CITIES OF THE FUTURE | FOUR| MAY 2024
Integrating Health Security in Urban Planning
Investing in health for the welfare of cities
INTRODUCTION
The fourth instalment in our Cities of the Future series showcases the ground breaking ways cities are incorporating health initiatives into their design. The report provides a global view with examples of innovation and collaboration emerging from a diverse spectrum of cities, including Seoul, Paris and Dubai.
Across the world, urban planners, politicians and the private sector are employing a range of solutions that are improving the welfare of citizens and, as a consequence, contributing to economic growth. Cities play a pivotal role in healthcare, serving as central locations for medical services, research, policy-making and education. Their importance in healthcare is multi-faceted, encompassing access to healthcare services and infrastructure, medical education, health policy and governance. They are often the epicentres for healthcare policy development and implementation, housing the regulatory bodies that oversee healthcare practices and allocate substantial budgets for public health, attracting private investment in healthcare.
Relationship between health and economic growth
The relationship between health and economic growth in cities is critical to urban development. Health spending is not just a cost but an investment in human capital, which is crucial for economic productivity.
New York stands out for its healthcare expenditure, with an estimated USD425 billion directed towards medical products and services. Although a substantial figure, the city accounts for a relatively small percentage of the total national healthcare expenditure, as shown in Fig 1.1. In contrast, Seoul represents 50% of South Korea's total healthcare expenditure, underscoring its central importance to the country's healthcare system and indicating a high concentration of healthcare resources and services within the city. This high percentage can also be attributed to air pollution levels in the city, the number of days of heat stress (see Fig 1.2) and Seoul’s investment in dealing with the COVID-19 pandemic.
Health security is a critical conduit connecting healthcare and the economy. Investing in health security is fundamental in mitigating disruption and maintaining economic stability during health crises like pandemics. The COVID-19 pandemic highlighted how a health crisis can have far-reaching and long-term economic consequences, stressing the need to make adequate investment in health security for urban economic resilience. For example, in response to the pandemic, the city of São Paulo enhanced its healthcare infrastructure, expanded testing and vaccination campaigns and implemented public health measures to control the spread of the virus. Despite its status as one of the most populous cities in the world, São Paulo achieved a significant milestone by fully vaccinating its entire adult population against COVID-19 by December 2021.
However, urban areas face specific health challenges, such as higher risks of infectious diseases due to population density and lifestyle-related non-communicable diseases. Addressing these requires significant investment in health infrastructure and public health initiatives. Furthermore, an unfortunate upshot of economic growth in cities is often increased inequality, affecting health outcomes for lower-income groups. Ensuring equitable access to healthcare is essential for sustainable economic growth in urban settings.
The relationship between health and economic growth in cities is intricate and mutually reinforcing. Investments in health are not only beneficial for the wellbeing of the population but also play a crucial role in enhancing economic productivity, education and urban attractiveness.
Fig 1.1 Cities and health expenditure
Source: OECD, WHO, BMI
"We need more countries to scale up the implementation of policies to support people to be more active through walking, cycling, sport and other physical activity. The benefits are huge, not only for the physical and mental health of individuals, but also for societies, environments and economies...”
Dr Tedros Adhanom Ghebreyesus, WHO Director-General
Cities have different healthcare needs requiring diverse innovation
A city with a high elderly dependency ratio, population density, high levels of air pollution, limited green areas, increased climate hazards and, most importantly economic affluence tends to be more open to innovative healthcare products and services. Tokyo is an example of a city with many of these characteristics; as one of the wealthiest cities in the world, it has been able to introduce solutions such as advanced air purification systems, telemedicine and remote health monitoring, robotic caregivers, and pollution-resistant clothing and accessories.
A city with a high elderly dependency ratio, population density, high levels of air pollution, limited green areas, increased climate hazards and, most importantly economic affluence tends to be more open to innovative healthcare products and services. Tokyo is an example of a city with many of these characteristics; as one of the wealthiest cities in the world, it has been able to introduce solutions such as advanced air purification systems, telemedicine and remote health monitoring, robotic caregivers, and pollution-resistant clothing and accessories.
Fig 1.2 Requirements of cities for innovative healthcare products and services
Source: OECD, BMI
Impact of politics and economics on healthcare
The global macroeconomic landscape presents several key themes with significant implications for healthcare, especially in cities. We are likely to see a de-synchronised slowdown in global growth, leading to reduced funding for public healthcare systems, while at the same time, an historic period of significant reductions in monetary policy restrictions will spur increased investment in health infrastructure and innovation. Tighter fiscal policy and looser monetary policy add complexity to health system planning. Research suggests that increases in unemployment lead to reduced health insurance coverage, but a resilient labour market can minimise disruptions. Developing markets are more likely to face strains on government health budgets due to increased debt rollover challenges. Meanwhile, an intense election schedule in 2024 could delay health initiatives and shift spending priorities temporarily. Any rise in protectionism, as industrial policy sharpens, is likely to elevate costs for medical supplies and pharmaceuticals.
In a post-COVID-19 era, the politicisation of healthcare will increase, especially in relation to underfunded and over-stretched public medical services. Government healthcare budgets will increase, but this will be accompanied by a focus on cost-effective solutions. Health technology assessments will become more common, limiting revenue for companies that commercialise undifferentiated innovation. Consequently, some focus will shift to the effectiveness of funds spent on health personnel, infrastructure and, particularly, administration. This will create opportunities for private healthcare firms and new entrants from the technology sector to drive operational efficiencies through innovation.
Cities face much of the burden
Key Global Macroeconomic Themes For 2024
Source: BMI
Healthcare Implications
Global health challenges
The outbreak of COVID-19 has brought the issue of health security to the forefront, emphasising the importance of having a fair and effective public health infrastructure and emergency medical response system in urban areas. However, there is still a lack of investment in environmental health, social determinants of health, and mental health on a global scale. This report delves into six major health challenges and, more importantly, how certain cities are successfully addressing them.
