Multidimensional Analysis of the Relationship between Sustainable Living Conditions and Long, Good Health in the European Union

Introduction

Health and sustainability are two pillars of the European Unions 2030 agenda. While ageing populations and chronic diseases challenge publichealth systems, the EU also aims to transition to a lowcarbon, circular economy and to guarantee a decent standard of living for all citizens. Understanding how the quality of the environment, the equity of social resources and the resilience of economies affect life expectancy and selfreported wellbeing is essential for designing policies that deliver long and good health.

This page presents a concise, multidisciplinary analysis that brings together four major dimensions:

• Environmental quality (air, water, green spaces, climate resilience)
• Social conditions (housing, education, gender equality, access to care)
• Economic stability (employment, income inequality, fiscal capacity)
• Governance and publicpolicy (healthcare spending, sustainability strategies, crosssector coordination)

Analytical Framework

We adopt a multidimensional index approach that allows each EU country to be positioned along two axes:

1. Sustainable Living Index (SLI) composite of 12 indicators covering environmental, social and economic sustainability.
2. Health Outcome Index (HOI) composite of life expectancy at birth, healthylifeyears (HLY) and selfrated health prevalence.

Both indices are normalised to a 0100 scale. Countries are then classified into four quadrants:

• High SLI High HOI (the Gold Standard)
• High SLI Low HOI (potential healthservice gaps)
• Low SLI High HOI (strong health system despite sustainability challenges)
• Low SLI Low HOI (priority for integrated interventions)

The multidimensional view highlights that high sustainability does not automatically guarantee better health; complementary policies are required.

Data and Indicators

Data were drawn from Eurostat, the European Environment Agency (EEA), the WHO European Health Information System and the European Sustainable Development Report (2023). Table 1 summarises the main indicators.

All indicators were transformed into zscores, weighted equally within each dimension, and aggregated using the arithmetic mean.

Key Findings

1. Overall Correlation

The Pearson correlation between the SLI and HOI across the 27 EU members is **0.62 (p<0.001)**, indicating a moderatestrong positive relationship. Countries that score high on sustainability tend to enjoy longer and healthier lives, yet the scatter plot (see below) shows considerable dispersion.

2. Quadrant Distribution

• Gold Standard (highhigh): Sweden, Finland, Denmark, Netherlands, Austria. These nations combine low airpollution levels, extensive green spaces, high education and low income inequality with robust healthcare systems.
• High SLI Low HOI: Estonia, Croatia, Latvia. Despite good environmental records, these countries face challenges in healthcare access and chronicdisease management.
• Low SLI High HOI: France, Italy, Spain. Strong healthcare provisions and high life expectancy coexist with higher pollution or housing pressure.
• LowLow: Bulgaria, Romania, Greece. Persistent issues across the three sustainability pillars align with shorter, lesshealthy lives.

3. DimensionSpecific Impacts

Air quality emerges as the single strongest predictor of HLY (=0.45). A 10g/m increase in PM2.5 is associated with a loss of roughly 0.8years of healthy life.

Housing overcrowding correlates negatively with selfrated health (r=0.38). Policies that improve affordable housing can therefore raise perceived wellbeing.

Income inequality shows a nonlinear effect: the health penalty intensifies once the Gini exceeds 0.30, suggesting a threshold beyond which social cohesion erodes health gains.

4. Regional Trends

Nordic and CentralWestern countries dominate the highhigh quadrant, whereas Southern and Eastern Europe show more mixed outcomes. Climaterelated stressors such as heatwave incidence are rising faster in Mediterranean states, potentially offsetting current health advantages.

5. Policy Interaction Effects

Regression models with interaction terms reveal that the health benefits of green space are amplified when coupled with high education levels (interaction =0.21). Similarly, the positive impact of low pollution is stronger in countries with universal health coverage.

Policy Implications

1. Integrate Health Impact Assessments (HIAs) into all sustainability programmes. Before launching new transport or energy projects, quantify projected effects on air quality and consequently on HLY.
2. Targeted investments in housing. Reduce overcrowding through rentcontrol incentives and the development of energyefficient social housing, especially in highgrowth urban areas of Southern Europe.
3. Strengthen primarycare networks in highSLI / lowHOI countries. Estonia and Latvia would benefit from expanding preventive services and chronicdisease management.
4. Address income inequality. Progressive taxation and robust socialsecurity nets can lower the Gini threshold where health declines become pronounced.
5. Promote greeninfrastructure in education settings. Schoolyard greening improves both environmental quality and educational outcomes, creating synergistic health gains.

Crosssectoral governance bodiessuch as the EUs Joint Research Centre (JRC) and the European Health and Environment Allianceshould coordinate data collection, set common metrics and monitor progress through an EUwide Sustainable Health Dashboard.

Conclusion

The multidimensional analysis demonstrates that sustainable living conditions are a decisive, though not exclusive, driver of long and good health in the European Union. While high environmental standards, equitable social policies and stable economies create a fertile ground for health, targeted interventions are required to close the gaps evident in several member states.

Future research should deepen the temporal dimensionassessing how the transition to climateneutral economies will reshape health trajectories over the next two decadesand expand the set of health outcomes to include mentalhealth indicators and diseasespecific morbidity.

Sources: Eurostat (2023), European Environment Agency (2023), WHO European Health Information System (2023), European Sustainable Development Report (2023).