Naveen Rao: Tomorrow’s Smart Cities Will Take On the Social Determinants of Health
Part One of a Two Part Series
Not all is well in the Smart City.
As a health innovation junkie, I began researching Smart Cities last summer, and I was dismayed to find a glaring absence of discussion related to healthcare payment and delivery, public health, or urban health equity. On the one hand, this is understandable: Healthcare has been the political hot potato of our era, a fully-loaded issue that most businesses haven’t wanted to touch for the last few years.
It goes deeper than politics. The regulatory complexity of coverage, access, and benefits administration at a population level, combined with state by state variability in policy and structure make scalability a tough nut to crack for would-be suppliers and vendors.
On the other hand: ignoring health is ill-advised for cities. The UN estimates that two-thirds of the world’s population will live in cities by the year 2030. We know that city living comes with higher risks for a variety of non-communicable, lifestyle-driven illnesses that manifest as chronic mental, behavioral, and physical ailments. Urbanites tend to be more stressed, more exposed to pollution, noise, and violence, and other issues that get worse the further down the income ladder you look.This has been notoriously dubbed the “urban health penalty.”
The economic implications aren’t looming - they’re here. The US spends far more on health than any first world country, without the same results in life expectancy or other key outcomes. A clue for the next frontier of progress in US health outcomes comes from previous studies, which show that the US also spends far less on social services than our global counterparts.
The new thesis for reform is a convergence of public health, value-based care, and urban equity that can be summed up into a tidy phrase - The Social Determinants of Health (SDOH):
“Social determinants of health are conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks…[p]atterns of social engagement and sense of security and well-being are also affected by where people live. Resources that enhance quality of life can have a significant influence on population health outcomes. Examples of these resources include safe and affordable housing, access to education, public safety, availability of healthy foods, local emergency/health services, and [clean environments].”
Cities have a unique opportunity - some would argue a moral imperative - to take on the social determinants of health (SDOH) head-on as part of their Smart City programs. Addressing SDOH will require a new mindset of progressivism and inclusion at the leadership level, as well as upgrades and technology enhancements to existing public health programs.
In the second part of this article, we’ll take a look at three city-level approaches to taking on SDOH. While these and other initiatives in urban health innovation haven’t been billed as “smart city” projects to date, we’ll explore how such projects embody the ethos of a smart city by combining the central tenets of smart cities: data-driven insights, public-private partnerships, and an eye towards more resource-efficient, human-centered urban living.