Hey all, greetings from Santa Monica!
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Last week I wrote about longevity research and the quest to extend human health span.
This week I’ll look at health and longevity through the lens of cities and urban life. I’ll discuss why people in Costa Rica and France are living longer than people in the US.
Why have US life spans fallen behind those in Europe? How does our geography, our physical environment, shape our health and well-being?
🧡 This post is inspired by my mother, Rhoda
My mom was 6 months pregnant with me when she interviewed for a job with New Haven city government. She ended up spending 25 years as a city planner. She created programs to tackle New Haven’s toughest problems: education, healthcare, creating new jobs.
My mother believed in the power of local government to improve lives and lift up communities.
As a kid growing up in New Haven I remember our family’s focus on community. We played kickball in the street and had neighbors over for dinner. Our street was diverse, both racially and socioeconomically. We had police officers, firefighters, doctors and rabbis.
We knew our neighbors. We looked out for each other.
As I moved into bigger ponds — Harvard, Wall Street, New York City — I often felt a sense of isolation. I didn’t know many people. One of the cruel ironies of living in New York: You can be surrounded by millions of people, yet feel lonelier than you’ve ever been.
It’s not just me. Millions of Americans suffer from loneliness and social isolation. We’re learning how this impacts our health in profound ways.
Why are Americans dying younger?
US life expectancy in 2020 saw its biggest drop since World War 2. Part of this is due to Covid, but it’s also part of a broader decline in life expectancy among middle-aged Americans.
Compare the US to Europe. In 2017, the average American lived for 78.6 years, the average French citizen four years longer, the average Briton almost three years more.
“Residents of the poorest parts of France live about as long as people in the rich areas around Paris do. But in the U.S., which has the highest poverty and inequality of just about any country, where you live is much more likely to determine when you’ll die. Infants in the U.S. are considerably more likely to die in the poorest counties than in the richest counties, and this is true for both Black and white babies.”
Economists talk about the surge in recent years of what they call “deaths of despair”—from alcoholism, drug addiction and suicides—among working-class white people.
Socioeconomic factors may have more of an impact on our life expectancy than healthcare services and individual behaviors. Factors such as good housing, secure jobs and income and social connections play a huge role in keeping us healthy.
The Fraying of American Communities
Americans are wealthier than ever in terms of GDP. Yet we also seem to be suffering from increased anxiety, loneliness, and the deterioration of community.
In his book “Tribe,” Sebastian Junger argues that the US’s high rates of depression and suicide are directly related to the isolating effects of modern society. Living alone in a suburb or city isn’t natural for us, says Junger. Humans evolved in close-knit tribes:
“We should recognize that by shrinking our network of strong social ties to our immediate families, we lose something important to our health and social identities, with the predictable result that we are ridden with anxiety and loneliness. We are meant to have tribes, to be among people who know us and care about us.”
When we look at deaths of despair—the high suicide rates, mass shootings, high depression and anxiety, drug and alcohol abuse—the common denominator is the catastrophic lack of communal connection that many Americans experience.
The Third Space
One thing I missed during the pandemic: those little human interactions I used to get at my local cafe. Studies show public places that promote social interaction can increase a community's social capital levels, which in turn promote longer lifespans.
Patricia Mou writes eloquently on the third space, a concept that refers to places which are not home (first place) or work (second place). Third spaces include bookstore-cafes, beer gardens, parks, coffeehouses:
“A place that doesn’t demand anything from us, yet gives us a sense of fullness and familiarity. Amongst a sea of strangers, we can choose to be blissfully alone or huddle over a miniature table with a friend.
Third places are important because they act as meditation between individuals and the larger society and increase a sense of belonging and community.”
What makes a Happy City
I read a book called “Happy City” by Charles Montgomery. The book’s central argument is that the way cities are built has a powerful influence on our mood and behavior.
Some key takeaways:
We’re happier when we live a connected life, establishing casual but regular relationships with the people we meet through simple residential proximity. Think about life on a college campus vs. an isolated suburb.
We’re happier around nature: “Green space in cities shouldn’t be considered an optional luxury. It is a crucial part of a healthy human habitat.”
We’re happier with fewer cars, more walking / biking / public transportation. Long commutes and noisy, polluting traffic detract from quality of life.
The most important psychological effect of the city is the way in which it moderates our relationships with other people. More densely populated cities, which encourage people to travel on foot or by public transport, create more opportunities for interaction.
We can learn from the successes of international cities: Oslo’s pedestrian-friendly streets, Tokyo’s public trust and safety.
The quality of our everyday social life affects not only our well-being, but also our physical health. When we’re tied into a supportive daily face-to-face social network we’re less likely to become sick than those who live more isolated lives. This health-protective function of social networks is called a “social immune system.”
Why people live longer in Costa Rica
The New Yorker ran a great piece by Dr. Atul Gawande on how Costa Rica radically increased average life expectancy, from 55 in the 1950s to nearly 81 today—above the United States' average life expectancy.
Costa Rica did this by unifying two approaches to health that are largely kept separate in America: public health and medical care.
Every Costa Rican is assigned a local primary health care team, including a physician, nurse, and a trained community health care worker known as an Asistente Técnico en Atención Primaria (ATAP).
These ATAPs—who combine the skills of a medical worker and a public health aide—each make a certain number of annual visits to local households, based on the health needs of each family.
While we can’t put a doctor in every family, Costa Rica's model “shows that we can provide something close: a primary care team whom individuals know personally and can call upon in the course of their lives.”
People in Costa Rica are living longer. It’s an example of how small changes can make a big impact on the health of our communities.
Thank you for reading. Until next week,
By Daniel Zahler
Every week I write an email newsletter with perspectives on health and wellness trends, and strategies & tactics on how to optimize cognitive, physical and emotional health. I hold a JD and BA from Harvard, have worked at Goldman Sachs and McKinsey, and advise global business leaders as a GLG council member.
Check out my articles in Thrive Global here.
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