Bolzano has been recognized as an Italian leader in urban quality of life, as it has been ranked as the first city in Italy and the 35th in Europe by the Healthy Urban Design Index, a new ranking developed by specialists from the Barcelona Institute for Global Health. Campobasso is also remarkable, as it takes first rank in Europe among small urban centers. The study looked at 917 European cities and 13 factors such as urban design, sustainable transportation, access to public green areas, and environmental quality. Three medium-sized cities lead the European ranking: Pamplona (Spain), Geneva (Switzerland), and Harlow (United Kingdom). Large cities, while functioning well in the mobility and urban planning sectors, have environmental limits. Madrid, the best large city, ranks only 39th, while Milan places 202nd and Rome 560th. Smaller cities, particularly in Northern Europe, stand out for their cleaner air and better capacity to reduce urban heat. Eastern Europe has the lowest results, particularly in Romania, Bulgaria, and Poland.