Sustainable development : health and well-being in an urbanizing world

Abstract

PURPOSE: This paper investigates how configurations of socio-economic, institutional and housing conditions are associated with self-rated health in Europe and how these macropatterns align with metropolitan residents’ priorities and perceived implementation barriers relevant to SDG-related agendas.

DESIGN/METHODOLOGY/APPROACH: An integrated, multi-level empirical design is employed. A cross-sectional typology of 29 European countries is produced via hierarchical agglomerative clustering (Ward’s method; squared Euclidean distance) using standardised Eurostat indicators capturing longevity, disability-free life years, deprivation by degree of urbanisation, self-reported unmet need for medical examination and care, healthcare expenditure by financing scheme, real GDP per capita, income inequality (Gini), and overcrowding by degree of urbanisation. In parallel, multiple linear regression (ordinary least squares) is estimated on a 10-year aggregated annual series to assess associations between the share of the population reporting “good/very good” health and key determinants, with model reduction guided by statistical adequacy and interpretability. The survey component uses country-level frequency distributions for six countries’ metropolitan residents to describe SDG prioritisation, perceived barriers, preferred first actions, and perceived quality-of-life impacts of municipal sustainability efforts.

FINDINGS: Clustering identifies three distinct country groupings, separating profiles with stronger longevity/disability-free life years and lower deprivation from profiles characterised by higher deprivation and weaker outcomes, while a small two-country grouping exhibits a specific multivariate pattern. The reduced regression specification is statistically significant overall and suggests that economic and distributional variables are statistically associated with self-rated health, while access-related constraints remain relevant but sensitive to specification under short time-series conditions. Survey evidence indicates that “good health and quality of life” is most frequently selected as the key SDG priority for local quality of life, yet national profiles differ markedly in whether cost constraints, regulatory ambiguity, or limited awareness/visibility dominate perceived implementation barriers and in how strongly municipal efforts are perceived to affect quality of life.

PRACTICAL IMPLICATIONS: Metropolitan policy design should combine distribution-sensitive measures with access-oriented interventions and implementation instruments tailored to the dominant barrier profile (cost, regulation, or awareness/communication), strengthening the visibility and measurability of local outcomes.

ORIGINALITY/VALUE: The paper links macro-level typologies and econometric associations with micro-level metropolitan perceptions, providing a coherent interpretation of objective conditions and implementation feasibility within an SDG localisation perspective.