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Volume 16
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10.3390/ijerph16050836
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Article

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

by
Claudia Costa
1,*,
Paula Santana
1,2,
Sani Dimitroulopoulou
3,
Bo Burstrom
4,
Carme Borrell
5,6,7,8,
Jürgen Schweikart
9,
Dagmar Dzurova
10,
Nicolás Zangarini
11,
Klea Katsouyanni
12,
Patrick Deboseree
13,
Ângela Freitas
1,
Christina Mitsakou
3,
Evangelia Samoli
12,
Sotiris Vardoulakis
14,
Marc Marí Dell’Olmo
5,6,7,
Mercè Gotsens
5,6,7,8,
Michala Lustigova
10,
Diana Corman
15 and
Giuseppe Costa
16
1
Centre of Studies in Geography and Spatial Planning, University of Coimbra, 3004-530 Coimbra, Portugal
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
4
Karolinska Institutet, Department of Public Health Sciences, Division of Social Medicine, 171 77 Stockholm, Sweden
5
Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain
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
10
Department of Social Geography and Regional Development, Faculty of Science, Charles University, 128 43 Prague, Czech Republic
11
Department of Public Health and Pediatrics, University of Turin, 10126 Turin, Italy
12
Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, 115 27 Athens, Greece
13
Interface Demography, University of Brussels, 1050 Brussels, Belgium
14
Institute of Occupational Medicine, Edinburgh EH14 4AP, UK
15
The National Board of Health and Welfare, 106 30 Stockholm, Sweden
16
Medical School of the University of Turin, University of Turin, 10124 Turin, Italy
 
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Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2019, 16(5), 836; https://doi.org/10.3390/ijerph16050836
Received: 1 February 2019 / Revised: 25 February 2019 / Accepted: 2 March 2019 / Published: 7 March 2019
(This article belongs to the Special Issue Social Determinants and Geographic Disparities in Health and Health Care)
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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. View Full-Text
Keywords: Population Health Index; Europe; metropolitan areas; health determinants; health outcomes; municipalities Population Health Index; Europe; metropolitan areas; health determinants; health outcomes; municipalities
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MDPI and ACS Style

Costa, C.; Santana, P.; Dimitroulopoulou, S.; Burstrom, B.; Borrell, C.; Schweikart, J.; Dzurova, D.; Zangarini, N.; Katsouyanni, K.; Deboseree, P.; Freitas, Â.; Mitsakou, C.; Samoli, E.; Vardoulakis, S.; Marí Dell’Olmo, M.; Gotsens, M.; Lustigova, M.; Corman, D.; Costa, G. Population Health Inequalities Across and Within European Metropolitan Areas through the Lens of the EURO-HEALTHY Population Health Index. Int. J. Environ. Res. Public Health 2019, 16, 836. https://doi.org/10.3390/ijerph16050836

AMA Style

Costa C, Santana P, Dimitroulopoulou S, Burstrom B, Borrell C, Schweikart J, Dzurova D, Zangarini N, Katsouyanni K, Deboseree P, Freitas Â, Mitsakou C, Samoli E, Vardoulakis S, Marí Dell’Olmo M, Gotsens M, Lustigova M, Corman D, Costa G. Population Health Inequalities Across and Within European Metropolitan Areas through the Lens of the EURO-HEALTHY Population Health Index. International Journal of Environmental Research and Public Health. 2019; 16(5):836. https://doi.org/10.3390/ijerph16050836

Chicago/Turabian Style

Costa, Claudia, 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, and Giuseppe Costa. 2019. "Population Health Inequalities Across and Within European Metropolitan Areas through the Lens of the EURO-HEALTHY Population Health Index" International Journal of Environmental Research and Public Health 16, no. 5: 836. https://doi.org/10.3390/ijerph16050836

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