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.
http://downloads0.cloud.lsecities.net/downloads/2011/11/2011_chw_hong-kong-newspaper.pdf (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.