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The places where you can live the longest are now predominately in Asia. Neville Bennett explores why this change has happened.

The places where you can live the longest are now predominately in Asia. Neville Bennett explores why this change has happened.

By Neville Bennett*

I found, tucked away in an alumni newsletter, first news of the greatest revolution in my lifetime: Asian longevity is now higher than European and American.

I do not pretend that this is absolute, as “Asia” is tricky to define. But if we look at life expectancy, the highest is now in Hong Kong.

We are accustomed to look at data on a national level, but a program launched by the London School of Economics and the University of Hong Kong is researching the rich lode of “Cities, Health and Well-being”. It is examining health, education and wealth across 129 major world cities in five continents with a combined population of 1.2 billion people.

Life expectancy is greatest in Hong Kong at 82.5 years, followed by Tokyo at 82.4 years. Osaka and Singapore (80.7) are also front runners. Paris is the highest western city (82.3) followed by Stockholm (81.2). New York (80.9) beats London (80.6). New Zealand is not covered and only Sydney qualifies for Australia, and it does very well at 81.9 years.

Moscow is not really 'Western', and its health is a notch lower with a life expectance of 70.3. This is perhaps to be expected, but I was mildly surprised that the Middle Eastern metropolises of Cairo and Tashkent beat Moscow. Cairo is a very creditable 71.3, Tashkent 70.9 and Tehran 70.1.

So why is this exciting?

I suppose I am conscious historically that western living standards in my youth far exceeded Asia. I have not been able to check it, but Japan excepted, I would guess there would be a difference of about 20 years. I have detailed knowledge of Japanese demography, and know its standards have generally always been the about the best in the world.

I worked at Hong Kong University in the 1960’s. It did not seem a candidate then for the healthiest city.

The dominating factor seemed to be the flow of penniless refugees who set up shanty houses on steep slopes. There was inadequate water and sanitation. Wages were incredibly low for most people as competition was high. But many were skilled, and industry developed (previously Hong Kong had concentrated on being an entrepot) and wages gradually rose.

I believe that the Hong Kong and Singapore miracles are based on the British Colonial Office’s determination to house its poor people.

It embarked on massive social housing. The apartments were basic and rent was low. This gave the population security and (later) even the ability to save. The administration also provided good clean water and public health. Strong policing and law provided a framework for the population to prosper by hard work.

Asia has been catching up for a long time, but now seems to be winning by a nose.

There are still great disparities. In the very unequal societies like Bolivia, life expectancy in La Paz is 63.3 years. Africa also lags; Nairobi’s life expectancy is 56.9, Johannesburg 51 and Zimbabwe’s Harare 38.2.

Cities and health

The health of urban dwellers is important, not least as it is expected that 70% of the global population will be urban by 2050.

At present cities provided some of the worst as well as the best health environments.

One key finding of the study is that the health of residents in big cities is better than their national averages.

Life expectancy is higher in New York than in the USA, higher in Mumbai than in India. It is higher in Jo’burg at 51 than in the rest of South Africa because of better access to healthcare and education.

It is historically significant that cities are as healthy as the village. Generally speaking that was not true before about 1900. I use to teach my students that cities were 'graveyards', with very high mortality and a dependency on immigration to maintain population levels.

Populations in the last 200 years have moved through an “epidemiological transition”.

In Europe and Asia, until the C.19 society was caught in the first stage of very high mortality rates rising from war, famine and pestilences.

In the C.19 health improvements in clean water, faster transport for food, better storage, and immunization brought a second stage of receding pandemics. Mortality levels were lower and pandemics were fewer.

We are now in a third age of low mortality, caused by degenerative and man-made diseases (especially heart, strokes, cancer and diabetes).

Smallpox was the biggest killer historically, later it was superseded by gastro-intestinal. Many of the scourges appeared in pandemics: measles, cholera, influenza and various diarrhea. Scarlet fever, diphtheria, tb, bronchitis etc also thrived. In the UK in 1850 life expectancy was 40 years and in Manchester it was 24 years.

Life expectancy was very influenced by child mortality.

