Some Situational Sources of Longer Life

In the latest edition of New York Magazine, Clive Thompson has a fascinating article, “Why New Yorkers Last Longer.” Below we have excerpted portions of the article which includes several situational explanations — from “smart public policy and sheer luck” to “the very structure of the city.”

* * *

Last winter, the New York City Department of Health released figures that told a surprising story: New Yorkers are living longer than ever, and longer than most people in the country. A New Yorker born in 2004 can now expect to live 78.6 years, nine months longer than the average American will. What’s more, our life expectancy is increasing at a rate faster than that of most of the rest of the country. . . . When these figures came out, urban-health experts were impressed and slightly dazed. It turns out the conventional wisdom is wrong: The city, it seems, won’t kill you. Quite the opposite. Not only are we the safest big city in America, but we are, by this measure at least, the healthiest.

The “average life expectancy” of a city is a statistically curious number. It’s not really a prediction about how long you’re going to live. It’s an average of how long everyone here lives—and thus it forms a good barometer of the overall health of the city. . . .

And this is precisely what the city has done, through a combination of smart public policy and sheer luck. All the boons of the nineties—the aggressive policing, the dramatic drop in crime, the renaissance of the city’s parks and street life, the freakish infusion of boom-time wealth—played a part.

* * *

Homicide, AIDS, and drugs are characteristically New York ways to die young, of course, so it’s no surprise that when we sharply decreased the fatalities they caused, we caught up with the rest of the country. But here’s the thing: It’s not just that we’ve conquered these urban blights. Cancer and cardiac arrest are down, too. The number of people in the city dying from heart disease has dropped by a third in the last twenty years, and cancer rates have slid by nearly a fifth. And again in these cases, New York is getting healthier faster than the rest of the U.S.

In essence, there is a health gap emerging between our massive metropolis and the rest of the country—some X factor that’s improving our health in subtle, everyday ways. . . . Like many New Yorkers, I’d moved here with some trepidation—always figuring that the stress, pollution, and 60-hour workweeks would knock about five years off my life. I was wrong—precisely wrong. But where, exactly, is our excess life coming from?

I take this question to Thomas Frieden, New York’s commissioner of public health. Frieden is a wonk’s wonk—a handsome, energetic doctor who has gained a nationwide reputation for his aggressive effort to push New York’s average-life-expectancy figure ever higher. The smoking ban of 2003? The trans-fat ban of last year? You can thank Frieden for both. . . .

But even Frieden admits that public policy can’t account for all the gains. When I ask what the X factor is—where the “excess life” is coming from—Frieden goes over to his desk and returns with a clear plastic statuette. It’s from the American Podiatric Medical Association and Prevention magazine: BEST WALKING CITY, 2006.

“We’ve won it a couple of years in a row,” he tells me with a grin. He’s got a bunch of them kicking around.

Walking? This isn’t quite as facile an explanation as it sounds. Scientists who study urban health argue that it’s not just that we walk more—it’s the way we walk that has a surprising spillover effect on life spans. . . . Eleanor Simonsick, a Baltimore-based epidemiologist, knew that regular walking is a powerful way to maintain your health. But she began to wonder, a question very germane to us in New York: Does the speed at which you walk also affect your health?

She decided to conduct an experiment to find out. She and a group of scientists assembled 3,075 seniors in their seventies and asked them to traverse a 400-meter course, walking as fast as they could. They monitored their subjects’ health over the next six years, during which time 430 of the geriatrics died and many more fell ill. When Simonsick crunched the data, she found that the ones who were dying and getting sick were the ones who walked the slowest. For every minute longer it took someone to complete the 400-meter walk, he had a 29 percent higher chance of mortality and a 52 percent greater chance of being disabled. People who walk faster live longer—and enjoy better health in their later years.

“Walking speed absolutely reflects health status,” Simonsick says. . . .

The thing is, as Simonsick points out, New York is literally designed to force people to walk, to climb stairs—and to do it quickly. Driving in the city is maddening, pushing us onto the sidewalks and up and down the stairs to the subways. What’s more, our social contract dictates that you should move your ass when you’re on the sidewalk, so as not to annoy your fellow walkers. (A recent ranking of cities found that New York has the fastest pedestrians in the country.) As Simonsick sees it, the very structure of the city coerces us to exercise far more than people elsewhere in the U.S., in a way that is strongly correlated with a far-better life expectancy. Every city block doubles as a racewalking track, every subway station, a StairMaster. Seen this way, the whole city looks like a massive exercise machine dedicated to improving our health while we run errands.

This idea of the city as a health club is fairly revolutionary. Back in the beginning of the industrial revolution, cities were regarded, quite correctly, as lethal places to live. . . . In the first decades of the twentieth century, cities began to clean up their acts drastically, when sanitation standards emerged and inoculations began to aggressively squelch infectious diseases; the actual life spans in cities began to catch up to and exceed those of people in rural areas. But the idea of urban rot remained strong, so the cultural bias against urban life lived on. It didn’t help when the seventies and eighties ushered in waves of urban crime, recession, and drug epidemics, and cities like New York and Detroit and Chicago sharply curtailed public-health services. Cities, more than ever, seemed like cesspools of dread and early death.

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. . . . 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. . . . 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.

* * *
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.

If it’s true that cities impose inherently healthier behavior on you, Turner reasoned, then people who move from cities to suburbs should get fatter—and vice versa. He began hoovering up data on 6,000 young Americans in their twenties to forties, tracking where they lived over a six-year period. He used satellite imagery and tallies of shops and churches to determine the level of sprawl in each subject’s neighborhood, then gathered information on each one’s weight.

When he examined the data, he discovered something surprising: People who moved between dense and sprawling neighborhoods didn’t change weight. Despite the claims of the new urbanists, Turner saw no evidence that one’s built environment has an impact on one’s health. “This idea that the built environment affects how much you weigh,” he told me, “is just wrong.”

But then why do cities harbor slimmer people who live longer and healthier than those in sprawl? Because, Turner argues, the populations are self-selecting. Highly active people who don’t like to drive—and who crave to make boatloads of money—naturally gravitate to places like New York, because that suits their chosen lifestyle. If we walk a lot here, it’s because we’re drawn to cities that force us to do so. The converse is also true: People who are heavier and less fit gravitate to suburbs precisely because that’s where they won’t need to walk—where nothing is possible without getting in a car. (Mind you, Turner’s rival scientists are not convinced by his argument. As one pointed out to me, moving to a differently dense area might take years to change your weight—longer than Turner’s time frame.) In Turner’s view, the logic of the urban health advantage is not only wrong, it’s backward. It’s not that New York makes us healthier. We make it healthier, by flocking here to live.

Ultimately, I’ve come to believe that Turner is likely correct—but so are the proponents of the urban health advantage. The two theories are not mutually exclusive. A city can be good for your health and, at the same time, attract healthy people.

* * *

To review a sample Situationist posts examining the situaitonal sources of obesity, click here.