Beyond average health: Urban-rural disparities in the distribution of self-perceived health

Urban and rural areas differ along multiple dimensions. Urban contexts typically offer better access to services and facilities, while in rural areas access to even essential services may be more limited. At the same time, rural environments often provide higher environmental quality, greater perceived safety and stronger social ties. How these contrasting features translate into self-perceived health and health disparities remains an open and policy-relevant question. This paper examines spatial disparities in self-perceived health by analysing both average outcomes and within-context inequality across municipality types. Using original survey data from an Italian metropolitan area, we compare health disparities across large and small municipalities as well as coastal and rural areas. Results show that differences in average self-perceived health are relatively modest, whereas health dispersion is significantly lower in small and rural municipalities. These gaps are only partially explained by observable characteristics and are largely driven by heterogeneous returns to psychosocial factors and perceived local services. The findings highlight the importance of adopting a distributional perspective and suggest that improvements in the quality of local services may play a key role in reducing spatial health inequalities.