WORLD CITIES PROJECT

The largest cities in the developed world all face an unprecedented challenge: how to meet the needs of a population that lives longer, has a declining birthrate, is generally healthier and – with an average life expectancy approaching 80 years – is radically altering the demographic profile on which municipal services and social welfare programs have long been premised. The World Cities Project (WCP) has produced two books and numerous articles based on comparisons among, and within five of the world's most dynamic cities: New York, Paris, London, Tokyo and Hong Kong. These cities are centers of economic growth and finance, culture and media, sophisticated transportation systems and innovations of all kinds. They are renowned for their centers of excellence in medical care, top-ranking medical schools, institutes of bio-medical research, and public health infrastructure. Likewise, they attract some of the wealthiest, as well as the poorest populations of their nations, which forces their health care systems to confront the challenge of glaring inequalities.

Although world cities consider themselves unique within their respective nations, because of the many characteristics they share in common, it is useful to compare them to one another. By comparing cities with common key characteristics, WCP aims to identify promising practices and interesting failures; and on this basis suggest lessons from comparative experience for these world cities in wealthy nations as well as for the rapidly growing megacities worldwide. Our studies focus on three substantive areas: 1) urban aging; 2) emergency preparedness; and 3) the health care system.

Urban aging: WCP seeks to assist nations and municipalities meet the needs of a population that is older and vastly changed from the traditional post-war model of the twentieth century. Though world cities share similar demographic trends, their means of providing services to elderly citizens and recognizing the impact of an aging population differ considerably. WCP compares health status and quality of life, informal support, social networks, health and social services and long term care –both within and among these cities.

Emergency preparedness: Thousands of older New Yorkers were left stranded and isolated during the days immediately after 9/11. Hurricane Katrina reminded us once again of how visible otherwise invisible problems can become. Similarly, the 2003 summer heat wave in France served as a dramatic example of how a city with a high concentration of older persons can be completely unprepared to cope with its aging population. In Paris, the result was close to two thousand excess deaths, mostly among older persons 75 and over.

WCP has developed a vulnerability index for identifying socially isolated frail older people. We have adapted similar kinds of mapping tools used by the police to fight crime (ComStat), in New York City (NYC), to identify frail older people. ComStat demonstrated the importance of spatial targeting and influenced cities around the nation. Likewise, effective use of targeting based on such indicators as older persons living alone, neighborhood income, levels of disability and linguistic isolation, can help local non-profit organizations identify high-risk neighborhoods and improve service delivery for many frail older people.

Health care systems: Beneath the prestige of academic medical centers in world cities lie large swaths of their populations who face significant obstacles to accessing these services and even have difficulty obtaining appropriate disease prevention and primary care services. Since world cities serve as important gateways to their respective nations and share high levels of population density, they can become dangerous breeding grounds for contagious diseases. Thus, they must be at the forefront of developing public health infrastructure, including systems of syndromic surveillance, capability for rapid analysis and transmission of clinical data and laboratory reports, and a skilled public health workforce. Finally, in response to population aging and the rise of chronic disease, world cities must become leaders in redesigning their health care systems so that we begin to care for those with chronic disease through community-based primary care services and avoid exacerbations of such conditions resulting in hospital admissions through the emergency room.

History of the Project

WCP originated as a joint research project between the International Longevity Center (ILC) USA and NYU’s Wagner in 2001 following Dr. Victor Rodwin’s receipt of a three-year, Robert Wood Johnson Foundation Health Policy Investigator Award on "Megacities and Health: New York, London, Paris and Tokyo" in 2000.

Since the inception of the WCP, the project has expanded to include the involvement of the ILC-France, ILC-Japan, and ILC-UK, in addition to the City of Paris Department of Health and Social Affairs, the Caisse nationale de l’assurance maladie des travailleurs salariés (CNAMTS), the Hong Kong Hospital Authority, the London Regional Office of the British National Health Service, the Tokyo Metropolitan Government Bureau of Health and Social Welfare, and the New York City Department of Aging and Department of Health.

The WCP began with an exploration of health, social services, and quality of life for persons aged 65 years and older in the four largest urban metropolises within countries belonging to the Organization for Economic Cooperation and Development (OECD): New York, Paris, Tokyo and London. While these four cities share several characteristics (e.g., immense international traffic resulting from trade, financial transactions, electronic communications, airline travel, and policy ideas; rapidly declining birth rates; a rise in the proportion of older persons), there exist significant differences across settings in regards to labor force participation rates, mortality rates, life expectancy, the percent of older persons living alone, and systems for the provision of long-term care services.

In order to investigate the intricacies of the aging experience in these urban environments, the WCP has conducted comparative studies of health, social services, and quality of life across settings using a spatial perspective (i.e., comparing smaller and more similarly situated units, e.g., inter-city and intra-city comparisons) to conventional economic and demographic analyses (i.e., aggregating data) of issues associated with population aging and longevity. In recent years, the project has expanded to include Hong Kong and Shanghai.