I recall that detailed demography was first done in York by the Rowntree Family (famous for confectionary) and they found that in York in 1899  infant mortality in the working class was 247 infants per thousand. So a quarter of babies died in their first year. In York’s middle-class the rate was 94/1000, a tenth of babies died. Interestingly, the bottom 20% in Hong Kong still have a 1.6 higher mortality rate than the  remainder of the population.

There are studies on the quality of life, cost of living and other liveability matter that concern business and investors. But so far there is no good research on health in cities.

Agencies tend to look to countries rather than cities. The LSE has made a start with 129 metropolises. It provides stunning detail and illustration.  (Warning: this is a 44MB download.)


* Neville Bennett was a long-time Senior Lecturer in History at the University of Canterbury, where he taught since 1971. His focus is economic history and markets. He is also a columnist for the NBR.

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Japan has boasted the world's greatest longevity for several decades , Neville , so your story is not exactly new ....... only that other Asian countries have now surpassed the west too .
...... one ponders if Harare's appallingly low figure is skewered downwards by a high infant mortality rate .

The point is in cities now you tend to live longer, this didnt tend to be the case, the Q is identifying why. Hygene and waste disposal were two of the biggest wins........
Japan is intresting.....pre-second world war the japanese tended to be quite small in stature and yes some lived very long second world war japanese have shot up in average height but there are now questions on longevity as it seems to be decreasing....the western diet has good and bad points its seems....
Harere has huge problems with AIDS and no medical capability to speek of.....and again such studies could show the effects of such relapses in the capability of society to cope say post peak oil.....however Cuba isnt having such a tough would be interesting to compare the two countries to find out why.

Has anyone figured out why Japan was the first Asian nation to industrialise? It's as if Britain had industrialised but the rest of Europe had lagged by a century. Why is that?

Im sure that this can be researched on the net.

Good question Roger! having studied some Japanese history and having lived in the country heres a few ideas:
- Japan's geographic isolation and racial homogenity
 These helped forge national unity and spirit, which unfortunately boiled over into rampant nationalism in the 1930s, but galvanised industrialisation
Compare this to the stifling circumstances in China - large country, many ethnic and political factions
- Its lack of resources
This fuelled militarisation and the closely related process of industrialisation 
- Meiji's ambition
Back in the late 19th century Emperor Meiji looked to Europe with envy, and decided he wanted to catch up. Japan threw all efforts into building their military based on European models. Also areas of health,education etc. The threat of the shogun to the emperor might have had something to do with this

It's easy to dismiss the general argument that life expectancy is now higher in Asia than Europe. There may be pockets of wealth in the biggest cities where facilties are world class, but by-and-large Asia is a dirty, poverty ridden place.
A quick look at somewhere like Wikipedia or the CIA handbook shows that when looking at countries - it's Japan first - and then the West - with a couple of Asian city states thrown in.
1-5 Japan, Hong Kong, Switzerland, Israel, Iceland.
6-10 Australia, Spain, Sweden, Macau, France
11-15 Canada, Italy, New Zealand, Norway, Singapore.

China itself ranks 80th (at 73 years - 7 years below New Zealand) , and most of the major Asian populations are below that.
It's clear that "Asia has not caught up" - some big asian cities have Western facilities and demonstrate what modern medicine can achieve - but as a whole asian expectancy is still 7-10 years below the standard we have in this country.

Kia ora
I beg to differ.
Longevity and Health tend to be yoked together yet this is not necessarily correct. The assumption that the standard of Health within a given City is superior, given its record of Longevity is erroneous. While it maybe assumed that Health is better today, the reality is that those who would succumb to disease, ill health etc some decades ago are being able to access superior Medical Aid within the confines of Cities, a service denied those living within a Rural Environment.
ie More Sick people live longer due to advances in Medical Care/ easier access to the latest techniques etc within the confines of a greater Metropolis. To use the example of an extreme situation. An individual is kept alive via Life Support Systems because the family cannot bear to turn the switch off or Science requires a guinea-pig to develop more efficient ways to extend life via artificial means skews the Stats.
Cities, far from being Healthier are a death trap. Longevity is more related to the best "Care Facilities" readily available. I know, I live in a Semi-Rural, de/sparsely populated Region, where even women are often sent to distant Cities for Child Birth due to a lack of suitably Qualified Personnel.