By 2000, though, the perspective looked altogether different. With a sharply reduced crime rate, runaway gentrification, and a geyser of boom-time dough, Manhattan had largely conquered the homicide, AIDS, and overdose problems that were pulling down the average life-expectancy figure. A trio of New York–based urban-health academics—Nicholas Freudenberg, David Vlahov, and Sandro Galea, professors at Hunter College and the New York Academy of Medicine—began to wonder if the “urban health penalty” still made sense. As they examined the most recent data about health in cities versus health in rural and suburban areas, they noticed that the cities were, contrary to theory, pulling ahead. This wasn’t merely because cities tend to have richer citizens. In fact, they found that people are almost equally likely to be poor—and to lack health insurance—in urban and rural areas. Yet the percentage of rural people who ranked their health as “fair/poor” is much higher than in urban areas. And people are more likely to die young in the sticks: Death rates for 1-to-24-year-old males are 60 per 100,000 in cities, versus 80 in rural areas. Perhaps worst of all for the suburbs, obesity is rising far more rapidly than in cities.
“We were just walking around New York and thinking, Wait a minute,” Vlahov says. “People in New York are in better shape than ever. So there’s obviously got to be something about cities that’s good for you.”
The urban health penalty, they decided, had inverted itself. The new reality was that living in the suburbs and the country was the killer. In January 2005, Vlahov and his colleagues penned a manifesto they cleverly called “The Urban Health ‘Advantage,’ ” and published it in the Journal of Urban Health. Cities, they posited, were now the healthiest places of all, because their environment conferred subtle advantages—and guided its citizens, often quite unconsciously, to adopt healthier behaviors.
Three years ago, Lawrence Frank, a professor of urban planning at the University of British Columbia, set out to measure this effect, examining 10,858 people in Atlanta and the type of neighborhood they lived in. Some were in purely residential suburban neighborhoods, where you had to get in your car to buy a carton of milk; others lived in “mixed” downtown areas with shops within walking distance. When he checked the results, the health difference was shockingly large: A white man who lived in a more urban, mixed-use area was fully ten pounds lighter than a demographically identical guy who lived in a sprawling suburb.
“The more you drive, the more you weigh,” Frank tells me after I call him to talk about it. He was unsurprised when I described New York’s increases in life expectancy. “You put people in an environment where public transportation is rational and driving is almost impossible, and it would be shocking not to see this outcome,” he says. Other scientists suggest that New York’s benefits do not occur merely because the city is walkable. It’s also because New York is old and filled with attractive architecture and interesting street scenes—since, as it turns out, aesthetically pretty places lure people out of their homes and cars. A 2002 study by the National Institutes of Health found that people living in buildings built before 1973 were significantly more likely to walk one-mile distances than those living in areas with newer architecture—because their environments were less architecturally ugly.
At the same time, New Yorkers are also more likely to visit parks than people who live in sprawl, because the parks are closer at hand. And proximity matters, as a study by Deborah Cohen, a senior natural scientist at the rand Corporation, discovered. When she examined the use of several parks in Los Angeles, she found that almost half the people using any given park lived no more than a quarter-mile away. In contrast, only 13 percent of the people using the park had come from more than a mile away. “The farther you are, the less willing you are to go to the park,” she notes.
Interestingly, urban theorists believe it is not just the tightly packed nature of the city but also its social and economic density that has life-giving properties. When you’re jammed, sardinelike, up against your neighbors, it’s not hard to find a community of people who support you—friends or ethnic peers—and this strongly correlates with better health and a longer life. Then there are economies of scale: A big city has bigger hospitals that can afford better equipment—the future of medicine arrives here first. We also tend to enjoy healthier food options, since demanding foodies (vegetarians and the like) are aggregated in one place, making it a mecca for farm-fresh produce and top-quality fish, chicken, and beef. There’s also a richer cultural scene than in a small town, which helps keep people out and about and thus mentally stimulated.