A SHC powered by interoperable data can transform the entire healthcare ecosystem with real-time access to data and advanced capabilities to capture, interpret and act on it. It enables citizens to be more aware. The value of having a SHC became evident when COVID-19 spread globally, as those that embraced strong public partnerships were the ones that did better in the crisis. A study in 167 cities found that 54 per cent consider that the pandemic has accelerated a shift to online healthcare and that this change will have a long-lasting impact. The same percentage is confident that this is a lesson to be learned and understood: cities need to pay more attention to the health and wellbeing of citizens.⁶ During the pandemic and health crisis, interconnected healthcare communities played a critical role in:

• Establishing platforms for accelerated secure information transfer and awareness drives; continuous risk monitoring; and real-time data generation, centralisation, and distribution
• Enabling health product developers to utilise insight engines to boost research into cures
• Building a support infrastructure by establishing localised health care hubs, advice platforms and finance/social assistance support gateways, along with engagement portals between care providers and patients.

Some reasons why Smart Health Communities will be the Future of Health:

• Increasing digital transformation in community care: Digitally-enabled health services are rapidly becoming mainstream, particularly in areas such as primary care, collaborative maternity support, and specialist nursing. An analysis in 2020 by the Healthy London Partnership, a group specialising in complex public health issues, predicted that digital adoption could increase capacity in primary care by 25 per cent.⁷ Remote medicine and telehealth services have recently been attracting the most investment by cities.⁸
• Removing barriers to care and create social equity: SHCs remove barriers to care, such as physical access difficulties, healthcare affordability and variations in Health Care Provider (HCP) management (due to their interconnected community) thereby improving healthcare standardisation and engagement. According to Health-Tech Digital, “NHS England’s National Diabetes Prevention Program (NDPP) is demonstrating the improvements to patient care achievable with digital adoption. Treatment pathways for this demographic are typically poorly attended, with less than 50 per cent of eligible people receiving the available support. The NDPP opened its program to telehealth providers, and as a result have seen dramatically higher engagement rates and outcomes across the target demographic.” ⁹
• Facilitating data collection, centralisation, distribution, and management: SHCs utilise technology-enabled tools (GPS-enabled technology, trackers and apps) to ensure secure collection and dissemination of large volumes of healthcare data. Most cities already do this for epidemic diseases. Furthermore, the focus is on boosting centralisation of data to improve access and data management efficiency. SHCs also handle secure mass distribution of healthcare-promoting data, which in turn helps improve understanding of healthcare operational processes, demographic needs, regulatory requirements, and patient information. The success of SHCs is possible only via cooperation and collaboration, and many private technology firms have increased their investment and innovation in this area. Popular technology solutions today act as value drivers and data enablers, for example by streamlining record maintenance, supporting cost assessment, and analysing patient and healthcare system movements. For example, Apple HealthKit is a health-targeted solution that is currently widely used by SHCs.
• Improving inventory planning: SHCs also focus on optimal use of collected data for predicting risk, continuous learning/knowledge exchange, and conducting research and evaluations. Various tools such as RFID tags, smart cabinets, blockchain and AI-enabled supply chain operations contribute to optimisation of data use by SHCs. Inventory management and frequent or real-time data collection also support programme evaluation by an SHC.
• Creating a sense of community and boosting the importance of preventive medicine: By leveraging geographic proximity and data sharing in virtual environments, cities can create a sense of community. Additionally, it raises the issue of preventive medicine, stimulating new behaviour and awareness of the importance of physical activity, nutrition and well-being. 47 per cent of cities in advanced economies already educate public about chronic diseases and most of the cities invest in real-time air-quality information.¹²

Work to generate trust: The rapid deployment of vaccines against COVID-19 made clear the importance of public trust in science and healthcare ecosystems. In an environment driven by data, trust is a critical success factor for this interconnectedness to achieve its full potential.

Invest in a data privacy and security infrastructure: Establishing a data-driven interconnected SHC creates a high risk of data security breaches – which can lead to deaths. It also results in increased public scepticism. So in order to sustain a SHC and encourage individuals to share their data on the network and feel safe about it, cities must invest in a strong cybersecurity infrastructure and increasing transparency within the system, by leveraging smart technology solutions and designing cybersecurity guidelines.

Establish a partnership between public and private stakeholders: A primary challenge in building and growing a SHC is to maintain community partnerships. By establishing a strong public-private partnership cities can support healthcare transformation initiatives via improved mass reach, funding support, regulatory compliance assistance, and greater access to resources. Collaborative working among stakeholders can help transform a city into a SHC. Every stakeholder brings unique support:

• Government agencies: Can help in improving cost-effectiveness of SHC via public programmes and payment models, or by increasing security by establishing data-sharing agreements and cybersecurity policies, acting as platforms and ecosystem connector
• Technology companies: Can support a SHC with digital strategies and network construction. Technology companies can help with secure data collection, analysis and interpretation
• Healthcare and life sciences players: Can help in improving accessibility and affordability of healthcare assistance, research and expertise, along with ease of engagement. ESI Thoughtlab found that 86 per cent of ‘sprinter cities’ (those more advanced in achieving SDGs) partner with hospitals to improve healthcare access, with a clear return on investment ¹³
• Media and NPO/NGOs: Can provide support with mass-awareness drives which can help build trust and improve the willingness of individuals to participate in a SHC
• Social care entities: Organisations and entities responsible for social care and support can contribute their knowledge and experience, as well as data to support the ecosystem
• Citizens: By sharing their data, experiences and behaviours with the community.

Collaborate with technology companies to launch awareness creation programmes and knowledge sharing platforms: Many social groups, especially in underdeveloped and developing areas, do not prioritise health treatment unless it is absolutely necessary. As healthcare shifts toward treating people before they get sick, with increased focus on predictive care using advanced technologies, community partners and government agencies must prioritise awareness and knowledge sharing programmes. Having such platforms and programmes in place will help individuals to become more aware of the benefits of SHCs, which in turn will encourage mass participation.

Establish community-driven funding hubs to strengthen the reach, support capabilities and operational efficiency of SHCs: Most SHCs are supported and established by collaboration between various stakeholders, and establishing a community funding hub can ensure better funding opportunities, to achieve a wider reach and bigger impact.

Restructure policies and consider incentivising SHC development plans to encourage community stakeholders and government to collaborate, organise and invest, with an intention to build a more interdependent and interconnected city healthcare and well-being system, with a clear focus on outcomes.

Chicago, USA

Chicago is prioritising the establishment of a highly interconnected health and wellness ecosystem. To do so, the city launched Healthy Chicago 2.0 in 2016 and Healthy Chicago 2025 (a cross-sector collaboration) in September 2020. This is the city’s multi-stakeholder plan to maximise the well-being of its residents and health equality.

The focus is on reducing health inequalities by developing partnerships and community engagement, addressing the root causes of poor health, increasing access to healthcare and human services, improving health outcomes, utilising data and maximising research.

The Healthy Chicago 2.0 initiatives were directed towards changing people’s living conditions. As cited in a report by the Chicago city government: “During Healthy Chicago 2.0, instead of just treating diabetes or counselling people on what to eat, we also worked on strategies to increase access to healthy foods and create more walkable neighborhoods.” As a part of the Healthy Chicago 2025 plan the focus is on closing the racial life expectancy gap, and continuing to prioritise other issues such as ending the HIV epidemic, improving mental health, and creating a drug-free society. The city conducts knowledge sharing and awareness events to communicate with residents about healthcare essentials and educate them about public health issues. Technology is used extensively to power innovative tracking and delivery models. For example, the city tracked public Twitter messages using a supervised learning algorithm for possible foodborne illness complaints that may have been linked to food consumed in establishments under the purview of the city’s food inspectorate, leading to early and targeted inspections.

