Health and the city

Lawrence Solomon
National Post
October 2, 2002

The farther we live from cities, the sicker we are and the sooner we die, Statistics Canada revealed in a series of recently released reports. The closer we live to cities, the healthier we are. Those who live in large urban areas – whether metropolitan areas such as Vancouver, Toronto and Montreal, or urban centres with populations of 500,000 or more – tend to be the healthiest of all.

In part, these bigger-city residents are healthier than small town and country folk due to clean living. Statscan placed different parts of Canada into one of 10 geographic groups, two of them citified (metro and large urban) and eight of them more rural in character, such as Maritime and Northern (see chart). Citified people are less likely to be smokers and drinkers, and less likely to be obese, than any of the other eight groups.

But clean living explains little of the salutary result of city living, let alone why some people get sick and others remain healthy. Neither does the availability of doctors, specialists, and hospitals in major centres explain the urban health effect. Says Statscan: “The variations between regions in the availability of these health-care services do not appear to play a role in accounting for individual health status differences.”

Instead, Statscan and the medical world agree, a dominant factor behind good health involves our social status. After adjusting for lifestyle factors such as eating and smoking, the health of the poor fares worst, followed by that of blue- and white-collar workers, followed by doctors, lawyers and other professionals. Even these professionals aren’t as healthy, and don’t live as long, as those who occupy higher-still rungs on the socio-economic ladder.

Why would highly educated, affluent professionals like doctors and lawyers fare worse than their socio-economic superiors? The best answer lies in the health effects of being in control. Study after study has shown that those who have most control over their lives are likeliest to live free and healthy. Thus individual empowerment, rather than the money, education or social status that tends to be empowering, may be the elixir that leads to a long and healthy life.

Statscan’s recent health studies support the empowerment hypothesis. The data describing small town and rural folk often paints an unflattering, devil-may-care portrait. Maritimers outside big centres are disproportionately big-time drinkers and smokers who are obese and rarely exercise. They’re also poorly educated and less likely to be employed. But while this live-for-today lifestyle harms their physical health, their mental health shows little sign of strain. Rural Maritimers are relatively stress free and unlikely to suffer from depression. Rural folk in other parts of Canada also broadly share these come-what-may characteristics.

In contrast, although urban residents tend to live high-stress lives, they’re more motivated to become well educated, they’re less likely to be dependent on government transfers, and they are much, much healthier. In the culturally diverse and commercially oriented city, even poor residents – the bottom 40% – outlive rural residents in most of the country, and the very poorest urbanites – the bottom 20% – outlive residents in Northern communities. Statscan doesn’t say why poor urbanites fare so well – they tend to be ill-educated and suffer from high unemployment – but the answer may well lie in empowerment. In the city, even the poor can be motivated by optimism, and have realistic prospects for a better life. In the more traditional countryside, change comes more slowly, and people are more often resigned to their lot in life.

Governments respond to the plight of rural residents with compassion, by providing rural residents with superior social safety nets. These safety nets have their benefits, but they also have their drawbacks. They encourage rural folk to stay put, preventing their horizons from straying from their fishing villages or logging towns, quashing thoughts that they may have of venturing out into the commercial world, with all its risks and rewards. In the rural areas, mother bird forces her young to leave the nest, knowing it’s ultimately best for her brood. Benevolent government, meanwhile, kills rural Canadians with its kindness.

Life Expectancy:

In yearsCanadian average: 78.3
Large cities (500,000+): 79.6
Metropolitan areas: 78.8
Smaller cities: 78.8
Ontario rural commuters: 78.3
Prairies (rural well-off): 77.9
Prairies (rural low-income): 77.8
Quebec rural: 77.7
Maritime rural: 77.0
Northern: 76.7
Northern aboriginal: 71.8
Source: Statistics Canada
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