Environmental determinants of health in Europe: a multi-factor approach

Introduction The One Health approach provides a multidisciplinary framework that recognises the intrinsic interconnections between environmental conditions and population health. However, empirical evidence on how multiple environmental pressures jointly shape health outcomes remains limited, particularly from a European comparative perspective. Methods This study analyses the relationship between a broad set of environmental factors and self-rated health in Europe, adopting a multidimensional approach. A multilevel logistic regression model was estimated, integrating diverse environmental exposures, including climatic conditions, pollution processes, pressure on water resources, components of natural capital, and environmental health hazards. These contextual indicators, interpreted as macro-contextual environmental characteristics rather than precise measures of individual exposure, are combined with individual-level data from Round 11 (2023) of the European Social Survey, covering 21 European countries. In addition, an environmental pressure index is constructed to capture the cumulative nature of contextual exposures and to facilitate territorial comparison. Results Several environmental factors were significantly associated with self-rated health, even after controlling for sociodemographic and economic characteristics. The findings indicate that the accumulation of environmental burdens is unevenly associated with health across Europe, generating a consistent territorial gradient. Discussion These results underscore the role of the environment as a structural determinant of health opportunities and demonstrate that the impact of environmental exposure is shaped by social and institutional contexts. These findings provide a relevant evidence base for public health policymakers to design targeted interventions aimed at mitigating environmental inequalities and improving population well-being in Europe.