Public Health

Within the CitiIQ scoring system, Public Health is one of the most intricately woven themes – what we call Considerations. There is a good reason for this: health across a population reflects many things working in a consistent and coordinated fashion.

Health outcomes and service offerings are vital to the wellbeing of a city. Public health programs assist in the maintenance of quality of life. Health initiatives and programs have led to increased life expectancy, worldwide reductions in infant and child mortality, and the eradication or reduction of many communicable diseases. Developing countries continue to struggle through sanitation issues or access to health care, while western countries continue to face obesity issues, an aging demographic, and subsequent medical issues associated with these situations. The Public Health consideration measures the ability of a city to provide adequate health care facilities and personnel in the context of the areas of service represented by the other 34 Considerations measured by CitiIQ. The Public Health consideration is generally composed of four indicator groups - it can be more easily understood by looking at them separately.

First, the indicators that are used reflect institutional health capacity and response. Healthy individuals in cities today are dependent on many institutional structures and processes. Healthcare personnel need to be trained, employed, paid, and cared for. At a small scale, individuals can care for each other but when scaled to meet the needs of a community or city, health care requires institutional structures. Hospitals epitomize this kind of structure that is measured in the Public Health consideration. Other related infrastructure assets that require institutional support are also included in this measurement. For example, the length of dedicated cycleways are measured because of the infrastructure implications of not only having bicycles but allocating scarce roadways or land to support cycling.

A second cluster of indicators provides feedback on family scale dynamics. Families represent a very wide range of social arrangements. Within that range, the indicators that are both available and relevant include new mother maturity, prevention of child mortality and low levels of child labour. Having children and caring adequately for them is very important for growing communities. Suicide prevention, including youth suicide, is also reflective of the prevalence of supports that an individual has when facing personal challenges. All of these contribute to the overall measure of life expectancy, yet another indicator in this cluster.

Basic needs are the foundation out of which other opportunities can be realized. This third group of indicators measure fundamental survival necessities like sanitation and clean water. Consistently delivering these to an urban population requires management expertise that can ensure quality and access over time. Basic needs are not periodic requirements for health but must be available to us over the long term. When issues like poor air quality affect a city such as Shanghai, citizens suffer immediately and continuously as long as the problem persists. Strategies leading to healthy public environments are the load-bearing beams and post of a sound urban structure.

A final set of factors that contribute to public health reflect an important core of social balances. Every city has unique characteristics that include differing sizes of age groups, the overall physical health of citizens reflected in average weight, as well as the stability of households. These social characteristics reflect the kinds of issues a city currently faces and also the challenges that will emerge in the future. Poor diet and low activity levels, for example, can lead to increased incidence of diabetes. Diabetes will, in turn, cost the health and other social systems at an increasing rate as people with diabetes age. Infectious diseases, as we have seen so starkly in 2020 and to the present, can radically alter cities, countries and the global community. Responses to these challenges reflect the capacity and capability of a city. Measuring and comparing these dynamics will give us a much better idea of where we are making progress and where we are falling behind.