How to achieve great health for all? Start in your city.

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How to achieve great health for all? Start in your city.

By Hemant Ahlawat et. al., | McKinsey & Company | February 9, 2024

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In the past 60 years, global longevity rates have risen substantially, increasing life spans for individuals by 20 years on average.  Yet that accomplishment has not resulted in an equivalent gain in time spent in good health: at a global level, every additional year of life means an average of six months in ill health.

Why has time spent in ill health increased so much? As the global population ages, the burden has shifted to three fields of age-related noncommunicable diseases (NCDs) broadly associated with the wear and tear of body and mind: cardiometabolic diseases, cancers, and mental, substance use, and neurological conditions. Today, all NCDs account for 69 percent of the global disease burden. The three big fields of age-related illness account for 65 percent of the NCD burden, a trend that is expected to accelerate: one in six people worldwide will be over 60 (one in three in some countries) by 2030.3 By 2040, 11 of 14 of the disease categories predicted to increase will be NCDs, with age-related diseases such as diabetes or kidney diseases increasing the most—possibly by more than 60 percent by 2040.  External threats to global health, including climate change and antimicrobial resistance (AMR), will further increase the disease burden. 

Addressing the shifting disease burden requires looking at factors beyond healthcare, including prevention and health promotion across all fields. MHI estimates that, by embracing a more comprehensive definition of health and actively working to address the drivers of health throughout life, each person on the planet could have up to six years of higher-quality life over the next decade.  Every institution and every individual has a role to play.

Cities are a hub of opportunity to realize this potential. They are where many of the long-term drivers of health that can help address this shifting disease burden are playing out. Cities have a unique ability to mobilize cross-sectoral stakeholders quickly to create an enabling environment and focus on near-term, influenceable interventions.Three reasons why cities have a vital role to play in enabling better health for their citizens are: Cross-city and local initiatives to improve health in cities, whether led by governments, nonprofit organizations, or the private sector, have been successful. Cities will also remain focus of attention because of three reasons: One, more than half of the global population today lives in cities. Two, the large disparities in health outcomes within urban populations suggest that a city-level focus could have substantial potential to improve health.  And three, many of the stakeholders that have a large influence on population health are located in cities.

Where possible, doubling down on what cities are currently doing to improve health with their current resources can be helpful. When investing more to drive initial change, immediately influenceable interventions are an effective way to start, especially for stakeholders that are stepping up their involvement in health. In contrast to large-scale infrastructure investments, for instance, immediately influenceable interventions take a relatively short time to implement, have a relatively short payback period, and can typically be advanced by a number of different stakeholders. In principle, any meaningful company, public agency, or civil-society organization can contribute.

Four categories of interventions can harness cities’ unique potential to tackle the growth in noncommunicable diseases: healthy longevity interventions (including those that address cancers, cardiovascular diseases, and diabetes), brain health interventions (including initiatives that address mental, substance use, and neurological conditions), climate-related health interventions, and interventions that improve health-worker capacity. All of these intervention groups are highly relevant across the globe, addressable, and underresourced.

So how, in practice, can cities start on the journey to becoming a healthy city? A four-step approach could allow stakeholders to rapidly mobilize around a joint aspiration for their city and get going:  Conduct a base line survey of key indicators, convene stakeholders across sectors, take actions to scale up and deliver, and schedule annual check-ups.

3 key takeaways from the article

1. In the past 60 years, global longevity rates have risen substantially, increasing life spans for individuals by 20 years on average.  Yet that accomplishment has not resulted in an equivalent gain in time spent in good health: at a global level, every additional year of life means an average of six months in ill health.
2. Why has time spent in ill health increased so much? As the global population ages, the burden has shifted to three fields of age-related noncommunicable diseases (NCDs) broadly associated with the wear and tear of body and mind: cardiometabolic diseases, cancers, and mental, substance use, and neurological conditions.
3. Addressing the shifting disease burden requires looking at factors beyond healthcare, including prevention and health promotion across all fields.  Cities are a hub of opportunity to realize this potential. They are where many of the long-term drivers of health that can help address this shifting disease burden are playing out. 

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Topics:  Global Health, Longevity, Economic Development