BackgroundIn recent years, there have been a growing number of studies on spatial inequalities in health covering a variety of scales, from small areas to metropolitan areas or regions, and for various health outcomes. However, few investigations have compared health status between cities with a view to gaining a better understanding of the relationships between such inequalities and the social, economic and physical characteristics. This paper focuses on disparities in respiratory health among the 55 largest French cities. The aim is to explore the relationships between inter-urban health patterns, city characteristics and regional context, and to determine how far a city’s health status relates to the features observed on different geographical scales.MethodsWe used health data describing hospitalizations for Chronic Obstructive Pulmonary Disease (COPD) as a proxy for respiratory health, and the total number of hospitalizations (overall) as a proxy for general health. This last indicator was used as a benchmark. A large set of indicators relating to socioeconomic, physical and amenity aspects of the cities (urban units) was also constructed. Data were analyzed using linear correlations and multiple linear regression models.ResultsThe results suggest that socioeconomic characteristics are major discriminators for inequalities in respiratory health status among urban units. Indeed, once combined to socioeconomic characteristics, only a climate indicator remained significant among the physical indicators. It appeared that the pollution indicators which were significantly correlated with COPD hospitalization rates loosed significance when associated to the socio-economic indicators in a multiple regression. The analysis showed that among the socio-economic indicators, an employment indicator derived at the regional scale, and two indicators reflecting the unequal intra-urban spatial distribution of population according to their education, were the most efficient to describe differences in the respiratory health status of urban units.ConclusionIn order to design effective urban policies, it is essential to gain a better understanding of the differences among cities in their entirety, rather than solely differences across small urban areas or individuals.

In recent years, a vast array of literature has shown that more and more city centres are affected by retail decline, be it in Japan, Belgium, Britain, the United States, or in France, while urban peripheries benefit from expanding retail activities. In this paper, we first rely on an international state of the art review, which allows us to identify recurring main factors that explain retail decline (such as sectoral concentration and competition from e-commerce), as well as more contextual factors bringing changes in urban settings and consumption practices (like demographic and labour market dynamics, the size of cities, or the location of municipalities within cities). Secondly, we examine how these factors, when combined, contribute to explain the decline in a superior diversity mix of retail activities in small and medium-sized French towns and cities, for four periods of about ten years each, from 1975 to 2014. The decline in shop diversity affects about a third of the municipalities observed in each period. Our hypotheses regarding the role of demographic size, employment mobility and location are then discussed and compared with the information given by the literature review.

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