Cities are a boon for public health—even now. As public-health experts have known for decades, people who live in a city are likely to walk and bike more often, and they live closer to community services such as grocery stores. Urban density also supports faster emergency-response times, better hospital staffing, and a greater concentration of intensive-care beds and other health-care resources.
Yet despite ample evidence that urbanites live longer and healthier lives than their counterparts in rural areas, the spread of the coronavirus—and New York City’s tragic experience in particular—has fueled a dubious association between population density and contagion. “There is a density level in NYC that is destructive,” Governor Andrew Cuomo tweeted in March, urging the city to develop “an immediate plan to reduce density.” The pandemic vindicates the exurbs, a number of commentators have concluded.
Yet given the profound economic and health dislocations the nation faces, Americans may feel tempted to make broad generalizations about why it happened and what the long-term ramifications will be. These generalizations threaten to harden into conventional wisdom—and to warp public policies in ways that, ironically, increase Americans’ vulnerability to COVID-19 and other harms in the future.
In fact, no correlation exists between population density and rates of COVID-19 infection, according to recent studies examining the disease in China and Chicago. But if state and local governments still conclude that density itself is a problem, they are more likely to promote suburban sprawl as a matter of law—instead of making the accommodations, in their housing stock and their streetscapes, that allow people to live in cities safely and move about them comfortably.
The policies that local governments adopt have profound effects on the health of their residents. While the nation’s densest city, New York, experienced a severe COVID-19 outbreak—more than 195,000 confirmed cases and more than 19,000 deaths to date—one must simply look at our nation’s second-densest city, San Francisco, to see a very different picture. San Francisco has so far experienced far fewer infections, with more than 2,000 confirmed cases and 36 deaths. While comparing confirmed-case rates is somewhat challenging because of disparate testing levels, the comparative death rates are revealing. Though New York City has approximately 10 times as many people as San Francisco, the former has suffered more than 500 times the deaths.
One difference between New York City and San Francisco? The Bay Area responded to the pandemic earlier and more decisively than New York did, imposing social-distancing measures before major cities on the East Coast.
San Francisco is not alone. Some of the world’s most densely populated cities—for example, Taipei, Hong Kong, and Seoul—have been much more successful than other less dense, more sprawling cities in containing the virus. To be clear, these cities are still struggling to contain the coronavirus. But they’ve taken firm, science-based steps to stop it from cascading into disaster and have seen positive results.
In California, we’ve also heard significant discussion of the relationship between crowded housing and COVID-19 infections. Crowding within homes is, indeed, bad for public health. Callous social policy and economic inequity—typically along racial lines—have forced many low-income people to live in crowded households. But density and crowding are different things. Crowding is what happens when, because of a lack of sufficient housing, families and roommates are forced into tight quarters designed for a smaller number of inhabitants. That crowding can increase the spread of a contagion. Density in cities—where people can live in uncrowded homes near neighbors, services, and commercial corridors—doesn’t.
To blame density for the devastation caused by the coronavirus is to ignore all the factors that really determine how badly communities suffer in crises such as the present one. Cities large and small that responded in a timely, effective, and firm manner appear to have fared better than those that responded more slowly or without a coordinated effort. A significant determinant of a community’s exposure to COVID-19, regardless of that community’s size and density, is the government’s responsiveness—or lack thereof—to its basic needs. Adding to this disparity is our nation’s pernicious legacy of racism, segregation, and willful neglect of the fundamental health needs of communities of color and low-income communities. We are sadly seeing these same patterns show up in full force during the pandemic.
Moreover, a lack of housing density results in sprawl—and sprawling development brings profoundly negative health consequences, including increases in respiratory conditions that make people more vulnerable to infections such as COVID-19. Sprawl exacerbates climate change, which damages the health of people all over the world. Already, evidence suggests that 21,000 Californians, disproportionately people of color, die early because of air pollution related to road transportation and residential and commercial heating and cooling. Sprawl makes all of those emissions worse. Just a slight increase in long-term pollution exposure can have serious coronavirus-related consequences, even accounting for other factors such as smoking rates and population density. Sprawl also forces people to spend so much time in their cars: an average of eight hours and 22 minutes of sedentary time each week. This sedentary time increases the risk of type 2 diabetes and obesity, both of which are risk factors for severe COVID-19 disease.
The current pandemic isn’t the first time cities have been blamed for disease. Historically, many campaigns against urban density have been justified as a matter of health and sanitation. They have often taken the form of land-use restrictions that promote not just sprawl but also racial discrimination.
Policy making—such as anti-density measures—that enshrine and exacerbate racial disparities are a public-health hazard to us all.
Cities are good for our health and remain so, even amid the threat of COVID-19. Now is the time for Americans to invest in cities and in equitable housing policy, not let the pandemic become an excuse to do the opposite.