Over three-quarters of Europeans live in cities, but their quality of life varies wildly — especially when it comes to factors that have a big impact on health. A group of international researchers developed a new Healthy Urban Design Index (HUDI) to track and assess well-being in 917 European cities, using indicators ranging from access to sustainable public transport and green spaces to air pollution exposure and heat islands.  The tracking tool was developed by the Barcelona Institute for Global Health using data gathered for a study to be published in this month’s Lancet Planetary Health journal. According to its findings there is a clear continental divide in conditions that favor healthy urban living. Analyses reviewed by POLITICO’s Living Cities showed that municipalities in Western Europe — especially in the U.K., Spain and Sweden — received significantly higher scores than comparable cities in Eastern European countries like Romania, Bulgaria and Poland. Natalie Mueller, one of the study’s authors and a researcher at the Barcelona Institute for Global Health and Pompeu Fabra University, said access to public funds plays a major role in this divide. “If there are financial constraints in cities, investing in sustainable and health-promoting urban forms and infrastructures, and defining environmental policies may be probably less of a priority than tackling other more pressing social and economic issues,” she said. Mueller also noted lingering cultural differences in environmental consciousness and the link between urban design and health. “Eastern European cities still have a strong car culture, where cars are still status symbols,” she said, adding that in some areas, active mobility options like cycling are frowned upon. “They still strongly cater to car traffic with necessary infrastructure, which leads to poor environmental quality and worse health outcomes.” By comparison, lower levels of air pollution, greater access to green spaces, and the reduced presence of urban heat islands enabled Europe’s smaller cities, with 50,000 to 200,000 inhabitants, to earn the highest HUDI scores. Topping the list is Pamplona — a regional capital in Spain that lies in a lush valley at the foot of the Pyrenees and that has used the considerable revenues from its annual “Running of the Bulls” festival to invest in active mobility infrastructure.  MADRID MAKES GOOD Earning the highest score among Europe’s urban areas with more than 1.5 million inhabitants was Madrid, another Spanish city. Like other big cities it ranked well on sustainable transport and housing density. However, Madrid’s placement was remarkable given that the Spanish capital routinely violated the EU’s air quality rules until 2023. Urbanism Councilor Borja Carabante told POLITICO this was precisely why the city had adopted aggressive measures to improve its expansive public transport system. “We’re the first EU capital to have a completely clean urban bus system,” he said, highlighting the number of electric or zero-emissions mass transport vehicles in the network. “We also have Europe’s largest low-emissions zone.” Carabante explained that the public transport initiatives accompanied subsidies for residents seeking to replace their cars or boilers with more sustainable models, or wanting to install e-charging stations in their buildings. Madrid is also taking on major infrastructure projects while building on the success of the Madrid Río regeneration project, which buried a major swathe of the capital’s ring road to recover the Manzanares River. | Jesus Hellin/Europa Press via Getty Images Madrid is also taking on major infrastructure projects while building on the success of the Madrid Río regeneration project, which buried a major swathe of the capital’s ring road to recover the Manzanares River. Work is currently underway on a scheme to redirect a major highway underground and to reconnect five neighborhoods that have been divided since 1968. The redeveloped 3-kilometer area will be a green axis with trees, playgrounds and space for pedestrians and cyclists.  Carabante said the project is emblematic of the city’s commitment to becoming a more desirable — and healthier — place to live. “While cities like Berlin, Rome, Paris and London continue to surpass the nitrogen-dioxide levels considered safe for humans, Madrid has drastically reduced it, complying with European standards, and has become a healthier, more pleasant and more sustainable city than ever before.” Citing examples from the study, Mueller emphasized there are plenty of low-cost measures that local authorities can implement to improve well-being within their municipalities. “You can open up streets and blocks to give people space to walk and cycle, as they’ve done in Barcelona’s superblocks, in London’s low-traffic neighborhoods or Berlin’s Kiezblocks,” she said. The researcher also recommended replacing parking spots with trees and other greenery to protect locals from deadly heat, or to prioritize public transport investments to boost connectivity and slash fares. Using the example of Amsterdam — which went from being a car-choked, smoggy port city in the 1970s to a global model for urban well-being — Mueller stressed that consistent long-term action is the key to making Europe’s cities healthier. Of course, the kind of measures that improve well-being in urban landscapes can be a challenge for municipal leaders, who are up for reelection every four years and are under pressure to prefer projects with immediate results. But Mueller urged them to think big.  “Building healthier urban infrastructure needs long-term, sustained investments,” she said. “Sometimes over many decades.”

