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Improving cities as healthy environments

The 2022 Cities Health Indexcarried out by the insurer DKV and the consultancy IdenCity, collects promising figures and shows that Spanish cities are becoming healthier environments. This is how the second edition of this study presents it, which points out Barcelona, ​​Granada and A Coruña as the cities with the best improvement.

Of the 53 Spanish cities which are taken as a reference, 42 comply with more than 70% of the indicators that structure the research, 15 more cities than in 2021. Also, this year, unlike the previous one, scores that exceed 75 %, as is the case in Madrid, Barcelona or Seville.

Five dimensions of analysis

To reach these conclusions, the evolution of cities is examined on the basis of five dimensionsin order to recognize the influence of the urban environment on health, in addition to serving as a reference for the promotion of policies that make environments healthier for the population.

In this way, and taking into account that health is understood from the World Health Organization as “the complete state of physical, mental and social well-being“, the following factors are taken as a basis for the analysis:

  • The health of the population: where indicators such as life expectancy, morbidity and healthy behaviors are considered
  • environment: dimension in which the environment, mobility, housing and different equipment come into play
  • Socioeconomic and labor conditions: where socio-economic security or the quality of employment is taken into account
  • community: category that includes indicators such as security or family and community networks
  • service of Health: which is understood as those preventive or health promotion activities, in addition to health care.
Image provided by DKV and IdenCity

Improvement over 2021

Based on these five dimensions, the results of the Cities Health Index show one slight improvement of Spanish cities towards the consolidation of healthier environments, distinguishing a greater appreciation not only of health services, but also of aspects of the environment, socio-economic conditions and community networks, and all of them are factors determinants for health. Specifically, this second edition of the study collects one 72.2% degree of compliance of cities, being 70.1% in 2021.

In addition, this generalized improvement implies the significant increase in the number of territories that achieve a degree of compliance above 70%, which in 2022 reaches a total of 42 cities, fifteen more than last year. Granada, Barcelona, ​​Vitoria and A Coruña are the cities with the highest degree of compliance. Even more, in this edition, unlike the previous one, scores that exceed 75% are collected, as is the case in Madrid, Barcelona or Seville.

The study also delves into each of the categories on which the analysis is based:


The best improvement occurs in this category. In total, 44 of the 52 cities analyzed improve in this aspect. Thus, compliance with requirements goes from 62% in 2021 to 67.6% in 2022.

The cities with the most improvement are A Coruña, Granada and Melillaalthough it should be noted that cities such as Vitoria, Salamanca, Barcelona, ​​Cadiz and Madrid exceed, in this sense, 75%.

Health services

On the other hand, health services are those that present the greatest opportunity for improvement. This is the edition with the lowest average value in 2022, although it has improved slightly from the previous year. The prevailing challenges in terms of hospital resources are evident: the availability of beds, ambulances and teams of skilled doctors remains a problem.

However, there are cities such as Seville, Pamplona or Granada that have 75% compliance.


It is about the dimension with best average rating between editions, driven mostly by the low levels of crime. The improvement between this year and the previous one is 2.2%.

Socioeconomic and labor conditions

Socio-economic and labor conditions have one minimal variation between editions (0.4%), although there are territories such as Sória or Huesca that improve significantly, exceeding 75% of the category’s requirements.

The health of the population

This is the only area of ​​analysis where there is stagnationwith average results showing a slight decline of 0.1%, which is explained by the unfavorable evolution of hospital morbiditywhich assess the degree of prevalence of the main diseases that affect the health of the population.

Healthier cities

In short, one is observed general trend of improvement the results obtained in the different dimensions that make up the index facilitated by DKV and IdenCity. Of course, challenges continue to be identified in the field of health services and a stagnation in the health dimension of the population that translate into opportunities for local governments. Because defining action plans that respond to the needs of each territory would completely change the situation.

city ​​health index
Image provided by DKV and IdenCity

The gender perspective

The novelties of this edition are the gender perspective and the analysis of new phenomenasuch as the degree of digitization or the existence of a health research institute.

In the case of the gender perspective, we must emphasize that in Spanish cities women present one more vine hopewith respect to the average, although there is a notable difference in figures in some indicators linked to this concept. This is the case of diseases of the nervous and circulatory system, with more mortality among women.

Women have healthier lifestyles (they consume more fruit and vegetables, higher figures of normal weight, lower mortality due to abuse of addictive substances), although they present a higher risk of poverty, loneliness and being victims of abuse. These risks precisely, and as the WHO points out, can translate into the consolidation of health inequalities.

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