Since the early 2000’s, drawing on findings from quantitative data collection and case studies, the WCP has organized working group meetings around specific themes with city officials, policy analysts, and health and social service professionals to review research findings and to identify innovative and successful policy or program interventions to accommodate the needs and wishes of an aging population within global, urban settings. Additionally, a series of papers and two books have been published using data from the WCP.

Principal Investigators:

Dr. Victor G. Rodwin, PhD

WCP Co-Director; Professor of Health Policy and Management, Robert F. Wagner Graduate School of Public Service, New York University

Dr. Michael K. Gusmano, PhD

WCP Co-Director; Research Scholar at the Hastings Center

Dr. Daniel Weisz, MD

WCP Research Associate; Adjunct Associate Research Scientist,Columbia Aging Center-International Longevity Center (CAC-ILC) U.S.A, Mailman School of Public Health, Columbia University

WORLD CITIES PROJECT PUBLICATIONS

Books

Gusmano, MK. Rodwin VG. Weisz, D. Health Care in World Cities: New York, London and Paris. Baltimore, Md: Johns Hopkins University Press, 2010.
Rodwin VG. and Gusmano, MK. (editors and principal contributors). Growing Older in Four World Cities: New York, Paris, London and Tokyo. Nashville TN: Vanderbilt University Press, 2006.

