PRESS RELEASE
Geneva, 28 August 2024 – World Heart Federation (WHF) today launched a first assessment of efforts undertaken by cities to combat cardiovascular disease (CVD), the leading cause of death including premature death, worldwide.
The City Heartbeat Index reveals a contrast in the different approaches taken to tackle threats to heart health, showing a correlation between high scores and increased life expectancy as well as the inequality created by living in lower income areas.
The Index is designed to act as a comprehensive benchmark ranking 50 cities globally on their efforts to protect their population’s health with measures including governance, city planning, and health services. The Index also highlights the challenges of comprehensive data collection especially in low to middle-income countries, and the need to implement and assess robust measures.
Cities in the Asia-Pacific (APAC) region dominate the top spots in the Index, with Hong Kong ranked number one as the most effective. Successful policies include Seoul expanding low-emission zones, Beijing’s “smog-free tower”, and Bangkok’s implementation of screening adults over age 21 for diabetes and hypertension.
Hong Kong was closely followed by London which scored high on introducing city-level policies addressing health promotion and specific health risks such as unhealthy diets, tobacco and air pollution – notably for expanding its Ultra Low Emission Zone (ULEZ) in 2023 to cover an entire urban area, adding bike lanes and banning junk food advertising.
Madrid ranked #3 on the Index, followed by Berlin and New York City, which are situated in countries with high CVD prevalence, and demonstrate proactive measures to address cardiovascular health in their urban heart health initiatives. Other cities, including Singapore and Toronto ranked high resulting from their excellence in data collection and proactive health measures.
Paris and Rome are the lowest ranking European cities on the Index, while cities in African and Middle Eastern countries face significant limitations with funding and policy support. However, the strong performance of several middle-income cities, such as Jakarta, demonstrates that success is not solely dependent on financial resources.
Top findings of the report:
- Data collection deficiencies: Critical data for understanding CVD risk factors are often not collected at the city level, hindering targeted public health interventions. Only Jakarta and Singapore have comprehensive data for all 12 data-availability indicators, showcasing their commitment to understanding and addressing cardiovascular health.
- Policy implementation gaps: The availability of limited data has had a knock-on effect on prioritising certain health risks. While data on some health risks including obesity, diabetes, and hypertension suggests that these areas are being prioritised, other risk factors such as low vegetable consumption, high cholesterol, and trans-fat intake are receiving less attention. Additionally, only 22% of cities have data on cholesterol levels, and only 14% on trans-fat consumption, creating barriers to implementing informed policies.
- Life expectancy correlation: Higher Index scores are associated with increased life expectancy and healthier aging. Cities with better physical environments and health services, such as Helsinki and London, have higher healthy life expectancy at age 60.
- Wealthier cities have an advantage: Middle and low-income countries face limitation in funding, infrastructure (including green spaces and public transport), and social determinants such as employment and education, that have impacted their ranking towards the bottom of the list.
Commissioned by Novartis and independently conducted by Economist Impact, the City Heartbeat Index aims to raise awareness of the importance of a city-level focus on CVD.
“The City Heartbeat Index is a call to action. By showcasing city-level interventions implemented by cities, we can inspire other urban centres to adopt similar strategies,” said Dr Jagat Narula, President Elect of World Heart Federation. “The burden of CVD is driving action because cities in countries with highest burden are actually more focused on understanding, preventing, and addressing CVD – which in turn is associated with greater life expectancy,” said Dr Narula.
“The City Heartbeat Index shows that the many efforts by cities – where over half of the world’s population resides – on heart health is visible and increasingly important,” said Dr Vasilisa Sazonov, Therapeutic Area Head, CRM International at Novartis. “There are opportunities to improve data collection at the city level including prioritising CVD risk factors that have typically been overlooked such as high cholesterol,” said Dr Sazonov.
The Mayor of London, Sadiq Khan, said: “I am extremely proud of the work we have done to make London a healthier place to live. We have made real progress improving health outcomes by taking old polluting cars off our roads and bringing cleaner air to millions more Londoners, enabling more walking and cycling and promoting healthier food advertising on our transport network.
“However, there is more we need to do to help Londoners to live in good health and I am determined to work with the new Government and our health partners as we continue to build a cleaner, greener and healthier London for everyone.”
You can access the full report here.
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About City Heartbeat Index
This project seeks to uncover the essential factors influencing cardiovascular health in cities and address barriers to its improvement. Cities were assessed across five domains: Social Determinants, Physical Environment, Health Risks, Health Services and Governance. The City Heartbeat Index assesses city-level efforts to understand, prevent and address CVD in 50 cities worldwide. Cities were selected based on the regional proportionality of CVD burden (by WHO region) and city population size (minimum population of 500,000 or more), representing diverse geographical locations and economies.
The Index framework was developed through a rigorous process of examining the evidence on factors influencing CVD risk and outcomes and validated the framework with a panel of experts. The Index includes 44 indicators and sub-indicators across the five domains that measure the policies, processes and risk-factor-mitigation efforts that are key to reducing the burden of CVD. In addition, it aims to enhance awareness of the multiple factors contributing to CVD risk within urban environments. It seeks to foster collaboration among diverse stakeholders to develop and implement evidence-based approaches, encourage improved public health infrastructure, and promote equity in access to healthcare services and prevention programmes.
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