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.

Agència de Salut Pública de Barcelona 08023 Barcelona Spain

Centre for Radiation Chemical and Environmental Hazards Public Health England Chilton OX11 0RQ Oxon UK

Centre of Studies in Geography and Spatial Planning University of Coimbra 3004 530 Coimbra Portugal

CIBER Epidemiología y Salud Pública 28029 Madrid Spain

Department of Civil Engineering and Geoinformation Beuth University of Applied Sciences Berlin 13437 Berlin Germany

Department of Geography and Tourism University of Coimbra 3004 530 Coimbra Portugal

Department of Hygiene Epidemiology and Medical Statistics University of Athens Medical School 115 27 Athens Greece

Department of Public Health and Pediatrics University of Turin 10126 Turin Italy

Department of Social Geography and Regional Development Faculty of Science Charles University 128 43 Prague Czech Republic

Institut d'Investigació Biomèdica 08041 Barcelona Spain

Institute of Occupational Medicine Edinburgh EH14 4AP UK

Interface Demography University of Brussels 1050 Brussels Belgium

Karolinska Institutet Department of Public Health Sciences Division of Social Medicine 171 77 Stockholm Sweden

Medical School of the University of Turin University of Turin 10124 Turin Italy

The National Board of Health and Welfare 106 30 Stockholm Sweden

Universitat Pompeu Fabra 08002 Barcelona Spain

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