulasantana.coimbra@ 123456gmail.com (P.S.); angelafreitas30@ 123456gmail.com (Â.F.)
                [2 ]Department of Geography and Tourism, University of Coimbra, 3004-530 Coimbra, Portugal
                [3 ]Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Chilton OX11 0RQ, Oxon, UK; Sani.Dimitroulopoulou@ 123456phe.gov.uk (S.D.); Christina.Mitsakou@ 123456phe.gov.uk (C.M.)
                [4 ]Karolinska Institutet, Department of Public Health Sciences, Division of Social Medicine, 171 77 Stockholm, Sweden; bo.burstrom@ 123456sll.se
                [5 ]Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; cborrell@ 123456aspb.cat (C.B.); mmari@ 123456aspb.cat (M.M.D.); mgotsens@ 123456aspb.cat (M.G.)
                [6 ]CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
                [7 ]Institut d’Investigació Biomèdica (IIB Sant Pau), 08041 Barcelona, Spain
                [8 ]Universitat Pompeu Fabra, 08002 Barcelona, Spain
                [9 ]Department of Civil Engineering and Geoinformation, Beuth University of Applied Sciences Berlin, 13437 Berlin, Germany; schweikart@ 123456beuth-hochschule.de
                [10 ]Department of Social Geography and Regional Development, Faculty of Science, Charles University, 128 43 Prague, Czech Republic; dagmar.dzurova@ 123456natur.cuni.cz (D.D.); michala.lustigova@ 123456gmail.com (M.L.)
                [11 ]Department of Public Health and Pediatrics, University of Turin, 10126 Turin, Italy; nicolas.zengarini@ 123456epi.piemonte.it
                [12 ]Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, 115 27 Athens, Greece; kkatsouy@ 123456med.uoa.gr (K.K.); esamoli@ 123456med.uoa.gr (E.S.)
                [13 ]Interface Demography, University of Brussels, 1050 Brussels, Belgium; patrick.deboosere@ 123456vub.ac.be
                [14 ]Institute of Occupational Medicine, Edinburgh EH14 4AP, UK; Sotiris.Vardoulakis@ 123456iom-world.org
                [15 ]The National Board of Health and Welfare, 106 30 Stockholm, Sweden; diana.corman@ 123456socialstyrelsen.se
                [16 ]Medical School of the University of Turin, University of Turin, 10124 Turin, Italy; giuseppe.costa@ 123456epi.piemonte.it
                Author notes
                Author information
                © 2019 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                : 01 February 2019
                : 02 March 2019

                Public health
                population health index,europe,metropolitan areas,health determinants,health outcomes,municipalities


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