Rationale

Within the cities of Europe, there are many examples of inequalities in health between different social groups.  In all European countries, disadvantaged populations exhibit higher morbidity and mortality rates (Whitehead and Dahlgren, 2006).  Moreover, these inequalities have widened over the years (Marmot, 2007).

Evidence that sheds light on the processes occurring in urban areas is critical to understanding the economic, social and political transformations in a country.  This is particularly important given that the majority of the European population now inhabit  urban areas (UN, 2006; Kjellstrom, 2008).  Socio-economic inequalities in health tend to be larger in urban areas, where disadvantaged and poor populations are concentrated in marginalised neighbourhoods (Diez-Roux, 2007).  It is also important to consider the urban health policies and social interventions directed at these populations, as they are essential in tackling inequalities in health (Whitehead and Dahlgren, 2006).

Over the last two decades, the number of studies that consider geographical areas as a determinant of health have increased, probably due to a reawakened interest in the social and societal determinants of health (Marmot, 2007; Susser and Susser, 1996).  Furthermore, there are contextual factors of geographical areas that explain health outcomes independently of individual factors, such as the physical environment, the labour market, educational facilities, health care institutions and so forth (MacIntyre et al., 2002).

However, intra-urban inequalities in mortality have been infrequently analysed in European contexts (Borrell and Pasarin, 2004; van Lenthe et al., 2005; Stafford et al., 2004) and interventions to tackle urban inequalities in health and mortality in Europe have hardly been described (Mackenbach and Bakker, 2003).

The majority of the programs and publications on health inequality are focused at the country-level and are often based on individual level data (e.g., educational qualifications [Mackenbach, 2006]).  Moreover, policy analysis of interventions that aim to reduce inequalities in health have often been studied at the national level (Dahlgren and Whitehead, 2006).  For all of these reasons, INEQ-CITIES examined health inequalities in mortality within the small areas of 16 European cities, and analysed policies and programs that strive to reduce urban inequalities in health.  As such, this research has importance to researchers, practitioners, policy makers and the general population.

References

Borrell, C., and Pasarín, M. I. (2004) Inequalities in health and urban areas. Gaceta Sanitaria, 18 (1): 1-4.

Dahlgren, G., and Whitehead, M. (2006) European strategies for tackling social inequities in health. Concepts and principles for tackling social inequities in health. Levelling up (part 2).World Health Organization: Studies on social and economic determinants of population health nº 3, Denmark, 2006.

Diez-Roux, A. V., Green, F. T., Alazraqui, M., Spinelli, H. (2007) Intraurban variations in adult mortality in a large Latin American city. Journal of Urban Health, 84 (3): 319-33.

Kjellstrom, T. (2008) Our cities, our health, our future. WHO Commission on Social Determinants of Health from the Knowledge Network on Urban Settings Acting on social determinants for health equity in urban settings. WHO.

Macintyre, S., Ellaway, A., Cummins, S. (2002) Place effects on health: how can we conceptualise, operationalise and measure them? Social Science & Medicine, 55 (1): 125-39.

Mackenbach, J. P., Bakker, M. J. (2003) European Network on Interventions and Policies to Reduce Inequalities in Health. Tackling socioeconomic inequalities in health: analysis of European experiences. Lancet, 362 (9393): 1409-14.

Mackenbach, J. P. (2006) Health Inequalities: Europe in Profile. An independent, expert report commissioned by the UK Presidency of the EU.

Marmot, M. (2007) Commission on Social Determinants of Health. Achieving health equity: from root causes to fair outcomes. Lancet, 370 (9593): 1153-63.

Stafford, M., Martikainen, P., Lahelma, E., and Marmot, M. (2004) Neighbourhoods and self-rated health: a comparison of public sector employees in London and Helsinki. Journal of Epidemiology and Community Health, 58 (9): 772-8.

Susser, M., and Susser, E. (1996) Choosing a future for epidemiology: II. From black box to Chinese boxes and eco-epidemiology. American Journal of Public Health, 86 (5): 674-7.

UN-Habitat: State of the World's Cities 2008/2009: Harmonious Cities (PDF).

van Lenthe, F. J., Borrell, L. N., Costa, G., Diez-Roux, A. V., Kauppinen, T. M., Marinacci, C., Martikainen, P., Regidor, E., Stafford, M., Valkonen, T. (2005) Neighbourhood unemployment and all-cause mortality: a comparison of six countries. Journal of Epidemiology and Community Health, 59 (3): 231-7.

Whitehead, M., Dahlgren, G. (2006) Concepts and principles for tackling social inequities in health. Levelling up (part 1).World Health Organization: Studies on social and economic determinants of population health nº 2, Denmark.