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Dissecting ISO 37120: How healthy is your city (and what zip codes have to do with it)

Submitted by scc staff on August 27, 2014

By George Karayannis, LEED AP

Image removed.We continue our series on the new ISO 37120 Smart City standard with a look at the eighth of 17 themes defined in the standard -- health indicators.  As previously described, ISO 37120 includes 46 ‘Core’ (must report) and 54 ‘Supporting’ (should report) indicators.  The health theme has 4 Core and 3 Supporting indicators.

This theme measures key health indicators including life expectancy, a city’s healthcare delivery system and its citizens’ mental health.  Businesses and residents generally want to locate in areas with a high quality of life -- and the health indicators included in ISO 37120 reflect key elements of a city’s quality of life. These indicators become even more important when measured in and around metropolitan areas, as a variance of just a few miles can result in dramatic differences in life expectancy and quality of life. 

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Core Indicators

1.    Average life expectancy.

For much of human history the average life expectancy was 20-30 years.  Life expectancy began to accelerate rapidly in the 1800s – primarily from improvements in sanitation, housing, and education, and continued to accelerate in the 1900s with the development of vaccines and antibiotics.  Increases now are due almost entirely to a decline in late-life mortality.   Global average life expectancy is around 71, up from just 56 in 1980. 

Image removed.Developed countries generally have higher life expectancies, however, countries like Saudi Arabia have very high GNP per capita but don't have high life expectancies. Alternatively, countries like China and Cuba have low GNP per capita yet have reasonably high life expectancies. According to the CIA World FactBook, Monaco has the highest life expectancy at 87.2 years, followed by Japan at 84.5 years.  Sierra Leone has the world’s lowest life expectancy at 47.5 years.  The U.S. ranks 51st at 78.5 years.

Wide variations also exist within countries and even within cities. Residents of Glasgow, Scotland, for example, have a life expectancy of 72.6 despite a country average of 76.5 years, putting Glasgow on a par with countries in sub-Saharan Africa.  In the U.S., Hawaii has the highest life expectancy at 81.5, and Mississippi the lowest at 75.0  A recent study by the Robert Wood Johnson Foundation found that babies born just a few miles apart in New Orleans can have a 25-year difference in life expectancy

“It's no secret that on almost every international ranking, U.S. residents have worse medical outcomes and shorter life spans than people in other affluent nations, despite spending far more on health care,” wrote Risa Lavizzo-Mourey, M.D., President and CEO of the Robert Wood Johnson Foundation in a recent article in the Huffington Post.  “Even more disturbing is that there are equally large gaps in health outcomes within the U.S. If you live in America, your zip code can be more determinant than your genetic code in determining how long you will live, and how well.”

2.    Number of in-patient hospital beds per 100,000 population.

Image removed.This indicator is one of the few available which monitor the level of health service delivery worldwide.  According to the Kaiser Family Foundation, the average number of hospital beds worldwide per 100,000 population is 300.  Monaco has the highest density of hospital beds per 100,000 population (1,650), followed by Japan (1,370).  U.S. hospital bed density is in line with the world average (300). Guinea (3) and Mali (1) are the countries with the lowest hospital bed density.

3.    Number of physicians per 100,000 population.

The availability of physicians is an important indicator of a city’s health system, as they are critical in providing both preventive and ongoing healthcare.  According to the World Health Organization, Qatar (774) has the highest density of physicians per 100,000 population, followed by Monaco (717) and Cuba (672).  The U.S. physician density (245) is 25-50% lower than most European countries, and significantly lower than Russia (431). 

4.    Under age five mortality per 1,000 live births.

Image removed.Child mortality rates are one of the most frequently used indicators to compare socio-economic development worldwide, and reflect the availability of a sustained food supply, a sanitary and safe environment, relatively little disease, absence of war and a stable social life.  The World Health Organization estimates that 6.6 million children under age five died in 2012, which equates to nearly 18,000 every day.  Globally, under-five mortality has decreased by 47%, from an estimated rate of 9,000 deaths per 100,000 live births in 1990 to 4,800 deaths in 2012. In addition, inequities in child mortality between high income and low income countries remain large. In 2012 the under-five mortality rate in low income countries (8,200 per 100,000 population) -- was more than 13 times the average rate in high income countries (600).

Supporting Indicators

1.    Number of nursing and midwifery personnel per 100,000 population.

Like many indicators in the health theme, the World Health Organization is the primary source of data.  Switzerland has the highest density of nursing and midwifery personnel per 100,000 population at 1,736, followed by Monaco (1,722) and Denmark (1,609). The U.S. ranks 19th (982).  The countries with the lowest nursing and midwifery density are Haiti (11), Chile (14) and, strangely, Greece (18), which ranks sixth from the bottom in nursing density yet sixth from the top in physician density (438 per 100,000 population).

2.     Number of mental health practitioners per 100,000 population.

An estimated 450 million people alive today suffer from mental or behavioral disorders or from psycho-social problems such as those related to alcohol and drug abuse.  However, the median number of psychiatrists, psychologists, psychiatric nurses and social workers active in the mental health sector per 100,000 population in the world is very low (2.7). The regions of Africa, Southeast Asia and the Western Pacific are particularly deficient in the number of mental health professionals, with European countries having by far the highest density of mental health practitioners in the world (50.6), well ahead of the U.S. (12.3).

3.    Suicide rate per 100,000 population.

According to, the global suicide rate is 16 per 100,000 population, resulting in over one million suicides worldwide each year. Globally, suicide rates have increased 60% in the past 45 years.  Eastern European countries have the highest suicide rates, including Lithuania (40.2), Belarus (35.1) and Russia (34.3). Greece (2.9) and Mexico (4.4) have the lowest rates. 

The U.S. average suicide rate is 12.3 deaths per 100,000 population. According to the  American Foundation for Suicide Prevention, suicide is the 10th leading cause of death for Americans.  It won't surprise anyone to learn that Las Vegas has the highest suicide rate in the U.S. -- almost three times the national average.  Las Vegas (34.5) is followed by Colorado Springs (26.1), a beautiful and otherwise average city with a high percentage of military personnel.  Colorado Springs’ dubious distinction reflects the alarmingly high rate of suicides among U.S. military veterans, which has increased nationwide from 18 to 22 suicides per day.  One sobering statistic that veterans’ groups offer: for every veteran killed by enemy combatants, 25 veterans kill themselves

Perhaps the unfortunate death of comedian Robin Williams will help to shed more light on the important issues of mental health and suicide.


George Karayannis  has over 25 years of emerging technology and complex solutions sales, business development and marketing experience and has held leadership positions at Schneider Electric, Lockheed Martin Energy Solution, AT&T and wireless sensor startups.  He has also served as a city councilman and is restoring a 100-year old opera house to LEED Gold status. @gkarayannis

Next in the series: Recreation indicators for smart cities

Previously in the Dissecting ISO 37120 series: