Health Improvements in BRIC Cities: Moscow, São Paulo, and Shanghai, 2000–10

Published date01 June 2016
Date01 June 2016
DOIhttp://doi.org/10.1002/wmh3.188
Health Improvements in BRIC Cities: Moscow, S~
ao Paulo,
and Shanghai, 2000–10
Michael K. Gusmano, Victor G. Rodwin, Daniel Weisz, and Rafael Ayoub
We compare health improvements among three megacities in BRIC nations as measured by declines
in amenable mortality (AM). Although there have been studies of AM in Brazil and the Russian
Federation using different def‌initions and age cohorts, this indicator has never been used to compare
these cities. During the period 2000–10, age-adjusted rates of all leading causes of AM fell in all
three cities. In S~
ao Paulo, it dropped from 1.57 to 1.19 per 1,000 population. In Moscow, it fell
from 2.10 to 1.40, and in Shanghai, from 0.72 to 0.54. The rate of decrease was highest in Moscow
(33 percent), followed by Shanghai (30 percent), and S~
ao Paulo (24 percent). All three cities
experienced large reductions in chronic cardiovascular diseases in the form of IHD and stroke, but
they remain the leading causes of premature death. Our f‌inding of the decline of AM deaths in S~
ao
Paulo, Moscow, and Shanghai suggests that all three health systems made signif‌icant improvements
over the 2000–10 period. It will be important to monitor this indicator as economic growth in these
countries and cities has slowed considerably since 2010.
KEY WORDS: amenable mortality, health system performance, megacities
Introduction
Urban health in developing countries is worthy of increasing interest since
United Nations (UN) demographers project two billion more urban dwellers by
2030 (UN, 2014) and over 90 percent of them will reside in low- and middle-
income countries. Global health will increasingly depend on our capacity to
improve the health of these urban populations (Sclar, Garau, & Carolini, 2005).
The urban advantage hypothesis suggests that cities are engines of economic
growth, opportunity, and innovation and can promote population health by
focusing on social determinants, public health infrastructure, and provision of
critical health-care resources. The urban penalty hypothesis, in contrast, empha-
sizes the convergence of high population density with the risks of infectious
disease, bioterrorism, and inadequate public health infrastructure (Vlahov, Gibble,
Freudenberg, & Galea, 2004). Add to these risks the growth of slums, the increase
World Medical & Health Policy, Vol. 8, No. 2, 2016
127
1948-4682 #2016 Policy Studies Organization
Published by Wiley Periodicals, Inc., 350 Main Street, Malden, MA 02148, USA, and 9600 Garsington Road, Oxford, OX4 2DQ.

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