The Novartis Foundation (formerly known as the Novartis Foundation for Sustainable Development) is a non-profit organization and part of the corporate responsibility portfolio of Novartis in Basel, Switzerland. The foundation conducts projects to improve health, mostly in sub-Saharan Africa and in south-east Asia.
ObjectivesHypertension is a major cardiovascular risk factor in Brazil and globally, requiring effective healthcare system strategies. This study examines how the health system in São Paulo manages hypertension, identifying patterns and connections that influence patient outcomes and resource use.MethodsUsing literature reviews and participatory discussions with experts, we developed a systems map, causal loop diagram, to illustrate dynamic complexity underpinning hypertension management. Thematic analysis of qualitative data informed the model, highlighting key interactions that shape screening, treatment, and long-term care.ResultsThe analysis reveals critical dynamics at individual, community, and system levels. Early diagnosis and expanded treatment access improve adherence and reduce complications. However, these improvements also increase the number of patients needing long-term care. This creates a challenge where healthcare gains today can raise future demands if prevention efforts are underfunded.ConclusionUnderstanding these interconnections is crucial for balancing treatment expansion with sustainable prevention strategies. By mapping system-wide challenges, this study offers a framework to help policymakers allocate resources more effectively and strengthen urban health systems. Future research will focus on using simulation modeling to test policy interventions and improve hypertension outcomes.
Background New York City (NYC) launched the HealthyNYC initiative in 2025, aiming to reduce cardiovascular disease and diabetes deaths by 5% by 2030. Effective place‐based interventions require evidence to address social risk factors associated with hypertension and diabetes. This study aims to identify key social determinants of health (SDoH) associated with variation in hypertension and diabetes prevalence across census tracts in NYC. Methods This retrospective cohort study analyzed clinical data on 3.2 million NYC residents integrated with SDoH data at the census tract level. Using Extreme Gradient Boosting, we identified the top 10 SDoH most strongly associated with both age‐adjusted and unadjusted prevalence across all census tracts in the city and neighborhood‐specific SDoH for census tracts in the highest prevalence quintile for hypertension and diabetes. Results SDoH explain 70% to 80% of the cross‐tract variation in hypertension (R2=66.2%–79.5%, root mean square error=2.6–3.2) and diabetes (R2=72.9%–79.3%, root mean square error=2.1–2.2) prevalence in NYC. Normalized mean absolute Shapley Additive Explanations values showed that the top 10 SDoH contribute to most of the model's prediction: 73% (age adjusted) and 70% (unadjusted) for hypertension prediction and 73% (age adjusted) and 71% (unadjusted) for diabetes prediction. The top 10 SDoH with the highest Shapley Additive Explanations values center on domains like socioeconomic disadvantage, built environment, and commute time. The neighborhood‐specific SDoH varied across census tracts and boroughs. Conclusions This study provides robust evidence that SDoH are strongly associated with prevalence of hypertension and diabetes and identifies neighborhoods where targeted, place‐based approaches could be prioritized for implementing and testing.
CARDIO4Cities is a multisector initiative that aims at improving cardiovascular population health in urban areas across the globe. Shared measurement systems are key to systematize reporting on progress and health outcomes and to provide comparable evidence across countries. This article documents the development of a global theory of change (TOC) and its evaluation framework (EF) to serve as scalable, global reference tool. It further describes the adaptation of the EF for long-term impact evaluation in Dakar, Senegal and São Paulo, Brazil. A mixed-method approach was applied including a document review and key informant interviews with seven individual CARDIO4Cities partners. The information obtained revealed a three-phased process for developing the global TOC and EF and the adaptation into local EFs: 1) planning of the global CARDIO4Cities strategy; 2) development of the global TOC and its EF; 3) co-creation of local EFs. Coherence between the global EF and local frameworks was assessed as an indication of the perceived local value and applicability of the global EF tool. The final TOC was composed of 14 interventions leading towards the overall expected impact of a 10
