The HHH Project
Research-based writing on cardiovascular disease, urban neighbourhoods, and the social determinants of heart health across European cities.
How does the air we breathe in cities like Edinburgh and Madrid shape our risk of heart disease? The answer reveals striking health inequalities and new directions for public health research.
The relationship between socioeconomic position and cardiovascular mortality is one of the most robust findings in all of epidemiology. It has been replicated in every country where the data exists to examine it, across multiple measures of socioeconomic status, across different health systems, and across different time periods. And in Europe, despite decades of medical…
The relationship between alcohol and cardiovascular health is more contested in the scientific literature than almost any other topic in preventive medicine. For decades, a large body of observational research suggested that moderate alcohol consumption was associated with reduced cardiovascular risk compared to abstinence. The “J-shaped curve” became a standard teaching point. More recent research,…
When Regent’s Park was laid out in north London in the early nineteenth century, it was not designed as a public health intervention. Yet the evidence accumulated over the following two centuries suggests that urban parks and green spaces function as precisely that — measurable contributors to cardiovascular health for the populations that have access…
In 1980, the Black Report — commissioned by the UK government and promptly suppressed — documented systematic differences in health outcomes between social classes in Britain that could not be explained by healthcare access, individual behaviour, or genetics alone. The report’s authors concluded that the primary drivers of health inequality were material: income, housing, working…
Edinburgh and Madrid have very little in common. One sits on a northern Atlantic coast, shaped by industrial heritage and a National Health Service; the other lies on the high Castilian plateau, Mediterranean in character, with a different welfare tradition and a healthcare system excellent at acute care but historically less focused on prevention. Yet…
When John Snow plotted cholera deaths on a map of Soho in 1854, he did something that changed public health forever. By placing disease in space — treating location as data — he identified the Broad Street water pump as the source of an outbreak that had killed hundreds within days. The map did not…
In Madrid, tobacco is sold through a licensed network of estancos — specialist shops that hold an exclusive state concession to sell tobacco products. There are roughly 5,000 estancos in the Madrid metropolitan area. They are not evenly distributed. Research conducted as part of the HHH Project mapped the geographic distribution of tobacco retail outlets…
Villaverde sits in the southern reaches of Madrid, separated from the city’s prosperous north by more than geography. It is one of the capital’s most densely populated districts and one of its most socioeconomically deprived. Premature mortality from cardiovascular disease here is significantly higher than the Madrid average — following the socioeconomic gradient in cardiovascular…
