Population health inequalities across and within european metropolitan areas through the lens of the euro-healthy population health index

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

Research output: Contribution to journalArticlepeer-review

26 Citations (Scopus)


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.

Original languageEnglish
Article number836
Pages (from-to)1-17
Number of pages17
JournalInternational Journal of Environmental Research and Public Health
Issue number5
Publication statusPublished - 1 Mar 2019
Externally publishedYes


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