Cyprus’s two largest cities—Nicosia and Limassol—have ranked among the lowest in Europe in a new urban health index launched today by the Barcelona Institute for Global Health (ISGlobal), in collaboration with the 'la Caixa' Foundation.

The Healthy Urban Design Index (HUDI), published in The Lancet Planetary Health and available here, assesses the urban health potential of 917 European cities using 13 indicators across four key domains: urban design, sustainable transport, environmental quality, and green space accessibility. The goal is to measure how conducive a city’s physical layout is to promoting public health and well-being.

Out of all surveyed cities, Limassol ranked 902nd overall, with a HUDI score of just 3.95, placing it 628th out of 638 in its category of small-sized urban areas (50,000–200,000 inhabitants).

Meanwhile, Nicosia scored marginally higher at 4.66, coming in 784th overall and 161st out of 177 in the medium-sized city category.

Larnaca and Paphos were not included in the survey.

These rankings place both cities near the bottom of the European urban health spectrum, highlighting serious concerns around air quality, green space access, transport infrastructure, and urban compactness—factors all linked to residents' physical and mental well-being.

Across Europe, smaller cities tended to score better. Pamplona (Spain) topped the entire index with a HUDI score of 6.8, followed by Geneva (Switzerland) and Harlow (UK). No city scored above 7 out of 10, indicating significant room for improvement even among the leaders.

According to lead author Federica Montana, “The HUDI shows tendencies and none of the 917 cities achieves a score of 7 or higher, which gives us an idea of the room for improvement in promoting health and well-being through urban design in Europe.”

A clear divide also emerged between Western and Eastern Europe. Cities in Romania, Bulgaria, and Poland were among the lowest ranked, while Spain, the UK, and Sweden dominated the top-performing clusters.

Greece had two cities in the top 100: Ioannina (#12 overall) and Athens (#88).