We often see headlines ranking cities on specific health-impacting measures such as air quality or commuting time, or highlighting regional differences in health outcomes, but rarely do we get a comprehensive picture of a city’s health and wellbeing.
Finding comparable city-level data is no easy task, but the Deloitte UK Centre for Health Solutions was able to help one of our teams achieve this by leveraging its global footprint to extract a set of insightful comparable data. Each city was profiled demographically (population size, population over 65 years old and foreign-born population) and compared on a number of health metrics (life expectancy and infant mortality), environmental factors (commuting time and air quality), lifestyle factors (smoking, drinking and exercise) and outcomes (obesity and suicide rates).
In Deloitte's study of 10 global cities (London, New York, Paris, Tokyo, Hong Kong, Johannesburg, Madrid, São Paulo, Sydney and Toronto) we found that Hong Kong is consistently ranked as the healthiest city, with the highest life expectancy (81 and 86 years for males and females respectively) and the lowest infant mortality rate (1.3 deaths/1000 live births). London, Tokyo and Toronto aren’t far behind. In stark contrast, however, life expectancy in Johannesburg is only 54 for males and 57 for females and infant mortality is the highest at 48 deaths/1000 live births.
London, New York and Sydney are among the most diverse populations with more than a third of residents born outside the country. Toronto, albeit a smaller population, is the most diverse with 49 per cent foreign born. This diversity impacts the health-related issues encountered and the care needed. Lifestyle factors that impact health also vary widely across the cities studied.
In London and New York more than half the adult population is overweight, with a Body Mass Index (BMI) over 25, compared to only 25 per cent in Tokyo and 19 per cent in Hong Kong. Indeed, New York has the highest level of adult obesity, with 24 per cent of the population with a BMI greater than 30. Meanwhile Tokyo, Paris and Madrid have low obesity rates, with less than 8 per cent of the population recording a BMI over 30.
Childhood obesity is a worrying trend that many national and local governments are attempting to tackle through nutrition and exercise programmes. New York has made recent progress on this through Take Care New York, a public health initiative led by Mayor Bloomberg. However, obesity in children still stands at 21 per cent, second worst behind London at 22 per cent. Tobacco smoking is another factor that Take Care New York tackled aggressively with strong public awareness campaigns and targeted taxation. The percentage of the population who smoke remains highest in Paris (40 per cent) and Madrid (28 per cent), with the rest have smoking levels of 21 per cent or less.
The World Health Organisation recommends 150 minutes of physical exercise each week, and in London, New York, São Paulo and Sydney, over 50 per cent of the population claim to achieve this level. Given that London and New York have high levels of overweight adults and high numbers of adults reportedly achieving the recommended levels of physical exercise, the complexity (and/or subjectivity of lifestyle data is evident. Some studies have questioned the health benefits of exercising in polluted environments, and all the cities in the study except Sydney had particulate (PM10) levels above the recommended safe level of 20 μg/m3. Yet Hong Kong, with the second highest pollution rates at 50 μg/m3, has the highest life expectancy.
So what does this mean for your city? As the above shows, the inter-relationships between lifestyle, environmental factors, and outcomes is complex. Many health and wellbeing initiatives, such as reducing smoking, take a nation-wide approach through taxing tobacco or banning smoking in public places. Others such as creating accessible green space, safe cycle lanes, pedestrian friendly urban areas and other measures to facilitate exercise, can all be influenced at a city planning level. Healthy cities have common themes that enable success, such as: a clear strategy championed by a committed, high profile individual (e.g. Mayor Bloomberg and Take Care New York); an engaged and supportive public (e.g. in Hong Kong healthcare reforms went through two rounds of public consultation); ensuring health is considered in all policies (e.g. Toronto’s Medical Officer for Health inputs into all relevant policies). While the approach should match the social, cultural and economic context of the city, many lessons can be learnt from pioneers in the field as well as case by case examples across the globe.