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Factors and processes influencing health inequalities in urban areas
  1. Carme Borrell1,2,3,4,
  2. Mariona Pons-Vigués1,4,5,6,
  3. Joana Morrison1,3,4,
  4. Èlia Díez1,3,4
  1. 1Department of Experimental and Health Sciences, Agència de Salut Pública de Barcelona, Barcelona, Spain
  2. 2Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain
  3. 3Department of Experimental and Health Sciences, CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
  4. 4Preventive Interventions and Programs Service, Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
  5. 5Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
  6. 6Nursing Department, Universitat de Girona, Girona, Spain
  1. Correspondence to Dr Carme Borrell, Agència de Salut Pública de Barcelona, Plaça Lesseps 1, Barcelona 08023, Spain; cborrell{at}

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In 2010, half of the world's population lived in cities, reaching three quarters in Europe.1 ,2 Health inequalities tend to be more marked in urban areas because they include neighbourhoods which concentrate deprived and poor populations. A number of scholars with a long tradition in studying ‘place effects and health’,3 ,4 ‘neighbourhoods and health’5 ,6 and ‘urban areas and health’2 ,7–13 have conceptualised the determinants of health inequalities in neighbourhoods and/or urban areas. All of them have stated the importance of aspects related to the physical environment, mainly the built environment,12 and also to the socioeconomic environment.

Based on these backgrounds, this editorial presents a conceptual framework of the factors and processes (determinants) influencing health inequalities in European urban areas (figure 1), which are also determinants of health behaviours, under the responsibility of municipal governments and citizens. National or international wider factors described by other authors have not been included,10 ,11 although the model may also be used for municipalities smaller than urban areas. We propose this framework as a helpful tool to analyse local policies to address inequalities in health as well as to place health equity in the political agenda of European cities. Compared with other frameworks based on urban areas, it focuses mainly on European cities, not highlighting aspects that may be more relevant for cities from other continents.2 Moreover, it includes aspects not taken into account in other approaches. The framework has been designed within the ‘Socioeconomic inequalities in mortality: evidence and policies in cities of Europe’ project (INEQ-CITIES,, funded by the European Union, which aims to analyse the different patterns of small-area health inequalities and to describe policies to reduce them in European cities. The paragraphs below detail the main sections of …

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  • Acknowledgements We would like to acknowledge all INEQ-CITIES researchers who have shared with us the ideas included in this commentary.

  • Contributors All authors have participated in conception and design, drafting the article or revising it critically for important intellectual content and final approval of the version to be published.

  • Funding This manuscript has been partially funded by the project INEQ-CITIES, ‘Socioeconomic inequalities in mortality: evidence and policies of cities of Europe’; project funded by the Executive Agency for Health and Consumers (Commission of the European Union), project n°2008 12 13.

  • Competing interest None.

  • Provenance and peer review Commissioned; externally peer reviewed.