Mapping of vulnerability and resilience indices to characterize environmental health inequalities


Issues and objectives

The principal issue of CISTERRES project concerns the characterization of the territorial environmental and social inequalities in health. The question is based on the optimization of Environmental and Social Inequalities in Health characterization thanks to holistic approach of territories.

In order to characterize the relevant determinants for a spatialized assessment of health inequalities and to describe the accumulation of territorial inequalities, two main objectives are considered:

  • Determine the descriptive dimensions and variables that can be associated with the environmental quality and the living environment. The main methodological obstacles to be clarified are the interoperability and the quantitative and qualitative data integration in spatialized indices. The existence of data in different formats have made these processes more complex.
  • Establish a comprehensive methodology for the development of vulnerability and resilience spatialized indices. The main methodological obstacle concerns the aggregation of variables, that must be realized while limiting the distortion of the information.

The methodology used involves that the balance between resilience and vulnerability will be qualified and quantified for each unit spatial concerned. It allows the simultaneous evaluation of the negative aspects of the territory in the Vulnerability Index (VI) and the positive aspects of the territory in the Resilience Index (RI). The joint interpretation of these two spatialized composite indices will allow to draw up territorial typologies.

A case study was conducted to demonstrate the feasibility of this methodology, using the municipality as a spatial unit of analysis within a region in the north of France. Economic, environment, policy, health, services and social dimensions are included in the two composite indices. Thereby the information is aggregated in relation to the territory vulnerability in the one hand, and the resilience in the other hand.


Main results

There is no consensus in the literature regarding the potential environmental benefits on health and their integration into a composite index. CISTERRES project allowed to define the resilience in health environmental issues as “the capacity of a territory to cope with health inequalities”. This characterization of the perimeter is an essential step in the implementation of the index construction strategy.

The identification of 23 spatialized composite indices was then realized, which are developed by scientists and public authorities. Each index was developed to a specific issue and was not easily transposable. The diversity of information used by these two actors highlights the lack of consensus for an index that would be acceptable to both parties (Strezov et al., 2017). It is also important to note that only one published index considers vulnerability and resilience independently and comparably (Estoque and Murayama, 2014). This index developed for the Philippines is not appropriate to the European specificities and thus not transposable for the Hauts-de-France region.

The concepts of “dimension” and “variable” are regularly used, and must be defined in this context.

A variable, which can also refer to an indicator in some studies although these two terms do not overlap (Maggino, 2017), is linked to an observable phenomenon to which different measured values can be attributed. A variable is a basic element permitting the understanding of a dimension. Several variables may be needed to obtain a complete characterization of a dimension. Each variable is constituted of “data” which are the quantitative or qualitative values attributed to each entity studied (e.g. to each municipality).

The dimensions partly reflect the determinants of health presented by Dahlgren and Whitehead (1991), namely environmental, social, economic, housing and educational conditions, all recognized as playing a role in health inequalities. These dimensions are not all systematically found within the composite indices. The authors generally present a classification of variables within each dimension before building the composite index. We observed that a given variable may be classified in different dimensions by different authors, because of a possible overlapping between dimensions.


Spatialized composite indices to evaluate environmental health inequalities: Meeting the challenge of selecting relevant variables (Brousmiche et al., 2020a, Ecological Indicators).

We have published a literature review that aims to identify and characterize the dimensions and variables that are included in environmental health indices. Our analysis highlighted (i) the diversity of the published composite indices, but also (ii) the diversity of variables used in these composite indices. This work was a first step towards a proposal of guidelines designed to provide a consensual framework that facilitates the exploitation of environmental health indices. Their transposability and comparability regardless of the spatial scale were considered as mandatory criteria. The availability or accessibility of data have also been given a special attention.


How can we analyze environmental health resilience and vulnerability? A joint analysis with composite indices applied to the north of France (Brousmiche et al., 2020b, Science of the total environment).

We have also published an article that aims to propose a new strategy based on a joint analysis of two optimized composite sub-indices. This balance between resilience and vulnerability allows the simultaneous evaluation of the negative aspects of the territory in the Vulnerability Index (VI) and the positive aspects of the territory in the Resilience Index (RI). On this basis, a cross-classification is validated with the objective to distribute spatial units within territorial typologies. These homogeneous groups can be analyzed in terms of health, environmental, political, services, social and economic dimensions.


This project was supported by the Conseil Régional Hauts-de-France, the ARS Hauts-de-France and by CPER CLIMIBIO.