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Contribution to the Annual Report 2017 of the MMI Network

Health in the Cities: Reimagining Health in Urban Populations

Health in the Cities: Reimagining Health in Urban Populations

The world is becoming increasingly urban. More than half of the global population lives in cities and this number is only expected to rise. Undoubtedly, there will be many positive consequences: cities are vibrant, connected and relatively well-resourced. But such rapid and unplanned urbanization is already having a significant impact on people’s health, and we face a major global health crisis if we don’t act now.

People living in cities increasingly lead lifestyles characterized by unhealthy nutrition, reduced physical activity, stress, excessive alcohol and tobacco consumption, all risk factors for the development of noncommunicable diseases (NCDs). Every year, around 39 million deaths are the result of NCDs such as diabetes, respiratory disease and cancer, and over 75% of these occur in low- and middle-income countries (LMICs). (1)

Managing NCDs is a huge challenge for health systems in LMICs because they still face a high burden of infectious diseases. In addition, current development aid is almost exclusively directed to addressing infectious diseases and maternal and child health issues, while less than 2% of the total development funding is allocated to fighting NCDs. (2)

The “silent killer” · Over 10 million people are estimated to die from hypertension (high blood pressure) globally every year. (3) Because hypertension doesn’t show any symptoms, it is often referred to as the “silent killer” and is the prime risk factor for cardiovascular disease. If left unaddressed, it can lead to stroke, heart- or kidney failure.  There is a lot of evidence on how to prevent, treat and manage hypertension but it continues to be poorly controlled, especially in LMICs where health systems are typically geared toward acute care and not set up to provide care for chronic patients like those with cardiovascular problems.

Cities as public health tools · Urbanization is undoubtedly a key driver behind the growing burden of NCDs such as hypertension, but we must also recognize cities’ unique potential as a tool for addressing public health issues. A high concentration of people and sectors - and of healthcare workers and facilities - means that cities provide the opportunity to enact change at scale.  This was the thinking behind the Novartis Foundation’s Better Hearts Better Cities initiative which aims to improve cardiovascular health in low-income urban populations.

Better Hearts Better Cities · To truly thrive, cities must become ecosystems of health and wellbeing, where each part works towards one goal: extending and improving people’s lives. Ulaanbaatar in Mongolia, Sao Paulo in Brazil, and Dakar in Senegal are the first three cities selected to demonstrate Better Hearts Better Cities’ integrated, multisector approach. Selected based on high unmet cardiovascular health needs and the strong commitment of local authorities to improve cardiovascular health, these first cities aim to establish conditions for the successful integration of the approach in other cities worldwide.

Better Hearts Better Cities builds networks of partners, reaching beyond the health sector. Partners can include healthcare providers but also digital and telecommunication organizations, food suppliers, employers, insurance funds, social enterprises and civil societies. Made up of both public and private organizations, these networks operate globally and at the local level.

Crucial to the success of Better Hearts Better Cities is local ownership; to achieve long-term impact and sustainability it is essential to work hand-in-hand with local governments and partners to innovate and strengthen health systems for the future, and this needs to be from the design and planning stages of the initiative. The multisector approach integrates complementary capabilities and resources to tackle hypertension from lifestyle choices, to prevention, screening, diagnosis and patient management.

Digital technology · Technology makes cities more inclusive, connected and vibrant. Digital health technology can support healthcare providers and empower patients to better manage their disease. It provides better data reporting, enables real-time, data-informed decision-making and can reduce costs while increasing overall quality of care. When its full potential is realized, digital technology can have a transformational impact on the way healthcare is delivered and health systems that fully embrace it will only be further strengthened in the future.

As cities become home to an ever-increasing proportion of the world’s population, new challenges and opportunities will arise for digital health to improve population health outcomes. Through partnership with companies such as Intel Corporation, Better Hearts Better Cities brings together complementary expertise to co-design digital health solutions to enhance the way health systems are performing.

What will success look like? The complex nature and heavy burden of NCDs around the world means we cannot afford to wait. Better Hearts Better Cities aims to operate at scale from the outset following a multisector approach for systemic and sustainable change. Through its initial focus on hypertension, Better Hearts Better Cities aspires to reimagine the way chronic diseases can be prevented and managed, as an example that can be applied to other noncommunicable diseases.



  1. World Health Organization. Noncommunicable Diseases Progress Monitor 2017.
  2. Institute for Health Metrics and Evaluation. Financing Global Health 2013: Transition in an Age of Austerity. Seattle, WA: IHME, 2014. /
  3. Olsen, Michael H et al. A call to action and a lifecourse strategy to address the global burden of raised blood pressure on current and future generations: the Lancet Commission on hypertension. The Lancet, Volume 388, Issue 10060, 2665 – 2712
  • Author: Dr. Ann Aerts, Head of the Novartis Foundation
  • Contribution by the Novartis Foundation (member of Medicus Mundi Switzerland) to the Annual Report 2017 of the MMI Network
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