Articles

Gusmano MK. Rodwin VG. Wang C. Weisz D. Luo L. Hua F.(2015) Shanghai Rising: Health Improvements as Measured by Avoidable Mortality since 2000. International J. of Health Policy and Management
Chau, P.H., M.K. Gusmano and J. Woo. 2015. “Social Vulnerability Index for the Older People: Hong Kong and New York City as Examples,” Journal of Urban Health: Bulletin of the New York Academy of Medicine doi:10.1007/s11524-014-9901-8.
Weisz, D., M.K. Gusmano, G. Wong and J. Trombley II. 2015. “Emergency Department Use: A Reflection of Poor Primary Care Access?” American Journal of Managed Care.
Gusmano, M.K., V.G. Rodwin and D. Weisz. 2014. “Using Comparative Analysis To Address Health System Caricatures,” International Journal of Health Services, 44(3): 553-565.
Gusmano, M.K., D. Weisz, V.G. Rodwin, J. Lang, M. Qian, A. Bocquier, V. Moysan, and P. Verger. 2013. “Disparities in Access to Health Care in Three French regions.” Health Policy doi: 10.1016/j.healthpol.2013.07.011.
Gusmano, M.K., V.G. and D. Weisz. 2013. “Accès aux soins primaires en Ile de France: Une vue de côté de l'Atlantique,” Revue Francaise des Affaires Sociales 3: 109-125.
Chau, P.H., J. Woo, M.K. Gusmano, D. Weisz and V.G. Rodwin. 2012. “Access to Primary Care in Hong Kong, Greater London and New York City,” Health Economics, Policy and Law, doi:10.1017/S1744133112000114.
Gusmano, M.K. 2014. “Regional Variation in China’s Health Care System,” in Comparative Health Care Federalism: Competition and Collaboration in Multistate Systems Edited by K. Fierlbeck and H. Palley. Burlington, VT: Ashgate Publishing Company.
Chau, P.H., J. Woo, M.K. Gusmano and V.G. Rodwin. 2012. “Hong Kong and Other World Cities,” Chapter 2 in Aging in Hong Kong. Edited by Jean Woo. New York: Springer.
Gusmano, M.K. and V.G. Rodwin. 2010. “Urban Aging, Social Isolation, and Emergency Preparedness,” Global Ageing, 7(2).
Rodwin, VG. 2011. Health in Hong Kong: An international urban perspective. LSE Cities. Urban Age Conference, Hong Kong.
Chau, P.H., J. Woo, K.C. Chan, D. Weisz and M.K. Gusmano. 2010. “Avoidable Mortality Patterns in an Asian World City – Hong Kong.” European Journal of Public Health, March 18: 1-6.
Gusmano, MK. and Rodwin, VG. 2010. Global Ageing, social isolation and emergency
preparedness. IFA Global Aging, 6(2).
Gusmano, M.K. 2009. “Growing Older in World Cities: Benefits and Burdens” Chapter 29 in Cultural Context of Aging, Fourth Edition. Edited by Jay Sokolovsky. Greenwood Press.
Gusmano, M.K., D. Weisz, and V.G. Rodwin. 2009. “Achieving Horizontal Equity: Must We Have a Single Payer Health Care System?” Journal of Health Politics, Policy and Law 34(4): 617-633.
Gusmano, M.K., V.G. Rodwin and D. Weisz. 2008. “Health System Inequities: Towards An Empirical Assessment,” Revue d’Epidémiologie et de Santé Publique, 56, Supplement 5: s250-s351.
Rodwin, V. G. 2008. Health and Disease in Global Cities: A Neglected Dimension of National Health Policy. Networked Disease: Emerging Infections in the Global City, 27-48.
Cadot, E., Rodwin, V. G., & Spira, A. 2007. In the Heat of the Summer. Journal of Urban Health, 84(4): 466-468.
Gusmano, M.K., V.G. Rodwin, D. Weisz and D. Das. 2007. “A New Approach to the Comparative Analysis of Health Systems: Invasive Treatment for Heart Disease in the U.S, France and their two World Cities,” Health Economics, Policy and Law 2: 73-92.
Weisz, D., M.K. Gusmano, V.G. Rodwin, and L. Neuberg. 2007. “Population Health and the Health System: Avoidable Mortality in 3 Wealthy Nations and their World Cities,” European Journal of Public Health 18(2): 166-172.
Gusmano, M.K., V.G. Rodwin and D. Weisz. 2006. “A New Way to Compare Health Systems: Avoidable Hospital Conditions in Manhattan and Paris,” Health Affairs 25(2): 510-520.
Gusmano, MK. and Rodwin, VG. 2006. Growing Older in World Cities: Implications for Healthy Aging. Aging Today (Bimonthly Newspaper of the American Society on Aging) 27(6).
Rodwin, Victor G., and Leland G. Neuberg. 2005. "Infant mortality and income in 4 world cities: New York, London, Paris, and Tokyo." American Journal of Public Health 95.1: 86.
Gusmano, M.K. and V.G. Rodwin. 2005. “Health Services Research and the City” in Handbook of Urban Health. Edited by David Vlahov and Sandro Galea. New York: Springer.
Weisz, Daniel, M.K. Gusmano, V.G. Rodwin. 2004. “Gender Disparities in the Treatment of Coronary Artery Disease For Older Persons: A Comparative Analysis of National and City-Level Data,” Gender Medicine, 1(1): 29-40.
Rodwin, V.G., M.K. Gusmano and G. Montero. 2003. “World Cities Project: Growing Older in New York, London, Paris and Tokyo.” Direction de la Recherche, des Études, de L’Évaluation et des Statistics (DREES), Etudes et let Resultats, September.
Gusmano, MK. Montero, G. Rodwin, VG. (2003) Vieillir dans quatre mégapoles: New York, Londres, Paris et Tokyo. Etudes et Résultats, 260.
Neuberg, L. G., & Rodwin, V. G. (2002). Neighborhood Matters. Indicators, 3: 15.
Rodwin, V G., G. Montero and M. K. Gusmano. 2002. “Vieillissement et Milieux Urbaines: le World Cities Project,” Les Politiques Sociales, 61(1&2): 115-121.
Rodwin, V.G and M.K. Gusmano. 2002. “World Cities Project: Rationale and Design for Comparison of Megacity Health Systems,” Journal of Urban Health 79(4): 445-463.
Gossiaux, S. Rodwin, VG. and Simon, M. 2002. A Paris, plus de six femmes sur dix vivent seules après 80 ans. INSEE Ile-de-France à la page. Paris. Mensuel. 210
Rodwin, VG. 2001. Urban Health: Is the City Infected? In Marinker, M. (Ed.), Medicine and Humanity (pp. 141-152). London: King's Fund.
Rodwin, VG. 2000. Project report: population aging and longevity in world cities. Japan Foundation Center For Global Partnership Newsletter 26.

WORLD CITIES PROJECT

- See more at: http://aging.columbia.edu/international-longevity-center/translational-research/world-cities-project

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HONG KONG MEETING, JANUARY 2015

- "The Challenges of Population Ageing for Health Systems in Global Cities"

PARIS MEETING, 13 JULY 2003

- "Vieillir ensemble dans les mégalopoles," From Le Monde, 4 July 2003

JOURNAL OF URBAN HEALTH: BULLETIN OF THE NEW YORK ACADEMY OF MEDICINE, VOL. 79, NO. 4 - DECEMBER 2002

- "The World Cities Project: Rationale, Organization and Design for Comparison of Megacity Health Systems"

INTERNATIONAL LONGEVITY CENTER - USA, ISSUE BRIEF: SEPTEMBER-OCTOBER 2002

- "Old and Poor in New York City"

THE NATIONAL INSTITUTE OF STATISTICS AND ECONOMIC STUDIES IN FRANCE (INSEE):

- "A Paris, plus de six femmes sur dix vivent seules aprés 80 ans," INSEE II-de-France A La Page, May-June 2002

CENTER FOR EUROPEAN STUDIES CONFERENCE: "NEW VISIONS OF THE EUROPEAN CITY: PARIS - NEW YORK," 25-27 APRIL 2002

- Presentation: "Growing Older in New York & Paris"