Future cities could be more powerful than countries

Cities are often the financial, political and cultural hub of a country and they’re only getting bigger and richer. We investigate whether city-based diplomacy could ever outrank state-led negotiations on the global stage

In a joint statement released in June, the Mayor of Paris Anne Hidalgo and her London counterpart Sadiq Khan declared: “If the 19th century was defined by empires and the 20th century by nation-states, the 21st century belongs to cities.” It would seem that they were more than correct.

Both globalisation and urbanisation are causing cities across the globe to grow in size and influence. The UN predicts that by 2050 66% of the world’s population will live in urban areas and that by 2030 there will be a total of 41 megacities (cities with more than 10 million inhabitants). People are flooding to cities for jobs, money and culture, and in turn mayors are pushing for more control over the money they generate and the citizens they represent.

Last month Khan travelled to Paris to commemorate the liberation of Paris during World War Two but also to cement the blossoming friendship between two of Europe’s most famous cities. Both Mayors campaigned passionately for the UK to remain in the EU, and despite the country’s choice to leave, the two friends seem determined not to let the result stand in the way of their shared agenda.

Hidalgo and Khan have made it clear in the last few months that they intend for Paris and London to lead the way on a number of global issues, hand-in-hand. And for this they require both power and autonomy from their home countries.

As cities step into the global arena could city-based diplomacy become more effective than international negotiations? And if cities can become self-sufficient then is independence in the pipeline for areas like London?

Money, money, money

Cities are currently growing at an astounding rate and although many urban centres, including London, would struggle to thrive without their surrounding areas, it is impossible to deny the financial importance and influence that they are increasingly gaining.

Image courtesy of Frederic Legrand - COMEO / Shutterstock.com

Image courtesy of Frederic Legrand – COMEO / Shutterstock.com

According to the McKinsey Global Institute, 600 cities (the City 600) currently generate about 60% of global GDP and by 2050 growing cities could inject as much as $30 trillion a year into the world economy. Urban areas in Asia are growing particularly quickly; between 2000 and 2010 nearly 200 million people moved to East Asia’s cities. With so much financial clout it is no wonder that cities are becoming increasingly powerful.

But rapidly growing cities don’t always precede a rosy future. It isn’t enough to be a megacity with a huge population and continuous urban expansion; cities must have the correct infrastructure and policy in place to support intense growth.

London is the perfect example of this problem.  In recent years its population has grown faster than any megacity in the developed world. Yet it is also suffering a crippling housing crisis, born out of an over-regulated property market that has priced out middle-class buyers. If governments fail to put in place appropriate regulations and support for industry and infrastructure, burgeoning cities can find themselves lacking jobs, suitable transport links, and robust police and education systems.

Tackling global issues

All over the world cities are beginning to step into the arena of debate on some of the most important global issues facing us today. As promised, the mayors of Paris and London have been leading the way, specifically focusing their efforts on climate change.

Before last month’s visit to Paris, Khan and Hidalgo penned a letter to the president of the European Union’s Environment Council Sharon Dijksma, calling for tougher pollution limits under the new National Emissions Ceiling Target. The two mayors are also tackling pollution individually on the streets of their own cities, with Khan calling to pedestrianise shopping hub Oxford Street and Hidalgo starting the Paris Breathes campaign, in which cars are banned from certain roads in the city on every first Sunday of the month.

It isn’t just these two cities taking the initiative on climate change, though. The Global Covenant of Mayors for Climate Change and Energy is the largest existing global coalition of cities committed to climate leadership, involving commitments from 7,100 cities. And the C40 Cities Climate Leadership Group (C40) is composed of 83 cities, including multiple megacities providing research and direct assistance to reduce greenhouse gas emissions. As C40 President Michael Bloomberg noted, “While international negotiations continue to make incremental progress, C40 cities are forging ahead.”

In the last few decades the threat of terrorism has mutated and crept into the lives of everyday city-dwellers, pushing Mayors and their cities to take security into their own hands

Climate change isn’t the only international issue that Mayors have been taking control of. In the last few decades the threat of terrorism has mutated and crept into the lives of everyday city-dwellers, pushing Mayors and their cities to take security into their own hands.

In the 1990s London created its ‘ring of steel’, a security barrier which encircles the City of London, the city’s financial district. The barrier consists of hundreds of CCTV cameras, checkpoints and road barriers which were built in response to the threat of the IRA and are now maintained as protection against other threats of terrorism.

Similarly, in the wake of 9/11 New York made monumental changes to its security and intelligence abilities including the addition of a counterterrorism bureau to the New York Police Department (NYPD). Relations between New York and Washington remain strained since 9/11, largely due to disagreements over funding; an issue that plagues cities around the globe and one that is forcing them to call for more control over spending.

Despite these demonstrations of city-based action on a global stage, Jack Airy, research fellow at ResPublica – a non-partisan think tank in London’s Westminster – believes it is unlikely that city-based diplomacy would ever overtake national power.

“On issues such as air pollution and finance – issues which are seen to be borderless – I think it’s natural to expect strong city mayors to work alongside one another,” he says. “However on issues of international diplomacy, I don’t think we should expect cities to supersede countries.”

Perhaps in the current state this is true, as many mayors find themselves lacking the power to implement the policies they want and that could increase their international influence. This is why many cities, including multiple urban areas in the UK are calling for devolution.