In the early morning hours of March 8, 2020, the lives of Milan’s more than 1 million residents were radically upended. Just three weeks earlier, a 38-year-old man had become the first resident of Italy’s northern Lombardy region to test positive for Covid-19. And after more locals developed symptoms, authorities placed a handful of towns under quarantine, with red zones declared to keep residents from spreading the mysterious new respiratory virus. During those first days of the crisis, few thought that Milan, the country’s economic powerhouse, would ever face similar restrictions. But the unthinkable became inevitable as the number of confirmed cases spiked, and on that Sunday in March, then-Prime Minister Giuseppe Conte held an emergency press conference to announce that Italy’s second-largest city was locked down. It was the beginning of an extraordinary period that would see Milan be transformed by measures that would ultimately endure far beyond the crisis. Pierfrancesco Maran — at the time a municipal councilor in charge of the city’s powerful urbanism portfolio — recalls feeling shocked when he heard the decision. “It all seemed incredible,” Maran, now a lawmaker in the European Parliament, told Living Cities in an interview. “We couldn’t believe that such dramatic measures were being adopted.” Leading up to lockdown, Milan was experiencing a “fantastic moment” in its history, Maran explained, with the city’s fortunes trending up since hosting the 2015 World Expo. Its shift from industrial capital to a global hub of innovation, tourism and prosperity was finally being consolidated. “As a city councilor, it was difficult for me to accept the that the lockdown was the only way forward,” he said. “But it was also clear that all other attempts to contain the pandemic weren’t working.” LA NUOVA NORMALITÀ Milan’s lockdown was the first to affect a major European city. But within days, the rest of the continent’s metropolitan regions would find themselves under similar conditions. The entirety of Italy was declared a red zone just 48 hours after the harsh restrictions were imposed on the capital of Lombardy. Countries like Spain, Belgium and France would follow suit just days later, and by the end of the month, every European country — and, indeed, much of the world — had quarantine rules in place. Maran said that by virtue of being one of the first cities to be subject to a lockdown, Milan was among the first to start working on “a gradual, post-pandemic reopening” — an ambitious plan that reimagined the urban landscape to prioritize access to public spaces. “Our strategy had the reconquest of public space at its core,” he explained, emphasizing that the outdoors was “the safest space from the point of view of contagion.” But, he added, the city’s approach aimed to make the most of the “extraordinary opportunity” provided by a lockdown that was, at the time, keeping everyone at home. “That made it possible to do things that would have otherwise been very difficult, if not impossible,” he said. “We created cycle paths on the main city arteries to manage the reduced capacity of public transport, promoted smart working, and substantially liberalized the possibility for bars and restaurants to place tables outside.” The city’s tactical Strade Aperte urbanism plan capped speed limits on roads at 30 kilometers per hour, widened sidewalks, and saw the installation of low-cost temporary cycle lanes throughout the city. And Milan’s approach to la nuova normalità — “the new normal” — quickly became an example for other cities across Europe. In Brussels, authorities similarly rolled out temporary cycling infrastructure and set 20 kilometer per hour speed limits within the Pentagon zone — the area encircled by the city’s inner ring road — where pedestrians and bikers were given priority. Meanwhile, Paris Mayor Anne Hidalgo moved to make pandemic terraces permanent and put French-Colombian academic Carlos Moreno’s 15-minute city model at the heart of her successful reelection campaign. The impact of these Milan-inspired measures were far-reaching, with air quality improving in urban areas throughout Europe. They were also enthusiastically embraced by city dwellers, who overwhelmingly supported making many of the temporary changes permanent. LASTING IMPACT Today, five years after the crisis began, Maran said he’s proud to see so many of “the most drastic changes adopted during the pandemic now consolidated as integral elements” in cities that are no longer threatened by Covid-19. The temporary cycle paths installed during Milan’s lockdown have blossomed into over 100 kilometers of new bike lanes, and smart working schemes have become standard in the countless businesses based in the capital of Lombardy. But Maran also noted that some of the other omnipresent lockdown practices — like public hand sanitizer dispensers or the use of face masks — were shunted as soon as the pandemic was brought under control with the roll-out of the Covid-19 vaccine. “I don’t think we’ve left these things behind for economic reasons or anything like that, but rather because they remind us too much of that period,” he said. This modern desire to forget the pandemic isn’t unusual — our ancestors had the same reaction to the similarly devastating Spanish Flu pandemic of 1919. Once its impact subsided, the world rushed to move on, and just five years after the disease claimed between 50 million and 100 million lives, the 1924 Encyclopedia Britannica failed to even mention it in its review of the 20th century’s most significant events. “I think most people want to erase anything that makes them think about it explicitly,” Maran observed. “It’s only been five years since it happened, but nobody wants to talk about it.” But while the general public can try to forget the trauma, local authorities don’t have that luxury, Maran said. And in its aftermath, municipal governments now have specific plans to put into action for the future pandemics experts say our cities will inevitably face. “We now all have pandemic management plans that are regularly updated, and our administrations have developed structures that allow us to work in even the most daunting emergency situations,” he said. “This experience has left us prepared to face a similar emergency, whenever it might arise.”