When it comes to social determinants, high income countries generally perform better.

The report, which has left out traditional risk factors like diabetes, hypertension and obesity in the population, focuses on how rapid urbanization itself has now become a risk factor for heart diseases. That’s why it looks at holistic measures that cities need to implement and keep their people healthy, primarily social and environmental factors, including access to green spaces, housing and nutrition safety, air pollution levels and infrastructure for walking and cycling.

Why is the city-based approach important?

“Cities become important when it comes to heart health because they have a concentrated population, many of whom have risk factors. We see people migrating for job opportunities to cities where work patterns create a sedentary lifestyle, where levels of pollution are higher, where there are limited green spaces, where stress is exacerbated because of high living costs and social isolation is felt the most. Twenty percent of India’s population lived in cities in 1947. That figure increased to 55 percent two years ago. Cities, therefore, pose a real risk,” says Dr Jagat Narula, president-elect of the World Heart Federation.

What are parameters for heart-healthy cities?

The report has marked cities on five parameters.
(1) Social determinants such as income level, education level and food security.
(2) Physical environment such as access to green spaces and levels of air pollution.
(3) Health risks such as use of tobacco, consumption of foods high in trans-fats and prevalence of conditions such as obesity and diabetes that increase the risk of heart diseases.
(4) Accessibility to healthcare and medicines.
(5) Whether governments develop and implement holistic policies for heart health.

When it comes to social determinants, high income countries generally perform better. However, middle-income cities such as Sao Paulo in Brazil, Bogota in Colombia and Yangon in Myanmar have performed well on these indicators with relatively low levels of inequality among the population.

While Hong Kong, London, Madrid, New York and Berlin make up the top five, the three cities from India — Delhi, Mumbai, and Kolkata — rank at 33, 34, and 37 respectively out of the 50 cities.

Most cities performed the worst in the physical environment. However, wealthy cities had a leg-up due to availability of open, green spaces, along with infrastructure such as cycle tracks. One of the biggest challenges was air pollution, with cities in Southeast Asia being exposed to as much as ten times the recommended levels of pollution. The report also highlighted solutions, citing the examples of smog vacuum cleaners in Beijing and pollution-absorbing substances that line the exterior of the building in Mexico.

What about access to healthy foods?

When it comes to ensuring a healthy diet — apart from looking at fruits and vegetable consumption of the population — Dr Narula cites the example of tobacco regulation. “India was one of the first countries to ensure a complete ban on advertisements of tobacco products. The food industry can be regulated similarly,” he says, adding that efforts are already under way to have proper labeling norms to help people choose healthier options. The food regulator has been working with the industry to reduce the artery-clogging trans-fats in food items from five percent to two percent.

How are Indian cities performing better in terms of healthcare services?

When it comes to delivery of healthcare services, the report appreciated the government’s National Rural Health Mission, especially its implementation in Mumbai. Says Dr Narula, “NUHM was designed to provide holistic care to the urban poor — this is extremely important in Mumbai with its large slum population. The food and immunization that a child receives have an impact on their lifetime risk of heart disease. Infection-induced inflammation can also lead to heart diseases while menopausal management strategies can help women prevent and treat heart diseases.”