Impact of the urban environment on self-perception of health in a medium-sized European city: A mixed-methods study

This mixed-methods study explores how the urban environment influences self-perceived health, with particular attention to the generational differences that became evident during and after the COVID-19 pandemic call for urban planning strategies that respond to all dimensions of health. The research was carried out in a medium-sized Spanish city, combining qualitative data from 27 in-depth interviews and quantitative survey responses from 185 residents across neighbourhoods with varying environmental characteristics. Although the study initially focused on built environment factors such as green space access, walkability, and infrastructure quality, the qualitative findings showed that mental health—especially among younger participants—emerged as a central factor shaping health perceptions. Feelings of isolation, hopelessness, and confinement were frequently described by younger respondents, often tied to perceptions of spatial and social marginalization in their living environments. In contrast, older participants reported greater resilience and a more positive outlook on their health. These findings highlight the need to address mental health disparities within urban policy and underscore the importance of creating inclusive, equitable environments that support psychological well-being across age groups. The study demonstrates the value of allowing emergent themes to guide mixed-methods research and points to the need for urban planning strategies that integrate improvements in the physical environment with attention to the emotional experiences of residents, particularly in post-pandemic settings. • The study analyses how urban conditions shape self-rated health using a mixed-methods design in a medium-sized European city. • Quantitative data reveal disparities in self-rated health tied to green access, walkability, infrastructure quality and SES. • Qualitative narratives show age differences in confinement, agency and stressors, and how they shape self-rated health. • Methods integration yields multidimensional insight into inequalities and experiences in urban settings. • Findings show a need for context-specific, equity-driven planning that tackles material and symbolic health determinants.