The impact of the Healthy Chicago 2.0 programme on priority areas such as tobacco use, healthy mothers and babies, and HIV prevention along with financial grants has included a reduction in the percentage of high school students smoking cigarettes (down by 13.6 per cent between 2011 and 2017), and in 2019 an all-time low in teenage birth rates and the lowest HIV transmission rates since 1990.¹⁵ Aspects of clean air and walkability were also prioritised and EUR 123,000 was awarded in 2019 to six community organisations.

Multiple community stakeholders have supported the initiatives, including local entities like CDPH and Lurie Children’s hospital.¹⁶

Cascais, Portugal

The municipality of Cascais has made health a key priority when developing its smart city strategy, with a focus on the creation of a strong interrelated healthcare community with strategies targeted at proactive healthcare management. Cascais was one of the first municipalities in the country to claim local responsibility for managing health, as part of Portugal’s decentralisation strategy in this area.

Through its ‘Vida Cascais’ programme, the city has a local integrated offering for health, education and social services, including access to telehealth appointments, updated information on physical and mental wellbeing (for instance, the ‘Espaço S’ psychotherapies support) and a free colon cancer screening programme. There is a strong network of informal caregivers to take care of citizens’ health, as well as a door-to-door drug delivery service that also collects and monitors health indicators about the most vulnerable communities. Other initiatives such as a ‘Health Municipal Strategy’ and ‘Health Academy’ (Academia da Saúde), under the motto ‘Everyday +Health’, benefit from the ecosystem that has been created – involving the private sector, hospitals, civic organisations, citizens, with the municipality as an enabler.

Through these efforts, along with a commitment to protect the quality of life, the city became a role model for managing the pandemic. In May 2020 the Cascais City Council (Câmara Municipal de Cascais) announced a programme for mass testing of the population for coronavirus antibodies, covering all 200,000 inhabitants. The city was the only one in Portugal to adopt such as strategy, to “help [citizens and visitors] enjoy as normal a summer season as possible despite the crisis.”¹⁷

Leveraging its Command Centre (powered by CitySynergy – Deloitte’s Smart Places Operating System) and its digital platforms, Cascais has worked with national healthcare institutions, integrating information from all testing centres, and establishing communication channels with citizens. Outcomes have included:

• A holistic overview of the entire COVID-19 management process in one single platform (suspicious cases, tests schedules and results, infections, maps showing the spread of infection)
• Maximum efficiency of health, emergency and related resources
• Engagement by citizens in the fight against COVID-19, promoting clear communication channels
• National and international perception of confidence and security, a key to restoring the city’s tourism-based economy.

By February 2021, more than 56,000 tests had been scheduled and managed through the platform (a 91 per cent test realisation rate), which has ten call centre operators working on the health crisis. The platform is also supporting the city’s programme for the mass vaccination of its population against the virus.

Cascais also announced in 2021 a plan to test students in all schools within the municipality, offering a broader coverage than the national government’s policy at that time. The initiatives have also targeted community-based knowledge sharing and health education.

Nice, France

Nice has an ageing population with almost one-third of its residents over 60 years old, and access to high quality healthcare, notably at-home care, has become a priority for the city's administration.¹⁸

As a response to growing community needs, the city of Nice launched a smart health project, which brings together stakeholders in healthcare to create tools and services for senior citizens to enable independent living. A part of the project is a living lab, in which users are directly involved in the evaluation and testing of new products and services. Additionally, an e-Health Business Innovation Centre and co-working space is supporting start-ups and boosting the creation of new jobs in the ‘silver economy’.

Other plans within Nice’s smart health community project include training for health professionals and citizens in digital health technologies and the launch of a number of research and EU-funded projects.

The initiative’s impact on the community is evident in successful implementation of multiple initiatives. For instance, according to impact data published by USE (Urban Sustainability Exchange) about 550 medical, nursing and ergotherapy students have received training, over 100 seniors have participated in internet and digital health education workshops, and 600 children have attended health education courses that use games and digital devices.^{19, 20, 21}