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City Living

The hidden health risks—and benefits—of urban life.

BY Dan Carlin | Current Issue | Nov 8, 2018
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More and more people are flocking to cities, from recent college grads to seniors looking for active retirements. Most of my patients live in cities, or spend a great deal of time in them for work. For this column, I wanted to dive into how cities can both help and harm your health, and leave you with easy ways to take advantage of the benefits while protecting yourself from the risks.

First, the good news about cities: You have access to the best doctors and medical treatments and you face a lower risk of becoming obese. Both are core aspects of good health and are especially important for protecting longevity.

A crucial part of great healthcare is going to the best doctors. I send all my patients facing a chronic or complex condition to the teaching hospital that is top-ranked for their condition. Illnesses like cancer and heart disease often present differently in individual patients, and it’s important to have a doctor who’s an expert in your particular variation of the disease in order to have the best outcome possible. From Memorial Sloan Kettering and MD Anderson to Johns Hopkins and Cedars-Sinai, almost all top hospitals are in cities. If you live in a rural area and are facing a serious health condition, you should take the time to seek care at one of these centers of excellence. 

Obesity prevalence was 39.6 percent among rural adults compared with 33.4 percent among urban adults.

In addition to proximity to the best doctors, city dwellers have lower rates of obesity than their rural counterparts. In one study of over 8,000 adults from the National Center for Health Statistics, obesity prevalence was 39.6 percent among rural adults compared with 33.4 percent among urban adults. Part of these results might be attributable to the ways that cities help residents incorporate small amounts of physical activity throughout the day. In rural and suburban areas, most transportation happens by car, and this means that it’s easy for people to go days at a time without experiencing more than a few minutes of physical activity. Whether it’s walking to the grocery store after work or walking a few blocks from the train or bus to the office, the small bursts of activity that are a daily part of city life add up over time.

U.S. cities have much better air quality than other places worldwide but particulate pollution is still a health risk.

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The not-so-good news about living in cities? Air quality is a serious issue and stress is compounded by the city environment. Though resources like the World Air Quality Index map show that most U.S. cities have much better air quality than other places worldwide, particulate pollution is still a health risk. One type of pollutant, PM 2.5, is especially harmful. PM 2.5 is a microscopic carcinogenic particle that is created as fuel burns, and then released into the air. As humans breathe them in, PM 2.5 particles work their way into the lungs and the bloodstream, where they contribute to heart attack, stroke, lung cancer and asthma. An article from the scientists behind climate nonprofit Berkeley Earth shows how PM 2.5 exposure can be equivalent to cigarette smoking in terms of health risk. According to the Berkeley Earth Air Quality Real-time Map, which you can find online, the Los Angeles and New York areas have PM 2.5 pollution levels equivalent to smoking around half a cigarette per day. Particulate exposure is part of the reason that people who live near busy roads are at higher risk for conditions like COPD and asthma as well as early death.

There are things you can do to reduce your particulate pollution exposure. High quality HEPA air filters can reduce particulates within homes. You should also avoid spending time outside during peak traffic hours and, if possible, live on higher floors in apartment buildings and away from heavily trafficked roads. The closer to street level you are, the higher the concentration of particulates from engine exhaust. Many people also exercise outdoors in cities, which can be harmful. I have several patients who live in cities and train for marathons or other endurance events. I encourage them to exercise indoors or away from heavy traffic.

Another issue is that the physical environment of cities increases stress. Cities lack the green space that reduces levels of cortisol, a hormone your body releases when stressed. Plus the stimuli of loud noises, bright lights and crowds at all hours can disrupt your circadian rhythm, further reducing your body’s ability to handle stress. Exposed to those same lights and noises, we are at risk for getting inadequate sleep in busy city environments.

Spending time in nature and getting good sleep are the antidote to city-induced stress. “Forest bathing,” or spending relaxed time in natural areas, has been shown to reduce blood sugar in diabetic individuals and increase the body’s cancer-fighting abilities, among a host of other benefits. To get high-quality sleep in a city, block light from the streets with blackout shades, reduce outside noise as much as possible and give yourself plenty of time to wind down in the evening. Allow yourself at least 30 minutes of quiet before bed, without looking at the blue screens of smartphones, laptops and tablets.

No matter where you live, the principles of good health and longevity are the same: Reduce stress, eat well and move your body to optimize the health of your cells. By becoming aware of the risks and benefits of your environment, you can maximize your health wherever you choose to call home. 

The risks of city life

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Poor air quality

Action: Get a high-quality HEPA air filter for your home, avoid spending time outside during heavy traffic hours and live as far from busy roads as you can.

Result: Reduced exposure to particulate pollution, which contributes to heart disease, heart attack, stroke, lung cancer and asthma.

Less access to green space 

Action: Spend more time in nature (especially forests) whenever you can.

Result: Reduced stress and reduced risk of many types of disease, including diabetes and cancer.

The benefits of city life

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Access to the best doctors

Action: Seek care from the top teaching hospitals, almost all of which are located in major cities.

Result: Better health outcomes, especially for chronic and complex conditions.

Lower risk of obesity 

Action: Take frequent walks, even if they’re short.

Result: Improved cardiovascular health, less likely to be overweight.

Dan Carlin, a physician, is CEO of WorldClinic, a New London, N.H.-based telemedicine practice.

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