Urban areas in Europe are facing a range of environmental public health challenges, such as air pollution, traffic noise and road injuries. The identification and quantification of the public health risks associated with exposure to environmental conditions is important for prioritising policies and interventions that aim to diminish the risks and improve the health of the population. With this purpose in mind, the EURO-HEALTHY project used a consistent approach to assess the impact of key environmental risk factors and urban environmental determinants on public health in European metropolitan areas. A number of environmental public health indicators, which are closely tied to the physical and built environment, were identified through stakeholder consultation; data were collected from six European metropolitan areas (Athens, Barcelona, Lisbon, London, Stockholm and Turin) covering the period 2000-2014, and a health impact assessment framework enabled the quantification of health effects (attributable deaths) associated with these indicators. The key environmental public health indicators were related to air pollution and certain urban environmental conditions (urban green spaces, road safety). The air pollution was generally the highest environmental public health risk; the associated number of deaths in Athens, Barcelona and London ranged between 800 and 2300 attributable deaths per year. The number of victims of road traffic accidents and the associated deaths were lowest in the most recent year compared with previous years. We also examined the positive impacts on health associated with urban green spaces by calculating reduced mortality impacts for populations residing in areas with greater green space coverage; results in Athens showed reductions of all-cause mortality of 26 per 100,000 inhabitants for populations with benefits of local greenspace. Based on our analysis, we discuss recommendations of potential interventions that could be implemented to reduce the environmental public health risks in the European metropolitan areas covered by this study.

Agencia de Salut Publica de Barcelona Spain; CIBER Epidemiología y Salud Pública Madrid Spain

Beuth University of Applied Sciences Berlin Germany

Centre for Radiation Chemical and Environmental Hazards Public Health England UK

Centre for Radiation Chemical and Environmental Hazards Public Health England UK; Environmental Change Institute University of Oxford UK

Centre for Radiation Chemical and Environmental Hazards Public Health England UK; Institute of Occupational Medicine UK

Centre of Studies in Geography and Spatial Planning Department of Geography and Tourism University of Coimbra Portugal

Consorzio per il Sistema Informativo CSI Piemonte Italy

Department of Atmospheric Physics School of Physics National and Kapodistrian University of Athens Greece

Department of Hygiene Epidemiology and Medical Statistics Medical School National and Kapodistrian University of Athens Greece

Department of Sociology Vrije Universiteit Brussels Belgium

Faculty of Science Charles University Czechia

Karolinska Institutet Sweden

Swiss Tropical and Public Health Institute Basel Switzerland; University of Basel Basel Switzerland

UK Small Area Health Statistics Unit MRC PHE Centre for Environment and Health Imperial College London UK

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Health Disparities in Czechia and Portugal at Country and Municipality Levels

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