The largest cites 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:

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

Michael K. Gusmano, PhD
WCP Co-Director; Research Scholar at the Hastings Center

Daniel Weisz, MD
WCP Research Associate; Adjunct Associate Research Scientist, Columbia Aging Center, ILC-USA, Mailman School of Public Health, Columbia University

Selected Publications:

1. Gusmano, M.K., Rodwin V.G., Weisz D.  Persistent Inequalities in Health and Access to Health Services: Evidence from NYC. World Medical and Health Policy 2017. Jun:9(2):186-205

2. Gusmano, M.K., Rodwin V.G., Weisz, D. Delhi's Health System Exceptionalism: Inadequate Progress for a Global Capital City. Public Health 2017. 145:23-29

3. Gusmano, M.K., Rodwin V.G., Weisz, D., Cottenet J. and Quantin C. A comparative analysis of hospital readmissions in France and the U.S. Journal of Comparative Policy Analysis: Research and Practice. 2016. 18(2):195-209.

4. Gusmano, M.K., Rodwin V.G., Weisz, D., Ayoub R. Health Improvements in BRIC Cities:Moscow, Sao Paolo and Shanghai 2000-2010. World Medical and Health Policy 2016.Jun;8(2): 127-138.

5. Weisz, D., M.K. Gusmano, G. Wong and J. Trombley. Emergency Department Use: A Reflection of Poor Primary Care Access? American Journal of Managed Care. 2015; 21(2):e152-e160.

6. Chau PH, Gusmano MK, Cheng JO, Cheung SH, Woo J. Social vulnerability index for the older people-Hong Kong and New York City as examples. Journal of Urban Health. 2014 Dec;91(6):1048-64. doi: 10.1007/s11524-014-9901-8.

7. Gusmano M, Rodwin V, Weisz D, Cottenet J, Quantin C. Comparison of rehospitalization rates in France and the United States. Journal Health Serv Res Policy. 2014 Sep 25. pii: 1355819614551849. [Epub ahead of print]

8. Gusmano MK, Weisz D, Rodwin VG, Lang J, Qian M, Bocquier A, Moysan V, Verger P. Disparities in access to health care in three French regions. Health Policy. 2014 Jan;114(1):31-40. doi: 10.1016/j.healthpol.2013.07.011. Epub 2013 Aug 5.

9. Chau PH, Woo J, Gusmano MK, Weisz D, Rodwin VG, Chan KC. Access to primary care in Hong Kong, Greater London and New York City. Health Econ Policy Law. 2013 Jan;8(1):95-109. doi: 10.1017/S1744133112000114. Epub 2012 May 1