2025 Concordia Annual Summit

Urban Population Health: Building Smarter Cities Together

  • Health Opportunities & Challenges
Dr. Ann Aerts, Juha Jolkkonen, Dr. David Napier, Dr. Michelle Williams, Daniella Foster, Dr. Nicole F. Roberts, Elena Bonfiglioli

Session
Partners

Session Summary

Important
Quotations

"We seem to miss a piece of the puzzle. We seem to do something wrong, and that is why we don't fully understand what drives cardiovascular disease. That's where my passion comes from. We have to use data to understand exactly in what kind of place and what kind of subpopulations the drivers of cardiovascular disease can be identified so that we can act upon it properly."
Dr. Ann Aerts
"Cities are closer to people, closer to families and communities. Cities are responsible for many services that affect people directly. Cities can really influence health and wellbeing and can be the platform for these kinds of actions."
Juha Jolkkonen
"The key for me in AI for healthy cities is that we are starting to consider complex heterogeneous risk factors that compound in real time and cannot be addressed through randomized controlled trials. These compounding factors can actually be modeled and scaled using prototypes of real people we all know."
Dr. David Napier
"Innovation only begins to reach populations in impactful ways 17 to 20 years after it occurs. We are at risk if we are not intentional in making sure lifesaving innovations reach the people who need them."
Dr. Michelle Williams
"I envision a world where every touchpoint, whether it's a bus stop or park bench, helps improve health. Cities can be designed so that health is integrated into everyday life, not just hospitals."
Daniella Foster
"I envision a world where every touchpoint, whether it's a bus stop or park bench, helps improve health. Cities can be designed so that health is integrated into everyday life, not just hospitals."
Dr. Nicole F. Roberts
"Imagine if every city could hold the banner of healthier cities with integrated policies and governance. Healthier individuals are not defined by the hour and a half spent at the doctor but by a holistic understanding of data."
Elena Bonfiglioli

Key
Takeaways

  • Data Integration is Critical for Understanding Health Disparities: The panel demonstrated that combining data from health and health-influencing sectors can reveal powerful insights about population health patterns. Research shows that diabetes in New York City can be predicted by census tract using just three to four factors: low education, low income, lack of internet access, and social isolation. Similarly, hypertension is primarily driven by commute time – making it the number one predictor of high blood pressure in New York City.

 

  • Health is Made Outside the Healthcare System: A fundamental insight emerged that health is largely determined by conditions where people live, work, and spend their time. Citizens spend only about 1.5 hours per year with their doctor, meaning the remaining 8,760+ hours are spent living in environments that significantly impact their health outcomes.

 

  • Innovation Adoption Takes Too Long Without Intentional Action: The panel highlighted a critical challenge: innovation typically takes 17-20 years to reach populations in impactful ways. This delay particularly affects underserved communities and can widen health disparities if not addressed proactively.


  • AI Can Scale Community-Level Understanding: AI enables identification of complex, compounding risk factors that affect real people in real time – factors that aren’t amenable to traditional randomized controlled trials. This technology can help scale understanding of “complex heterogeneous risk factors that compound one another” to create actionable interventions.

 

  • Trust and Community Engagement Remain Fundamental: Despite technological advances, 85% of accurate diagnoses still come from person-to-person case history engagement. The most vulnerable populations – those “who don’t have health agency, who remain invisible, who cannot present themselves in focus groups” – require human-centered approaches.

Action
Items

  • Establish Community Health Advocate Programs: Health departments should create training programs for community health advocates who understand local contexts and can build trust, hiring trained advocates to help people stay healthy longer while saving money.

 

  • Implement Hyperlocal Data Integration: Cities should combine data from transport, food, sports, housing, security, and health sectors to identify specific community needs, focusing on hyperlocal interventions targeting neighborhoods with high burdens of chronic diseases.

 

  • Deploy Accessible Screening Tools: Expand use of smartphone-based diagnostic tools like the Heart Health Risk Calculator, which has over 90% accuracy for 10-year heart disease risk assessment, and integrate them into everyday touchpoints throughout cities.

 

  • Create Multi-Sector Partnerships: Establish formal partnerships between private sector, government, academic institutions, and community organizations, focusing on place-based solutions that meet people where they live, work, and worship.

 

  • Transform Healthcare from Reactive to Proactive: Move health systems from passive reactive care systems to proactive and ultimately preventive systems, using predictive analytics to identify high-risk populations before they become symptomatic.

 

  • Build Health into City Infrastructure: Design cities so that every touchpoint throughout the day becomes a place to help improve health, ensuring health considerations are embedded in urban design rather than limited to hospitals.

 

  • Achieve Health Equity Through Targeted Interventions: Work to close life expectancy gaps that can be as large as 9-12 years between neighborhoods in the same city, ensuring each citizen has access to personal health data and awareness.

 

  • Establish Citizens as CEOs of Their Own Health: Promote science-based self-care that empowers individuals during the 364+ days per year they are not in healthcare settings, leveraging social determinants data to make informed decisions.

 

  • Scale Successful Models Globally: Replicate proven interventions like Helsinki’s AI for Healthy Cities model to 10, 20, then 30+ cities through learning coalitions, focusing on accessibility, affordability, and ease of adoption.

 

  • Pursue Ambitious Health Goals: Work toward eliminating heart attacks for the next generation through combined scientific innovations and predictive tools, transitioning from sick care to WellCare as the fundamental paradigm for health systems.

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