Where does your city stand in terms of health and well-being?

And more importantly, where do you stand? At the recent Urban Age Conference 2011 in Hong Kong, this was one of many topics addressed. Victor G Rodwin, director of the World Cities Project and professor of health and policy management at New York University, admitted that the term ‘health and well-being’ “covers everything and touches nothing” – a bit like the sky.

In his attempt to understand a city’s impact on the health of its population, Rodwin compared five major cities in his research: New York, London, Paris, Tokyo and Hong Kong as the focus. His approach is to study health systems rather than use the World Health Organisation’s (WHO) ‘social determinants of health’ – income, education levels, housing conditions, nutrition, social relationships, health promotion and health care services.

According to Rodwin, there are two other indicators that are key in measuring the performance of health systems: avoidable mortality (AM) and primary care. “AM measures deaths before the age of 75 due to diseases for which there are effective health care interventions: disease prevention services, primary care and specialty services. Access to primary care is often evaluated by measuring the magnitude of hospitalisations for so-called ‘avoidable hospital conditions’ (AHC).” 

Of the five cities studied, he found that Hong Kong had the best indicators of health, with the lowest infant mortality rate at 3.0 per 1,000 births and greatest life expectancy at 83.9 years, surpassing Tokyo at 77.7 years. However, when evaluated on the basis of the extra indicators, Hong Kong has highest proportion of AM compared to the other four cities: “Hong Kong also has the second lowest rate of hospital admissions for AHC, at least with respect to people aged 65 and over.”

Such findings are evidence that while Hong Kong does fare well compared to most other cities in terms of health, there is still room for improvement. “Since only around 30 per cent of the population have employer-based insurance, most of the population has to pay out-of-the-pocket for primary care by physicians in private practices or rely entirely on the public hospital system and its affiliated outpatient clinics, where physician-patient encounters are notoriously brief and available primary care is considered inadequate to meet the population’s needs.”

Hence, there is a lot to learn among cities on how to improve a population’s well-being. Paris, for example, pays special attention to locating local social service offices and maternal and child programmes in higher-risk areas. In London, neighbourhood regeneration is promoted. How else can we improve the overall health of a population?

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