The four largest cities among the wealthiest nations of the world—New York, London, Tokyo, and Paris—are known for their economic success, mayoral leadership, and creativity. In the United Kingdom, Japan, and France, which are unitary states, national policies have always promoted their capital cities; in the United States, since New York is not the capital and since our government is federal, national policy has been more ambiguous. Yet, few would deny that New York, and its world city counterparts, contribute massively to their national economies and economic growth. All of these cities serve as transportation gateways to the rest of the world, bastions of cultural expression and media, and centers for corporate headquarters with their affiliated financial and specialized legal services.
Columbia University sociologist Saskia Sassen calls them “global cities” because they function as strategic hubs of “command and control” in the global economy. Small wonder that in his 1961 science fiction story, The Martian Shop, Howard Fast had his Martian visitors establish outposts in these cities. Likewise, when COVID-19 spread around our planet, it should come as no surprise that it struck these cities with particular ferocity.
Their response to the pandemic, as well as that of their national governments, reveal just how vulnerable these world cities can be, how the consequences can continue to ripple outward, and how important it is for national governments to consider the strategic importance of world cities.
Vulnerable Giants
Gov. Andrew Cuomo reflects New York City hubris in repeatedly calling New Yorkers tough and smart. This attitude perpetuates the myth that New Yorkers are exceptional and invincible while glossing over a condition that New York shares with other world cities: its position as an epicenter of the COVID-19 pandemic and an incubator and transmission belt for microbial travelers. COVID-19 thrives in residential areas with high population density and massive public transport, and is further strengthened by the incessant (until recently) flow of commuters and tourists attracted by the intense social interaction abundantly available in offices, universities, restaurants, and theaters.
As of the end of April, New York City (3 percent of the US population) accounted for 20 percent of all US COVID-19 deaths. London (14 percent of the United Kingdom’s population) accounted for 33 percent of its deaths. The Paris region—Ile-de-France—(18.6 percent of France’s population) accounted for 25 percent of its deaths. Tokyo (11 percent of Japan’s population) accounted for 30 percent of its deaths. Consider their excess mortality, from all causes, beyond what would have been expected given past mortality trends. In New York, London, and Paris, the New York Times reports that COVID-19 and other deaths, in mid-April, exceeded their level from the previous year by a factor, respectively, of 5.83, 3.02, and 2.61. More reliable comparisons of excess mortality, including Tokyo, will have to wait until early 2021 when annual mortality statistics are available, but the evidence to date suggests that death rates in all four cities have far exceeded their respective national average.
Since world cities include some of richest residents of their nations, along with some of the poorest, large swaths of the population, including what we now call “essential workers,” live in the shadows of high-rise luxury towers and gated communities. COVID-19 can infect humans of all ages, often without any symptoms, but those in most danger of hospitalization and death are older people, residents in poorer neighborhoods, minorities, and obese people who suffer from chronic diseases such as asthma, hypertension, diabetes, and cancer. This virus is a spark that dropped onto a haystack of degenerative disease, and it kills, disproportionately, those in crowded environments who have been victims of longstanding and persistent inequalities—in wealth and income, among neighborhoods, and among ethnic and racial minorities. In summary, it has exposed the fact that world cities are also vulnerable giants.
Following World War II, national governments in the US, Britain, France, and Japan have all shaped urban policies. However, these policies have neglected the challenge we now face: to ensure urban health over the long haul. Although there is a long tradition in the US of denigrating cities and highlighting the urban health penalty, there is also a strong tradition, in economics and urban planning of celebrating urban innovation, vitality, even the “triumph” of cities.
For example, in this time of COVID-19, many observers point out that population density does not have to lead to backlash against cities. Nevertheless, re-inventing cities to assure safety and population health will require renewal of public health infrastructure in the directions concisely outlined by political scientist, Michael Sparer. Such a program—to reduce health inequalities, address the challenge of overcrowded housing, adapt urban transportation systems, design more pedestrian and bicycle pathways, confront the social determinants of health, and strengthen urban resilience and preparedness—falls squarely within city planning traditions. Although expensive, many of these interventions, beyond physical distancing and shelter-in-place orders, will be necessary to protect world cities and all other urban agglomerations to which infectious disease can so rapidly spread.
For example, syndromic surveillance that analyzes real-time data from emergency departments, ambulance dispatch, and medication sales can provide early warning to health officials about possible infectious disease outbreaks. This should be part of smart-city technologies that combine artificial intelligence and big data from many sources, including mass media and social networks, to track and respond to disease outbursts as they occur. One sure way to overcome our vulnerabilities—even for giants—is to recognize them in the first place and to learn by comparing interesting failures and best practices, worldwide. Despite differences among unitary and federal states, London, Paris, Tokyo, and New York were all slow in responding to the pandemic in comparison to Taipei, Seoul, and Singapore. We will have to learn more about how that can be avoided in the future. We should also investigate comparative experience, among world cities, in adapting to a post-COVID-19 world.
A Necessary Investment
Throughout history, world cities have served as breeding grounds for epidemics and been struck, periodically, by disasters. In response, their public health leaders, biomedical researchers, and health care industry have learned to combat disease and strengthen their infrastructure. The challenge we now face—not only in New York but in other world cities—is whether these vulnerable giants and their national governments will make the investments needed to protect and promote health in the future. It seems that our federal government is once again echoing President Gerald Ford’s policy of telling New York City to drop dead.
Some, such as political theorist Benjamin Barber imagining a world in which mayors rule, argue that dysfunctional national governments may no longer be the most important players in an increasingly urbanized and connected world dependent on cities and multilateral institutions.
At this time, however, multilateral institutions are weak, world cities are vulnerable, and protecting urban health continues to be a neglected aspect of national policy for world cities, particularly in the United States. The need to renew public health infrastructure, including syndromic surveillance and preparation for a surge in demand for hospital care and protective equipment is now a widely recognized priority. But national governments must have a role in shaping urban policies and assisting in financing the specific challenges faced by world cities to protect and promote their populations’ health and safety.
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June 24, 2020 at 07:15PM
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World Cities And National Policy In The Time Of COVID-19 - Health Affairs
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