Hong Kong and London topped the list of 50 cities ranked for their efforts to prevent and address cardiovascular diseases – while Kathmandu and Cairo languished at the bottom.

The City Heartbeat Index is a first-of-its-kind initiative of the World Heart Federation (WHF), a Geneva-based non-profit that works on cardiovascular disease (CVD) prevention.

CVD is one of the top causes of death worldwide, according to the World Health Organization (WHO).

Preventing them could significantly improve public health and quality of life for the population living in a city.

The index evaluated cities using 44 indicators including social determinants of health such as poverty, environmental factors such as air quality, and health risks like hypertension, access to health services and health policies.

It used data from city government websites, health departments and published literature, along with interviews with local experts to validate findings and fill information gaps.

“This is the first attempt of this kind, and more importantly that it is going to enthuse the governments or the non-governmental organizations or the local bodies to be trying to do better,” said Dr Jagat Narula, president-elect of the WHF. “We are talking about the heartbeat index here, but it is actually going to give you a much broader vision and much better chances of working towards policies.”

While there were a few exceptions, cities in Asia and Africa performed the worst. Even high-income cities such as Riyadh and Kuwait City ranked poorly.

“I am extremely proud of the work we have done to make London a healthier place to live. We have made real progress improving health outcomes by taking old polluting cars off our roads and bringing cleaner air to millions more Londoners, enabling more walking and cycling and promoting healthier food advertising on our transport network,” said London mayor Sadiq Khan.

The burden of CVD is driving action

Of the 10 highest scoring cities on the Index, four (Berlin, Toronto, Helsinki and New York City) are in countries with high burden of CVD.

Access to universal healthcare has also helped cities’ ranking.

“It is the factors of what is the will, how much is the advocacy, how the policy has resulted in all those things, whether there is a universal care. Or the National Health schemes, for example, in London and Madrid and other places where the healthcare is available to all,” Narula told Health Policy Watch.

Some cities in middle-income countries like Sao Paulo in Brazil and Bogota in Colombia have also done well, said Narula, emphasizing that resources are not a constraint when there is will.

Critical data is still missing

However, critical data is missing to evaluate cities. Few cities have data on food security (42%), cholesterol (22%) or transfat consumption (14%) – key risk factors for CVD.

This data would provide the first step in understanding the scale and scope of how key risk factors are affecting populations.

Only Jakarta and Singapore had data available for all 12 sub-indicators included in the Index, demonstrating intent to understand and address the factors affecting cardiovascular health.

Cities prioritise some risk factors over others

Based on the average scores across the key CVD risk factors, cities most often prioritise diabetes (78.9), tobacco use (66.5), hypertension (63.0) and obesity (62.9).

High scores on these indicators are due to the presence of city-level data.

Other key risk factors, including levels of consumption of vegetables (45.8) and trans fats (53.9), and levels of physical activity (60.4) and cholesterol (31.8), have lower scores, which may indicate fewer city-level efforts to monitor and address these health concerns.

“The City Heartbeat Index shows that the many efforts by cities – where over half of the world’s population resides – on heart health are visible and increasingly important,” said Dr Vasilisa Sazonov at Novartis who sponsored the index.

“There are opportunities to improve data collection at the city level including prioritising CVD risk factors that have typically been overlooked such as high cholesterol,” said Sazonov.

Worsening climate impacts like heat were not a part of the report this year but Narula said that the indicators will evolve.

Image Credits: City Heartbeat Index Report.