Of course, the built environment wouldn’t have done New Yorkers’ health any good if it hadn’t been catalyzed by the city’s economic bonanza. The nineties were so lush they actually lifted some of the city’s poorest out of poverty. But gentrification cut both ways. A more cynical—and possibly clear-eyed—explanation for New York’s life-expectancy gains is that gentrification drove many of the city’s poorest people out of town. Though no figures exist to accurately calculate it, what social scientists can measure is the effect of gentrification on the health of the poor who have stayed put: It turns out to be—unexpectedly—benevolent. One study by Ming Wen, a sociologist at the University of Utah, crunched data on 8,782 residents of various neighborhoods in Chicago. She expected to find the typical bleeding-heart conclusion: Poverty is bad, income inequality is bad, and the two together are worse yet. But in reality, income inequality at the neighborhood level paradoxically seemed to mitigate the bad effects of poverty. In neighborhoods that mixed affluent people alongside poor ones, the poorer residents were statistically healthier than those in non-mixed neighborhoods.
That’s because, Wen concluded, the presence of relatively wealthy people has a spillover effect on the immediate neighborhood: safer streets, cleaner environments, better food in stores. (Indeed, another study found that poor teenagers in mixed-income neighborhoods ate more leafy green vegetables than poor teenagers in non-mixed ones.) Wen is careful not to say that all income equality produces trickle-down effects; if the poor and wealthy are completely sealed off from each other in different parts of a city, the effect doesn’t occur.
And this, as it turns out, helps explain the one troubling chapter in New York’s life-expectancy success story: the Bronx. Alone among the five boroughs, the Bronx’s average life expectancy has actually declined in the last twenty years. And it is the only one that saw very little financial uptick from the nineties boom years, and virtually no gentrification.
The effect on everyday health becomes pretty apparent to me when I take a trip up to St. Barnabas, the Bronx’s largest acute-care hospital, to meet with Jerry Balentine and David Perlstein, the chief medical officer and associate medical director, respectively. They urge me to wander around a bit and look at the local bodegas, where the food options are pretty lousy—mostly fatty canned foods and virtually no fresh vegetables. The new reality is, the Bronx is ballooning. “You walk along here and you almost never see an actual supermarket,” Balentine says with a shrug. “So people can’t eat healthily even if they want to. It’s all fast food. That’s what’s cheap—Chinese food, pizza.”
The life-expectancy revolution destroys one of New York’s most cherished self images—our mean streets. Health is our new urban stereotype.
Perlstein takes me for a stroll through one of St. Barnabas’ clinics, and it’s hardly a picture of good health. Virtually everyone is overweight, many enormously so: One white-haired woman poured over the edges of a small chair as she sat knitting; she looked as though she could easily crack 300 pounds. “This is our biggest problem,” he says. There’s an ethnic component; Hispanics tend to be stockier to begin with, he notes. But there’s also a cognitive drift among his patients. Since they’re surrounded all day long by people who are huge, they lose the ability to recognize what it means to be overweight. People who are healthy look creepily skinny.
“I get mothers coming in with their kids, and the kids are already looking a little too heavy, right?” Perlstein says. “But the mothers are going, ‘He’s not gaining enough weight! Give me a pill that makes him gain more weight!’ They see being heavy as being healthy—you’re growing. It’s completely the opposite of what people think in Manhattan.”
Granted, New York is pushing various policies to affect the “food environment” in poorer areas of the city. In a pilot program in central Brooklyn, the South Bronx, and Harlem last winter, the city subsidized bodegas to carry one percent milk in addition to the unhealthier full-fat variant. And Frieden recently passed a law that will require most fast-food chains to prominently post the calorie content of their meals. But you can’t get past the sheer difficulties of being broke. Perlstein has female patients who schedule mammograms but then skip them—“because they’ve got three kids, and who’s going to look after them while they’re getting screened?”
At times, talking to Frieden and some of the other scientists, I wondered if all the talk about how healthy cities had become might be the latest species of boosterism, of civic mythmaking, partly because he’s staked his legacy on such aggressive policies as bad-food bans. And urban theorists have begun a fierce beat-down on the suburbs, castigating them endlessly for being the epicenter of the obesity epidemic. As it happens, this is the argument of Matthew Turner, an economist at the University of Toronto. Last year, he decided he was a bit sick of hearing about the health benefits of cities. The “urban health advantage” sounded to him like mere self-congratulation—the skinny, attractive folks in the megalopolises crowing about their innate superiority, and recoiling at the barbarisms of the SUV-driving, Wal-Mart-shopping exurban masses. It seemed too much like blue-state snobbery. So Turner devised a new experiment to test the power of the urban health advantage.