In New York City, Density Saves Lives, Too – CityLab

Before coronavirus transformed urban life, New York had achieved a massive public health success, thanks in part to the city’s now-maligned layout.

This is part of an ongoing CityLab series on the debate over urban density during the coronavirus crisis. For more, go here.

New York’s coronavirus death toll is rawly staggering — as of April 24, more than 15,000 in the city are believed to have died from Covid-19-related reasons, magnitudes more than the 2,747 souls lost on 9/11. It’s easy, superficially, to blame the city’s density, and many have: Surely, so many people living, working, and traveling in close quarters caused Covid-19 to spread more easily. We don’t know that yet. But what we do know is that for the three decades leading up to this pandemic, New York ably used its density and wealth to increase life expectancy for its most vulnerable residents, saving hundreds of thousands of lives.

Last summer, New York City’s health department announced a milestone: For 2017, life expectancy had reached 81.2 years, up a full year over a decade. “Premature mortality”— people dying before their natural lifespan — was down nearly 15 percent since 2008. Though the city can seem chaotic and dangerous to Americans outside the region, New York’s life expectancy was better than the nation’s, which, at 78.6 years, had stagnated over the same decade.

How have so many New Yorkers been able to enjoy, in many individual cases, extra years and even decades of life? One big factor is its transit system — now demonized, in the words of Florida Governor Ron DeSantis, as “the perfect Petri dish [in] a very urban environment.”

Until this pandemic, though — which has taken the lives of at least 83 transit workers — the transit system was responsible for saving hundreds of lives a year in New York City. Last year, New York had 221 traffic deaths, with the number having fallen steadily from a record high of 701 in 1990. Largely thanks to its largest city, New York State’s traffic fatality rate is 4.8 per 100,000, just a third of Florida 14.7 deaths per 100,000.

This remarkable success over nearly three decades is partly the result of traffic safety improvements like crackdowns on drunk driving, new bike lanes, pedestrianized plazas, and speed and-red light cameras. But the biggest factor is mass transit: 6 million people a day can travel without having to get into an automobile.

Then, too, is the city’s murder tally —  down, last year, to 319, from 2,262 in 1990. Many forces have helped save these lives, including better policing to get illegal guns off the streets, higher high-school graduation rates, and a transfer of much of the drug trade from outdoors to online. But density is itself a deterrent: The city’s increased population, from 7.3 million people three decades ago to 8.6 million today, means more eyes in public. Even the city’s suicide rate is lower than the national average, in part, perhaps, because of the sheer relentlessness of human contact in the city. A recent Cigna study found that New York scores slightly better on a national “loneliness score” than the national average, with “daily in-person interactions” making a difference.

Finally, public-health initiatives launched during the Michael R. Bloomberg administration have helped cut the mortality rate. Declines in smoking, and the prohibition of transfats in food, helped reduce hypertension and heart-disease rates. As the city’s health department noted last year, New York’s death rate from heart disease was down 20 percent between 2008 and 2017.

Even just basic exercise — walking home from the subway — keeps the average New Yorker healthier than most suburban Americans. Just 22 percent of adult New Yorkers are obese, according to the city’s health department, compared to the 42 percent rate for the U.S. as a whole, as reported by the CDC.

Overall, these factors combined to create a great public-health success story: In 1990, 73,875 New Yorkers died, or 10.1 out of every 1,000 (most from natural causes). By 2017, the toll was down to 54,319, or 6.3 out of every 1,000, a record low, and a nearly 40 percent decrease. That’s tens of thousands of people still alive each year — both because the city’s density and the wealth it creates allow it to invest in safe streets and public health, and because density naturally supports a healthier lifestyle: It’s easier to walk — including walking to transit — than to drive.  

These numbers don’t dampen the coronavirus toll — which has already nearly quadrupled New York’s average number of deaths per day to 555 from 149 over the past six weeks. Nor can they refute disparites across race and income, in terms of health outcomes: Even as average life expectancy increased across all of New York’s racial groups, as of 2017, black New Yorkers still had the shortest life expectancy, and those living in the poorest neighborhoods had a higher death rate. Though it’s too early to conclude, Covid-19 may deepen these disparities, as black and Hispanic men, in particular, succumb to the virus, due to public-facing jobs, pre-existing health conditions, poorer access to health care, factors we don’t yet understand, or a combination of the above.

But New York can once again use well-managed density and wealth to learn lessons from this crisis, and prevent recurrences. Just like it did after 9/11, in creating a counterterrorism force to prevent terror attacks, it likely will have to create a stronger public-health force to better track global outbreaks and predict and prevent disease from spreading locally. Just as NYPD officers have deployed to posts around the world to track terror developments and prevent attacks at home, a New York public-health intelligence network could react quickly to an emerging public-health threat elsewhere in the world, directing New Yorkers to don masks or to engage in social distancing.

New York has a difficult recovery, and the lives lost too soon can never been recovered. But it is not at all clear that density is the main culprit here. What is factually incontrovertible is that record density — and reasonably good, if always imperfect, management of that density — made New York safer and healthier than it ever had been before the coronavirus spread.