Context –Over half of the global population lacks health service access, and rapid urbanization has significantly strained urban health systems. –Early disease detection can alleviate downstream pressure on health systems. However, the absence of user-friendly and people-centred solutions leaves early risk detection underused. –As part of the CARDIO4Cities public-private partnership (PPP) initiative, a screening approach for early detection of hypertension has been scaled in three Brazilian cities, resulting in 22% increased blood pressure measurements and rapid improvement of blood pressure control levels in the city populations. Quality, affordable and accessible healthcare provides the foundation for stable communities, societies and economies. However, more than half of the global population, or 4.5 billion people, do not have full access to essential health services.43 In 2021, 20.5 million people died from cardiovascular disease (CVD), many of those prematurely before the age of 60.44 Most acute cardiovascular (CV) events, such as heart attacks or strokes, can be prevented through early detection and adequate management of the main risk factors for CVD. That makes proactive early detection and prompt management of hypertension key to reducing the burden of CVD on health systems. Despite ample evidence on how to manage CVD and great progress over the past decades, CVD is on the rise – specifically in underserved populations. Rapid urbanization, often leading to increased sedentary lifestyles, decreased access to nutritious diets, reduced social connections and higher exposure to air pollution, fuels this increase in CVD. Yet cities also offer new opportunities to become drivers of CV population health. This makes cities the ideal place to start. How can urban health systems inverse their current burden? Health systems in cities need to address multiple priorities, making it sometimes challenging to engage health professionals and integrate new solutions without disrupting existing workflows. Improving population health requires a deep understanding of the interaction between health systems, health providers and their patients. To re-engineer urban CV health, new approaches have to engage end users and take a people-centred approach to the design phase of the innovation. This highlights the need to bring early detection of CV risk closer to people and provide it where and when they need it. Currently, health systems face a significant gap between the number of people at risk for CV health risks and the number of diagnosed patients who are managed for those risks.45 To reduce this gap, early detection and subsequent adequate management of people with CV risk is a priority and innovative methods are needed, particularly in primary healthcare settings, within high traffic venues in the cities and within communities. Accessible solutions for early detection of CV risk relieve pressure on the health system Strengthening primary healthcare through early detection and adequate management of CV risk can lead to improved health outcomes, reduce the burden on health systems and lower long-term costs by avoiding complications, hospitalizations or acute events of CVD.46 One opportunity to strengthen primary healthcare is to take advantage of waiting times in health facilities by offering CV risk screening to every person visiting the facility (regardless of the reason) and expediting doctor-patient consultations for those who screen positive. In addition, primary healthcare and high- traffic spaces in the city, such as vaccination sites, street markets, football stadiums and schools, offer possibilities to proactively reach people and guide them into routine health services when needed. Innovations alone have limited impact. To be effective, they must be combined with critical enablers such as PPPs that empower providers and patients to co- create impactful, cost-effective and scalable solutions. The “screening corner” as an example of impactful CV innovations Within its CARDIO4Cities initiative, the Novartis Foundation co-designed the “screening corner” to accelerate early detection of CV risk factors.47 Developed, implemented and evaluated by a consortium of public and private partners, this tool focuses on accelerating the detection of CV risk within and outside of primary care settings. A screening corner is equipped with a blood pressure measurement device, a digital stadiometer, Quality, affordable and accessible healthcare provides the foundation for stable communities, societies and economies. Shaping Tomorrow: Responsible Innovation for a Brighter Future 27

Shaping Tomorrow Responsible Innovation for a Brighter Future 2025