HEALTH AND THE CITY...
Experts in Health Economics and Health Insurance use to show how the pooling of risks helps finance and cover the costs of catastrophic diseases. If that is the case, Tokyo, Delhi, Shanghai, Dhaka, and Sao Paulo should be the top 5 cities in terms of social protection financing in health. Unfortunately, having millions of people does not mean you have the best health in your city, even when you should have it, in order to prevent risks caused by the massive presence of vectors (human ones) that are able to create health disasters under the always hard to combat communicable diseases. Fortunately for the big cities, the opposite: Noncommunicable Diseases (NCDs) are the ones that kill almost 8 out of 10 humans: 41 million people each year, equivalent to 74% of all deaths globally (World Health Organization, 2022). Together, the 6 most lethal communicable diseases kill 2.7 million people per annum (2019, before COVID-19). Avoiding the biases that COVID-19 would introduce, the six selected communicable diseases killed 6.59% (in 2019) of what NCDs killed (in 2022): fewer people than their opposite, as can be seen in the following chart from Statista: Having more population means having more problems because, at the end of the day, the solution for health financing is helped by health insurance yes, but is more helped by economic growth, generation of income, reduction of poverty, and openness to rich patients with means of payment for covering the costs of the treatments they require, in special if they are old and retired. 2.6 million people live in Taipei, the top city in terms of quality of health care. Taipei is top 1 in health care in the world and counts only for 7% of the people that live in Tokyo, the top 1 city in population in the globe. Tokyo is only the 12th best city in terms of the quality of its health care system. The other 4 in the top 5 in population: Delhi, Shanghai, Dhaka, and Sao Paulo are not among the top 40 in health care in the world. They are big markets for health care but do not offer guarantees for quality. As a matter of fact, none of the other 15 top most populated cities in the world (2023) are ranked amongst the 40 top cities in health care. Having more people can mean only more problems, as the top-10 Latinamerican city of Cuenca (in Ecuador) can show with its 445 thousand people, compared to the 1.96 million people of the capital of the Andean country, that does not show as a top city in terms of quality. The only 3 cities with top healthcare systems are Cuenca in Ecuador (82.1 points), Guadalajara in Mexico (79.7 points), and Medellin (78.6 points). When you have to decide where you are going to invest and live the rest of your days, education is not the top variable, but health. If you are planning to invest and get retired, Mexico, Ecuador, and Colombia are places ranked in the top then, for the millions and millions of rich people who have worked and educated themselves and their kids in the most populated cities in the World: Mexico, Panama, and Ecuador are the 3 Latin American countries among the top 5, and above 80 points. If Ecuador works its governance and takes it to the level of Panama (10 points more) it would reach 85 points: and would be the top 1 Latin American destination, only 2 points below the benchmark country of Portugal. You decide: we all decide (by now)... In the future, the climate will decide, and in that sense, the Andes will be the best place... Roberto F. Salazar-Córdova Economist, Hexagon Group Lat-Am/UK-Global Santiago, Chile