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Density Isn’t Always Bad for Your Health

In the age of pandemic, don't write off cities as "existential threats."

As the coronavirus pandemic continues to ravage the planet, a number of voices have begun to question the ideals of the well-established New Urbanism movement. Proximity, community, walkability, and the use of transit seem to be harbingers of disease and death, where just one carrier could infect thousands. In this new era of “social distancing,” self-quarantine and remote work, the idea of living in an apartment and going out to a cafe or a movie theater, or just to hang out with friends, is suddenly scary and irresponsible. One can hardly bring up urban design on Twitter these days without someone suggesting that the population density of cities is a vulnerability.

The New York Times asks “Can City Life Survive Coronavirus?” and Joel Kotkin argued in the Tablet that coronavirus is an “existential threat” to New York City.

With a rapidly spreading novel coronavirus leading to national and local lockdowns, it seems far better to stay in your home with your family, several yards away from the neighbors’ place—and if you need to go anywhere, go by car. Using public transportation and thus being cooped up in a bus or train car for a time seems downright foolish.

As a quick aside, it’s worth pointing out that the Times and Kotkin are charitably engaging in hyperbole. Urban life survived the 1918 Spanish Flu pandemic, 19th-century outbreaks of cholera and tuberculosis, various fevers, polio and, of course, the medieval-era Black Death. The Plague of Pericles ended the Athenian Golden Age, but Athens survived both the plague and the war it was fighting at the time. So it takes a lot to kill a city—many have survived wars, famines, floods, fires, and earthquakes at one or more times in history.

But people are hardly the first to think that public health should be considered in how we build cities. Cholera and tuberculosis outbreaks, among other things, led to reformers crafting some of the earliest planning regulations. New York City’s Old and New Law tenements were created with the intention of providing “light and air” to each resident, as experts believed that those things could prevent disease. (While it’s true that light, especially in the UV spectrum, has disinfectant properties, it’s unlikely to be a very effective method of cleaning an apartment).

Yet such thinking does not explain why cholera and TB were so common in the 19th century and remain so in the developing world.

Cholera spreads where drinking water and human and animal waste are allowed to mix. The automobile also eliminated another vector of contamination: the manure of millions of horses that turned the wheels of major cities. Similarly, tuberculosis was no more a reflection on the architecture of the time than it was on their morals. That disease thrived because people, especially recent immigrants from Europe, were too poor to afford to rent more than one or two rooms (and even then, it was not uncommon for two or more families to share one room for further savings); new arrivals were sometimes malnourished. TB was also aggravated, along with conditions like asthma, by the widespread use of coal for fuel.

With proper sanitation, uncrowding, running water, and electricity, New York tenement apartments are perfectly livable and even desirable. Similarly, some faulty plumbing or a humid, rainy summer can turn an idyllic suburban single-family home on an acre and with a white picket fence into a breeding ground for toxic mold, but no one opposes suburban sprawl because of that.

The reality is that dense, walkable neighborhoods have many public health advantages. People who commute by car are more likely to be obese, as well as experiencing added stress from their daily commute, leading to high blood pressure and heart problems. Car exhaust contributes to asthma, heart attacks, lung cancer, strokes, and even played a role in crime! Loneliness is also greater in suburbs, contributing to high levels of depression and anxiety. A place where you can walk and get to know your neighbors, even on a nodding basis, can be the line between life and death for many vulnerable people.

In one of her later books, Dark Age Ahead, the venerable urbanist and journalist Jane Jacobs wrote about the great Chicago heat wave of 1995. The heat was so intense that air conditioner usage overloaded the power grid in many places, and so many fire hydrants were opened that buildings lost water pressure. One week in July saw over 700 more deaths, mostly among the elderly poor, than Chicago would normally see.

Jacobs wrote that the high death rate among the elderly confused the Centers for Disease Control, whose researchers found that many Chicagoans had essentially barricaded themselves in their apartments, even as they lost electricity and water, with no refuge from the heat. The CDC was at a loss to explain why, but sociologist Eric Klinenberg found that when comparing two neighborhoods even spatially near, were worlds apart socially. In North Lawndale there were 40 deaths per 100,000 people, but in neighboring South Lawndale, there were four deaths per 100,000 people. According to Jacobs, Klinenberg found that in North Lawndale, people were unused to walking places and there were few to no places to walk to. The residents had few connections to each other, so they didn’t check up on each other and feared leaving their apartments and strangers coming to them. By contrast, in South Lawndale, which had businesses and other places to walk to, the elderly were much more connected to the other residents in the neighborhood. They didn’t fear leaving their homes to places that still had air conditioning and water, nor did they fear people coming to check on them.

As Jeff Speck wrote in Walkable City, “Increasingly, it is becoming clear that the American healthcare crisis is largely an urban design crisis, with walkability at the heart of the cure.”

Yet there is more evidence that cities are not especially vulnerable to pandemics. We can compare the response in Western cities to those of East Asia. The cities of Japan and South Korea, plus Singapore and Hong Kong, have not become the hot spots of Covid-19.

According to the New York Times, Taiwan, Singapore, and Hong Kong made plans building on their failures from the SARS outbreak in 2002-03. The three attempted to intervene as early as possible to contain any outbreaks, using multiple researchers to track contacts, enforcing quarantines, and monitoring neighbors like China very closely. Along with Japan, the near-universal practice of people wearing face masks may also slow the spread of the disease, especially from asymptomatic carriers.

The spread of coronavirus around the world has not been one of densely-populated cities succumbing first and the infections tapering off as suburbs become rural. Instead it’s been about “super-spreading events” where a lot of people are in contact with each other, something that is just as likely to happen in a crowded suburban Walmart or megachurch as anywhere in Manhattan.

Intelligence, preparation, and early action are making the difference. South Korea introduced widespread testing and tracing from the beginning, while the United States was pretending there was no problem. The Koreans have successfully contained the virus and without a lockdown.

Bad urban design will not stop this pandemic or the next one. But good urban design will reduce your risk of succumbing to the virus—especially when some of our neighbors will be left uninformed, alone, or vulnerable.

Matthew Robare is a journalist living in Boston.