AHA: Sustainable cities ‘ground zero’ for transforming global heart health
Key takeaways:
- A new policy statement highlights the importance of considering cardiometabolic health in any urban planning.
- Access to green spaces, healthy foods and safe drinking water can reduce CVD risk.
Cities designed with sustainable measures such as green infrastructure, access to safe open spaces and healthy foods can directly improve the cardiometabolic health of the people who live and work in those urban areas, researchers reported.
In a new policy statement from the American Heart Association, researchers argued that any urban planning should address seven key “physical provisioning systems” that support people living in urban cities and also consume more than 90% of the world’s water and generate more than 94% of global CO2 emissions: systems that provide food, energy, mobility-connectivity, housing, green infrastructure, water and waste management. The statement was published in Circulation.
“We are moving into some existential problems for humanity: climate change, rising costs globally and disruptive technologies all around us,” Sanjay Rajagopalan, MD, chief of the division of cardiovascular medicine and chief academic and scientific officer of University Hospitals Harrington Heart & Vascular Institute and Herman K. Hellerstein, MD, Chair in Cardiovascular Research at Case Western Reserve University, told Healio. “We need much more comprehensive ways to view health. The fault lines in society confronting us is that all too often health care is often siloed, relegated to people sitting in hospitals who are not talking to other experts and policymakers whose decisions may have an indelible impact on large populations. Unfortunately, as physicians, we often do not address health, but spend our time predominantly addressing sickness and disease, as this is what we are currently incentivized to do. If we want to build healthy societies, we must focus on primordial drivers of health, most of which is driven by the environments people live in. The questions that are relevant for many patients to transform their health are questions like ‘Do you have time for recreation? Do you have walkable areas, access to fresh food? How do you spend your leisure time? Do you have highways cutting through your backyard exposing you to noise and air pollution?’ If you are interested in population health, you must put health at the center of urban planning. These aspects, while in the background, should facilitate automatic health decisions and therefore should be in the forefront of our minds, while thinking about primordial prevention of chronic non-communicable diseases. Yes, these are huge ideas. But, they are doable, if we get our act together by getting people together not only to think about health but also to work on integrating urban planning decisions with health at the epicenter.”
Building with CVD in mind
In the statement, the authors noted that inadequate and problematic provisioning systems contribute to adverse environmental exposures that are associated with premature mortality globally. Nearly 56% of the global population lives in cities, with this number expected to increase to 6.6 billion, or more than 70% of the world’s population, by 2050, according to the researchers.
“In 2019, nearly 12 million people died globally as a result of living or working in an unhealthy environment — nearly 1 in 4 of total global deaths,” the researchers wrote. “Environmental risk factors such as air, water and soil pollution; chemical exposures; climate change; and ultraviolet radiation contribute to more than 100 diseases. Atherosclerotic CVD and risk factors such as hypertension and type 2 diabetes dominate disease burden attributable to environmental pollution.”
The policy statement is built on the concept of building or reforming cities around access to green open spaces, easy access to healthy foods, safe drinking water and stable housing, and incorporating energy efficiency into any building designs, Rajagopalan said.
“Provisioning systems present a once-in-a-lifetime opportunity to us, as we are thinking about renewing, building or rebuilding these infrastructure systems in cities across the world,” Rajagopalan said during an interview.
Talk with patients about their environment
The statement, which called moving toward heart and brain health in sustainable cities “ground zero” for transforming global population health, also encourages health policy research, urban health impact assessments and educational outreach that stresses the impact of urban spatial planning.
“Even for me, writing this statement with my colleagues was an aha moment,” Rajagopalan told Healio. “Things like obesity, from a social construct perspective, are affected by having a place to go and walk outside. Is that something we should be talking about as cardiologists? I would say it is time that we do that.”
Rajagopalan also encouraged cardiologists to be advocates for policies that incorporate health into urban planning measures.
“We often emphasize things like eating a healthy diet and getting plenty of exercise,” Rajagopalan told Healio. “This is a clarion call to be reiterating those ideas and finding better ways to solve these problems. Having a conversation with patients about this is not reimbursable, clearly. But if you want to make an impact on type 2 diabetes and obesity, it is going to require focus on these factors.”
Reference:
- Adapting cities for heart-healthy, sustainable living requires integrated public policies. https://newsroom.heart.org/news/adapting-cities-for-heart-healthy-sustainable-living-requires-integrated-public-policies. Published March 4, 2024. Accessed March 19, 2024.
For more information:
Sanjay Rajagopalan, MD, FACC, FAHA, can be reached at sanjay.rajagopalan@uhhospitals.org.
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