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Fresher - FoResight and Modelling for European HEalth Policy and Regulation Project 

Horizon 2020

  Horizon 2020


More than half of the world population lives in cities and this percentage will increase to 70% by 2050. In Europe, these percentages are higher1-3. Socioeconomic inequalities in health tend to be larger in urban areas with disadvantaged and poor populations being concentrated in marginalized neighbourhoods, usually inner city areas, and having higher incidence of many diseases3. However, the evolution of intraurban inequalities in health and specifically in mortality have been few analysed in European contexts and specially the changes that have occurred during the economic crisis that started in 2008. For this reason, one of the objectives of this WP is to analyse the evolution of socioeconomic inequalities in mortality in nine metropolitan areas. Moreover, the WP reviews and identifies indicators to be included in the Population Health Index.

● To identify, in the literature, the socioeconomic and lifestyle/behaviours determinants that influence population health and wellbeing and, to assess the availability of data needed to construct these indicators to be used in the Population Health Index, between 2000 and 2015 across Europe, particularly in selected metropolitan areas;
● To collect socioeconomic and mortality data for small areas of metropolitan areas / cities;
● To analyse the evolution of socioeconomic inequalities in mortality in nine metropolitan areas.

For this, we reviewed scientific articles published in several scientific databases and also key reports on socioeconomic inequalities in health in order to find socioeconomic indicators (including cultural and demographic) and lifestyle/behaviours risk factors relevant to monitor health inequalities. In addition, we prepared a manual so that each focal point collected socioeconomic, mortality and population data for small areas of the respective cities or metropolitan areas, for a fifteen year period, in a harmonised way. To analyse the evolution of socioeconomic inequalities in mortality we performed an ecological study of trends based on three periods (2000-2003, 20042008 and 2009-2014). The units of analysis were the small areas of nine European cities/metropolitan areas (Athens Metropolitan Area, Barcelona, Berlin plus Brandenburg, Brussels-Capital Region, Lisbon Metropolitan Area, London, Prague, Stockholm and Turin).

A list of identified indicators in the literature is provided. The maps show that in most of the cities and for most of the causes, the distribution of the composite deprivation indicator is similar to the distribution of mortality. Socioeconomic inequalities in mortality are more important for men than for women and they tend to be stable through the years.

The majority of indicators of economic and social environment and demographic change are not available at small area level as, for example, municipalities or even inside the cities. This disaggregation would be very useful. Indicators of the built environment are not easy to define and therefore it is necessary to improve them and to have more sources of information as, for example, those referred to urban regeneration, green spaces, mobility, etc. Lifestyles are well measured through health interview surveys, but these data are available at country level. It is necessary to increase the sample sizes of the surveys in order to have data at small area level (e.g. regions, cities). Usually data on mortality are not easy to be obtained at small area level inside the cities. This information should be available to monitor trends in mortality inequalities in cities. Socioeconomic inequalities in mortality have to be reduced implementing specific policies focussed on the main determinants of health.

1. UN HABITAT. State of the World´s Cities 2010/2011: Bridging the Urban Divide. London, United Kingdom: UN-HABITAT; 2010.
2. WHO/UN HABITAT. Hidden Cities: Unmasking and Overcoming Health Inequities in Urban Settings; Switzerland: 2010.
3. WHO. Global Report on Urban Health: Equitable, Healthier Cities for Sustainable Development; Switzerland: WHO Press; 2016.

PREPARED BY Carme Borrell 1, Laia Palència 1, Mercè Gotsens 1, Marc Marí Dell’Olmo 1, Maica Rodríguez-Sanz 1, Lucia Bosáková 2, Katarína Rosičová 2, Zuzana Hajduová 2, Marleta Seidlova 3, Michala Lustigova 3 and Dagmar Dzurova 3
1 Agència de Salut Pública de Barcelona (ASPB); 2 University of Economics in Bratislava (EUBA); 3 Charles University (CUP)

Page last modified on 21 dec 17 13:41