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This year of 2017 is the inaugural term for most mayors in Brazilian cities, including Mr. João Doria, in the largest city of Brazil, São Paulo. During the electoral period, debate on healthcare issues focused on access, either to medical care or to high-cost examinations. Mr. Doria prioritized access at primary healthcare units, so that people could undergo imaging examinations during the night with the claim of “no queues for examinations”! Mr. Doria’s proposal was driven by marketers and not by a serious evaluation of health determinants. Considering that cardiovascular diseases are the leading cause of death in São Paulo, and most frequently among people living in the poorest districts,1,2 we have a question: How will Mr. Doria remedy the high and unequal burden of cardiovascular diseases? Will this be achieved through greater access to echocardiography, angiography, nuclear medicine etc.? Absolutely not. This goal is more likely to be achieved through actions to improve and support cardiovascular health outside of the Health Department. Specifically, the mayor should look towards the Parks & Green Areas and Transportation Departments. We have enough evidence to advocate that increasing the green areas of the city and exchanging diesel-fueled buses for vehicles equipped with cleaner engines will have an impact on the burden of heart diseases and stroke that will benefit all the citizens of this city. Our proposal is not presumptuous. Rather, it results from knowledge coming from contemporary research on cardiovascular epidemiology, including data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).3 The focus within cardiological preventive actions is shifting from only identifying lifestyle and genetic factors that predispose towards high incidence and lethality of cardiovascular diseases, to a more open view of the meaning of risk factors for a population, and not just for individuals.4 Air pollution, noise and physical inactivity may be consequences of the geography of cities, with long distances from home to work that place strain on accessing education, shopping and leisure activities.5

Green areas, clean air and cardiovascular health in the city of São Paulo