Background: Translating urban environmental health evidence into actionable policies remains challenging in South-Eastern Europe, where environmental epidemiology has yet to reach maturity and institutional capacity and cross-sector coordination are suboptimal. This study assessed stakeholders’ awareness, perceived roles, and prioritization of urban health challenges, alongside the barriers and evidence needs related to healthy and sustainable urban development. Methods: A cross-sectional online survey was conducted between March and May 2025 among 108 stakeholders identified through a collaborative evaluation process. Participants represented national institutions, municipal actors, academia, non-governmental organizations, business, and citizens. They reported on their role and influence, and were asked to identify priority urban health problems, relevant policies and actions, perceived barriers to decision-making, and expected benefits of addressing priority problems. Results: Most respondents reported limited or moderate influence on urban decision-making. Priority problems clustered around air pollution, traffic, and land-use pressures, with climate change and heat also frequently cited. Dominant barriers included lack of coordination and policy continuity, insufficient political support, and limited funding and institutional capacity. Anticipated gains centered on improved public health, cleaner air, and citizen satisfaction, with broader quality-of-life and economic co-benefits also identified. Conclusions: Prioritized urban environmental problems are largely consistent with scientific evidence on their health impacts, though certain risk factors remain underestimated. Access to specific, actionable scientific evidence and the co-production of solutions with broad stakeholder representation are essential prerequisites for effective urban health policy and practice.
Костадинов et al. (Tue,) studied this question.