Better Hearts Better Cities: Launching a Multisector Effort to Combat Hypertension in Low-income Urban Communities

By Dr. Ann Aerts, Head of the Novartis Foundation

Walking through the wealthier streets of cities like Geneva, London or New York, it seems that health and fitness is an international obsession. National food chains boast of fresh ingredients, light options, and low-fat meals. Shelves are stacked with the trendiest superfoods – quinoa, chia seeds, kale and avocado.

On the streets, flocks of brightly-dressed cyclists and runners check their Fitbits as they commute to work. In places like London and New York, diets and exercise seem to have become fashionable habits.

But large segments of the urban population, especially those in low-income settings, are not sharing this health craze. Instead, they are facing issues that experts now broadly group under the label “urban health”.

Urbanization is one of the defining trends of our time, changing the way millions of people work, eat and live. City-dwellers now represent over 50% of the global population.

And what cities like London and New York or Paris have in common with Lagos, Rio de Janeiro or New Delhi is that urban lifestyles are taking a toll on many people’s health. From work-related stress and sedentary lifestyles, to exposure to pollution, these changes in lifestyles can affect health in many interrelated ways.

Whether it be commuters travelling to work via heavily polluted streets, or busy parents working shifts and unable to cook healthy meals for their children, the combined impact of multiple urban factors can be corrosive to health.

Non-communicable diseases (NCDs), such as cardiovascular disease, diabetes, respiratory disease and cancer are a global health crisis of increasing concern. NCDs are ubiquitous, but disproportionally affect low- and middle-income countries (LMICs), as almost 75% of NCD deaths occur in those settings.

Take high blood pressure, otherwise known as hypertension, for instance. This condition can easily be managed, but is out of control in many cities. Largely symptomless, hypertension is the prime risk factor for cardiovascular disease and kills more than 10 million people per year.

In LMICs, rapid and uncontrolled urbanization can also create health problems linked to inadequate infrastructure, poor diet, sanitation and waste management.

The study of urban health looks at these issues and asks: how can we prevent the global urbanization boom from becoming an unmanageable health crisis?

The challenge is clearly more than simply treating disease: it is about managing factors as diverse as lifestyles, aging populations, housing, and infrastructure. Equally, the response will have to look beyond health systems.

Earlier this year the Novartis Foundation convened stakeholders from urban planning to business to academia to discuss urban health. The dialogue shed light on the road ahead. It is clear that we need to come together to deliver healthier outcomes for city-dwellers.

We need new thinking and strong partners to work alongside us if we are to tackle the wide range of issues successfully to deliver better health for city-dwellers.

It cannot be addressed in a vacuum and by one sector alone. It needs a multisector, multidisciplinary approach.

This means forging new alliances, and an understanding that this challenge requires a jigsaw approach bringing together healthcare providers and urban planners, NGOs, governments and businesses alike.

Better Hearts Better Cities is a Novartis Foundation initiative to improve cardiovascular health in low-income urban communities by increasing the control of hypertension as a key risk factor for cardiovascular disease.

We are working with partners including Intel Corporation, the NCD Alliance, city governments and other local partners, looking at lifestyle choices, diet, transport, workplace practices and air pollution.

The innovative approach is being launched on three continents: in Mongolia, Senegal, and Brazil.

Our initiative is most advanced in Ulaanbaatar, the capital of Mongolia and home to half of the country’s population – around 1.4 million people. Ulaanbaatar is also one of the world’s most polluted cities, and cardiovascular disease is the leading cause of death, with more than 25% of the population suffering from hypertension. The situation is similar in Dakar, the capital of Senegal.

We are shaping Better Hearts Better Cities as we go, learning from multisector partners and on-the-ground experience to draw a blueprint for managing the urgent challenges of urban health.

This is the way forward: making our cities places of wellbeing, exciting growth and opportunity, not centers of poverty and disease. Together, we can build a brighter and healthier future for cities around the world.

Learn more about the Novartis Foundation: http://www.novartisfoundation.org/