Cities and Urbanization

How data and partnerships can help us improve heart health at scale 

A nurse sorts out pamphlets at a desk: Cardiovascular disease is one of the world’s biggest killers.

Cardiovascular disease is one of the world’s biggest killers. Image: Novartis Foundation

Ann Aerts
Head of the Novartis Foundation, Novartis Foundation
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Cities and Urbanization

  • Cardiovascular disease is one of the world’s biggest killers and a monumental economic burden, costing $300 billion in the European Union.
  • The broader environment shapes eighty per cent of our health outcomes, so the social determinants of health cannot be ignored.
  • The Novartis Foundation has launched CARDIO4Cities and AI4HealthyCities, using data to determine the root causes and patterns of heart disease in cities.

Every 40 seconds, at least one person in the world has a heart attack and every year, 18 million people die from cardiovascular disease. It is one of the world’s biggest killers.

If this shocking death toll wasn’t enough, know that there is an enormous price tag – in the European Union alone, costs related to cardiovascular disease amount to $300 billion per year. However, we can prevent up to 80% of its deaths.

Often described as the “invisible disease,” the condition is mainly symptomless and can go unnoticed. Previous evidence suggests that specific lifestyle factors such as unhealthy diets, physical inactivity and alcohol and tobacco abuse are individual behavioural risk factors for heart attacks and strokes, offering an early opportunity to target this deadly disease.

However, to scale our response, we need to look beyond the individual. Up to 80% of our health outcomes are not shaped by our health systems but by the broader environment, affecting entire communities.

Cities are some of the planet’s most populated and connected spaces, holding a whole host of data about how we live as individuals and communities. Unlocking this data could be part of the solution.

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A population health approach

The Novartis Foundation looks through a wider lens, away from individual healthcare delivery, toward improving health in the population at large. Thus, it is essential to collaborate with cities and local partners and leverage their available data to target diseases and promote healthier communities.

Through two main initiatives – CARDIO4Cities and AI4HealthyCities – the Novartis Foundation integrates and analyzes diverse data to provide insights into the root causes of heart disease and its associated disparities, especially in cities.

The Foundation identifies the true drivers of health outcomes by leveraging local communities, harnessing citywide health data and applying artificial intelligence (AI). Localized, data-driven responses then become part of effective health policies. This approach aims to revolutionize how health and care are understood and delivered and foster healthier, more equitable communities in urban settings.

Localized knowledge and human connection

In São Paulo, Brazil, CARDIO4Cities has empowered people locally to take control of their blood pressure between 2018 and 2019. It could understand the local needs around cardiovascular health and use insights to inform community initiatives.

Thanks to advanced training for healthcare professionals, standardization of primary care management, intersectoral collaboration and community engagement at football stadiums or outside of the metro, for example, the team involved in CARDIO4Cities could reduce people’s chance of having a stroke by 13% and heart attack by 12% during the implementation phase alone.

CARDIO4Cities goes to the grassroots to affect change, and such public-private partnerships are crucial to better people’s lives globally.


Data and AI as a population health asset

Acknowledging the need for more evidence-based decision-making in healthcare alongside the richness of data that many cities offer, the Novartis Foundation took things one step further. Using AI and data, the aim was to understand the impact of social and broader determinants on health equity and have the greatest number of people benefit from these insights.

Various factors contribute to our health outcomes beyond individual determinants, known as social determinants of health, which can significantly impact our risk of developing certain diseases, access to healthcare and expected health outcomes. These determinants include:

  • Economic (employment, financial situation).
  • Social (immigration status, acculturation).
  • Environmental (climate, air pollution, transportation).
  • Digital (access to the internet or a computing device).
  • Psychosocial factors (local language, literacy).

AI4HealthyCities is an initiative run in partnership with Microsoft AI for Health and corresponding local health and educational institutions, focusing on reducing health inequalities in data-rich cities. It uses AI to analyze both health records and social determinants of health data, e.g. zip codes or census tracts, aiming to identify the modifiable socio-economic risk factors for cardiovascular disease, ultimately guiding policy interventions for whole cities.

Looking to the future

Efforts to tackle cardiovascular disease have shown promise at a local level but to truly make a difference, we need to expand our efforts globally. The urgency is clear, so CARDIO4Cities is being expanded to other cities worldwide through the CARDIO4Cities Accelerator, which was officially launched in partnership with IntraHealth International during the 2023 World Health Assembly in May.

The Accelerator’s mission: channel action and funding toward enhancing cardiovascular disease population health and promoting equity. The ambitious goal is to transform the cardiovascular disease population’s health in 30 cities across the globe within the next three years.

In parallel, AI4HealthyCities has been making strides since its New York launch in 2022, expanding its footprint to major cities, such as Singapore and engaging in conversations with Lausanne, Basel and Helsinki.

As this initiative continues to be implemented and delivers first insights into what shapes local cardiovascular health outcomes, it is crucial to emphasize its potential in providing insights for effective interventions to tackle cardiovascular disease, which could even inform similar policies for data-scarce geographies in the future.

City-centric solutions

Cities serve as the heartbeats of nations. While often associated with exacerbating health challenges via environmental health factors, they can also become part of the solution by leveraging existing data infrastructure and forging solid partnerships with established multi-sector initiatives.

Their success highly depends on appropriate resources and funding, so it is important to create awareness with policymakers that preventing 10 years of coronary heart disease can allow for savings of almost $15 billion in gross domestic product, which amounts to $51,000 per person.

Investing in long-lasting, sustainable solutions that tackle and prevent the increasing burden of cardiovascular disease will not only save lives but also alleviate the ever-increasing economic burden of cardiovascular disease. Harnessing insights from data to inform evidence-based decision-making is thus an important stepping stone to successful predictive and proactive health systems in today’s reactive systems of care.

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