The devolution of power

Disparity in funding is one of the primary forces behind the desire for increased devolution in cities like London. Currently the capital city has an economy the same size as Sweden and generates 22% of the UK’s GDP. Yet it is often written about and discussed with resentment, as people from around the country accuse the city of sucking in all the best workers and resources away from the rest of the country.  To a certain extent this is true; thousands of young, talented people are still flocking to London in search of the best jobs.

London is receiving a much smaller amount of public funding than it generates, and it has little power over the money it does receive

But this is only one half of the story. In fact, London contributes a great deal to the rest of the UK. It was reported last year that London generates a quarter of the UK’s total national tax and yet it is only ranked 7th in spending per population. This means that the capital is receiving a much smaller amount of public funding than it generates, and it has little power over the money it does receive.

Khan has promised that he doesn’t want more money, only more control over the cities current allowance. He has been calling for devolution of fiscal responsibility (things like raising taxes), a greater role in running the NHS London services and more freedom to raise money for infrastructure and housing.

Other cities within the UK have also been working on devolution: the West Midlands Combined Authority was established in 2009, Liverpool elected its first Mayor in 2012 and the first Mayor of Greater Manchester will be elected next year.

Airy seems to think it won’t be difficult for London to achieve the same success. “As the mayors for Greater Manchester, Liverpool and the West Midlands are elected and mature, it seems likely that they [Khan and Hidalgo] will follow suit – much like Nicola Sturgeon has in Scotland,” he says.

“This will be particularly true if Scotland and London continue to seek some sort of special relationship with the European Union after the United Kingdom does exit.”

In theory devolution should allow for better services for the taxpayer’s money, and an increase in transparency and accountability. It then makes perfect sense that as city populations and economies expand, mayors around the world will be calling for further devolution.

City independence

Cities around the globe are contributing more and more to the global economy, growing in population and size and taking steps to address their own challenges, as well as those affecting us globally. If this continues, and it is extremely likely that it will and at a greater pace, it is possible that city-based diplomacy will become increasingly important too.

So if megacities begin to outshine their own countries, could we witness the birth of more city-states? Immediately after the EU referendum result, a petition for London to become independent gained 200,000 signatures in just four days: London had overwhelmingly disagreed with the rest of England.


Although the petition was started as a joke it highlighted something important; a city that revels in multiculturalism felt it had been betrayed by a country that resented the very person that makes London what it is; the immigrant.

Khan rejected calls for independence, but the petition did lead him to affirm his desire for further devolution in London. The petition for independence revealed that in many cases people would call themselves a Londoner before a Brit, but despite this it seems unlikely London would ever become independent, as Airy explains: “while there is a very strong argument for the city to gain greater ownership of its governance and tax base, despite populist impulses, I don’t think enough legislative and democratic hoops could be jumped through for independence to ever be even a possibility.”

New research claims a video game can improve doctors’ ability to recognise severe trauma in patients

New research has concluded a specifically-designed video game improves doctors’ ability to recognise when patients need to be transferred to a severe trauma centre.

The research, by the University of Pittsburgh School of Medicine and published today in the BMJ, revealed the game Night Shift was better at preparing doctors to recognise patients who needed higher levels of care than reading traditional educational materials.

This was the case even though doctors who were made to play the game, in which doctors play as a fictitious, young emergency physician treating severe trauma patients, enjoyed it less than those who were asked to read relevant materials.

“Physicians must make decisions quickly and with incomplete information. Each year, 30,000 preventable deaths occur after injury, in part because patients with severe injuries who initially present to non-trauma centres are not promptly transferred to a hospital that can provide appropriate care,” said the game’s creator Deepika Mohan, MD, MPH and assistant professor in Pitt’s departments of Critical Care Medicine and Surgery.

“An hour of playing the video game recalibrated physicians’ brains to such a degree that, six months later, they were still out-performing their peers in recognising severe trauma.”

Night Shift was designed by Mohan to tap into the part of the brain that uses pattern recognition and previous experience to make snap decisions by using subconscious mental shortcuts – a process called heuristics.

Doctors in non-trauma centres typically see only about one severe trauma per 1,000 patients. As a result, their heuristic abilities can become skewed toward obvious injuries such as gunshot wounds, and miss equally severe traumas such as internal injuries from falls.

On average, 70% of severely injured patients who present to non-trauma centres are under-triaged and not transferred to trauma centres as recommended by clinical practice.

“There are many reasons beyond the doctor’s heuristics as to why a severe trauma patient wouldn’t be transferred to a trauma centre, ranging from not having an ambulance available to a lack of proper diagnostic tools,” said Mohan.

“So, it is important to emphasize that recalibrating heuristics won’t completely solve the under-triage problem and that the problem isn’t entirely due to physicians’ diagnostic skills. But it’s heartening to know we’re on track to develop a game that shows promise at improving on current educational training.”

For the study, Mohan recruited 368 physicians from across the US who did not work at hospitals specialising in severe trauma. Half were assigned to play the game and half were asked to spend at least an hour reading the educational materials.

Participants then responded to questionnaires and completed a simulation that tested how often they “under-triaged,” or failed to send severe trauma patients to hospitals with the resources necessary to handle them.

Physicians who played the game under-triaged 53% of the time, compared with 64% for those who read the educational materials.

Six months later, Mohan reassessed the physicians and found that the effect of the game persisted, with those who played the game under-triaging 57% of the time, compared to 74% for those who had read the educational materials.

Multimedia courtesy of Schell Games.

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