Don’t blame dense cities. They have been resilient
It’s not density, but socioeconomic factors, State capacity, and lack of experience which explain case load
The Covid-19 pandemic has upended the world as we know it. In the subsequent blame game, dense cities occupy pole position. Prima facie, this looks like a fair accusation given the extent of the outbreak in Mumbai, Delhi, New York and London. However, a more granular look at the data suggests that this is not accurate.
High densities and agglomeration effects, the secret sauce of successful big cities, are precisely what make them vulnerable to threats such as pandemics. Social interactions are higher in cities, and an infected person is likely to come in contact with a larger number of people, say while commuting on a train, thus hastening the spread of the disease in cities such as Mumbai and New York.
But what are we to make of similarly dense cities that were able to control and contain the outbreak? Seoul, with a population density of 16,000 persons per square kilometre, had far fewer cases than New York. Taipei, whose density is comparable to New York, did not suffer from a serious outbreak. Other Asian megacities such as Hanoi, Hong Kong and Bangkok have done well too.
In New York itself, Manhattan, the densest of the five boroughs has the lowest number of infections. Data suggests that in terms of share of population with Covid-19, rural counties such as Trousdale in Tennessee, with one in eight people, outstripped New York with one in 44. A World Bank study of the outbreak in China shows that population densities in cities are not correlated to the spread of the virus. Very dense cities such as Beijing, Shanghai and Tianjin have remained relatively unscathed.
Clearly, density is not the sole culprit, if at all. As the urbanist Richard Florida has pointed out, we must not conflate density with overcrowding. To paraphrase Robert McDonald of Nature Conservancy, there is a difference between a 500 sq ft apartment in Mumbai occupied by two people, versus the same space occupied by 10 people in a slum — the latter sets the stage for the rapid spread of infectious diseases. Needless to say, a dense urban population does not imply low per-capita square footage. The latter occurs due to bad urban policies.
What else might explain the conundrum? A recent study on metropolitan counties in the United States (US) suggests that socio-economic factors and levels of education were better at explaining outcomes related to mortality and spread of infection. It also suggests that dense urban areas may, in fact, have benefited from better public awareness and consequent behavioural adaptation, such as wearing masks, due to the immediacy of the threat. Obviously, big cities, even in India, have much better health care facilities, including large public and multi-speciality hospitals, and health professionals, compared to other places because these require economies of scale to be viable.
Studying policies for tackling Covid-19 adopted by different countries, regions, and cities gives us further insight into why some were extremely successful. The biggest explanatory variable, besides socio-economic factors and State capacity, appears to be previous experience (including by osmosis) with infectious disease, be it in Vietnam, Taiwan, Japan, or Kerala. These places simply took the disease more seriously. The suite of measures they undertook includes aggressive testing, tracing, isolation, clear communications, hand hygiene and extensive mask-wearing.
Once these measures were in place, even super-dense slum clusters such as Dharavi in Mumbai, where over 800,000 people live in an area of 2.4 square kilometres, have turned the corner. At the time of writing, there are visible signs of the curve being flattened.
Every crisis is an opportunity to rebuild better. Instead of calls for de-urbanisation, building resilient cities is the need of the hour.
The more immediate policy responses that will earn large dividends in India include: One, addressing crowding by increasing per-capita consumption of floor area by drastically reducing regulatory barriers to construction. Two, administratively, the crisis has taught us that a pandemic response cannot be federally-mandated and requires a decentralised, proximal, and accountable response. To enable this, city leaders need to be empowered. Three, social protection systems need to be redesigned to protect the poor and vulnerable in urban areas, in addition to the current focus on rural settlements. Four, countries such as India with large out-of-pocket expenditures on private health care must restore the balance between health care and robust public health that focuses on improving health outcomes for all — only a capable State can deliver the latter.
Covid-19 is neither the first nor the last public health crisis to hit cities. Everything from the Black Death to the bubonic plague to the Spanish flu, not to mention world wars and terror attacks, have ravaged cities in the past. Each time, people worried that it was the end of big cities, only to watch them re-emerge stronger and more vibrant. This time will be no different. The demise of dense cities is greatly exaggerated.