Color & Control:

Focusing on healthy cities: 

Local interventions are the key to good health for all

By Kaylie Dolan

Projections show that nearly 70 percent of the world’s population will call cities home by 2050. A recent report from the McKinsey Health Institute (MHI) is highlighting the importance of a number of influential local interventions that can have an immediate impact on the quality of life and health of people living in urban spaces. 

The United Nations predicts that global life expectancy will reach an impressive 77.3 by 2050, showing a significant jump of 30.8 years since 1950. While we celebrate longer lives, a recent McKinsey Health Institute (MHI) report warns that the extra years we’ll be living might not be as healthy as we’d hoped. In fact, it predicts that we’ll be spending more time in not-so-great shape. While this unsettling finding challenges our usual excitement about longevity, it also urges us to think about the quality of those added years. But here’s the good news: there are opportunities for positive changes – changes that can start in the cities we live in. 

Lands of opportunity… and health?
According to the MHI, if we focus on improving some of the basics related to health in our cities, we could add 20 to 25 billion extra years of good quality life globally. That’s like getting an extra five years of living for each city dweller.  Researchers suggest there are 3 main influencing factors: (1) large urban populations, (2) a limited number of stakeholders with significant wealth, and (3) the fact that cities have the most pronounced place-based health disparities. Let’s take a closer look: 

1. Over half of the world’s population already resides in cities. Projections indicate that by 2050, this will likely surge to 70%, reaching up to 87% in high-income economies. Older adults are also increasingly drawn to city living, marked by a 68% increase between 2000 and 2015. This demographic, which often faces worsened health challenges and social isolation, is most likely to benefit from targeted health improvements in urban areas wherever they may be. 

2. Cities are not just concentrations of people, but also hubs of wealthy corporations. The MHI report notes that in major cities like Paris, London, Nairobi, and Singapore, a small group of stakeholders hold the biggest influence over billions of people’s health. A handful of employers, hospitals, supermarket chains, and philanthropists, when motivated, can significantly shape the health landscape of a city. 

3. Stark health inequalities within and between urban populations provides a compelling case for a city-centric approach. Examples from London and Chicago illustrate the significant discrepancies in life expectancies, not just between cities, but even within cities in neighbourhoods just short distances apart. Such disparities highlight the urgent need for targeted interventions to bridge the health gaps that persist within city confines.

Essential actions to drive change
We’ve acknowledged the need for action, but what specific health interventions are we talking about? The report recommends that we start by ‘doubling down’ on what cities are already doing to improve health. In other words, expanding existing initiatives with the aim of achieving more immediate results. 

In contrast to large-scale infrastructure investments and other lengthy projects, these immediately influenceable interventions are relatively quick to implement and can typically be advanced by any committed company, public agency, or local organization—the involvement of a corporate giant is not necessarily required. 

The MHI report outlines four key areas within which cities can harness their potential to implement interventions that directly contribute to better population health:

1. The first, focusing on healthy longevity, involves initiatives such as screening and treating cardiometabolic conditions, promoting better diets, and enhancing societal participation among the elderly. Even small-scale, low-cost interventions, like providing blood pressure testing kits to health workers, can bring big improvements. 

2. The second explores brain health interventions and emphasizes the crucial role of increasing access to effective mental health supports. According to the World Economic Forum, deteriorating mental health is one of the top five global risks. One strategy involves the implementation of task-sharing models, where both clinical and nonclinical workers are trained to provide brief, basic versions of psychological treatments for common conditions such as anxiety, depression, and substance use. Task sharing not only helps improve patient outcomes but also aims to lessen the reliance on emergency services and community mental health settings. 

3. The third category outlines crucial climate-related interventions that are necessary to tackle the increasing impact of climate change on people’s health. These interventions include implementing customized heat-health actions plans with prompt responses to heatwaves, identifying heat respite spaces, and enhancing urban greenspaces to alleviate extreme-heat impacts that are especially pronounced in urban areas.

4. The fourth target area of immediate city intervention aims to grow health-worker capacities. The MHI report suggests this can be achieved through the implementation of scalable training programs focused on certifying and upskilling the medical and clinical workforce, especially nurses, therapeutical staff, and community health workers who play a vital role in the healthcare system. 

Navigating the path to good health
To help cities improve health, the MHI recommends a simple four-step approach that stakeholders can consider to drive improved health outcomes in their city:

1) Conducting a baseline assessment of a city’s health status;
2) Involving key stakeholders to discuss findings, plan and prioritize initiatives;
3) Taking action to scale-up the implemented initiatives; and
4) Scheduling yearly checkups on key indicators to ensure urban health improvement.

While the MHI report does an excellent job in laying out a roadmap for institutional action, it might feel daunting for the everyday citizen, like myself, to put their recommended interventions into practice. It only feels right, then, to close with a few changes that we can incorporate into our everyday routines: 

• A simple but impactful change is to prioritize a balanced and nutritious diet, incorporating more fruits, vegetables, and whole grains into our meals while limiting the consumption of processed foods and sugary drinks. 

• Regular physical activity is another key aspect, and it doesn’t necessarily require a gym membership – simple activities like walking, cycling, or even taking the stairs can significantly contribute to overall well-being. 

• Ensuring an adequate amount of sleep and being mindful of stress levels can positively impact our mental and physical health. 

In all, everyone stands to gain from healthier cities. Businesses can have happier, healthier, and more productive employees and customers. Health innovators have a chance to tap into the vast, largely unexplored market of prevention and promotion within cities. Residents, both young and old, may enjoy extra healthy years. For all those invested in the city’s well-being, now is the time to explore ways to participate.ϖ

Kaylie Dolan is graduate student in International Migration and Public Policy at the London School of Economics and Political Science, and a freelance writer for the Canadian Abilities Foundation. Source:

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