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Survival of the City: Living and Thriving in an Age of Isolation Hardcover – September 7, 2021
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Cities can make us sick. They always have—diseases spread more easily when more people are close to one another. And disease is hardly the only ill that accompanies urban density. Cities have been demonized as breeding grounds for vice and crime from Sodom and Gomorrah on. But cities have flourished nonetheless because they are humanity’s greatest invention, indispensable engines for creativity, innovation, wealth, and connection, the loom on which the fabric of civilization is woven.
But cities now stand at a crossroads. During the global COVID crisis, cities grew silent as people worked from home—if they could work at all. The normal forms of socializing ground to a halt. How permanent are these changes? Advances in digital technology mean that many people can opt out of city life as never before. Will they? Are we on the brink of a post-urban world?
City life will survive but individual cities face terrible risks, argue Edward Glaeser and David Cutler, and a wave of urban failure would be absolutely disastrous. In terms of intimacy and inspiration, nothing can replace what cities offer. Great cities have always demanded great management, and our current crisis has exposed fearful gaps in our capacity for good governance. It is possible to drive a city into the ground, pandemic or not. Glaeser and Cutler examine the evolution that is already happening, and describe the possible futures that lie before us: What will distinguish the cities that will flourish from the ones that won’t? In America, they argue, deep inequities in health care and education are a particular blight on the future of our cities; solving them will be the difference between our collective good health and a downward spiral to a much darker place.
- Print length480 pages
- LanguageEnglish
- PublisherPenguin Press
- Publication dateSeptember 7, 2021
- Dimensions6.3 x 1.06 x 9.53 inches
- ISBN-100593297687
- ISBN-13978-0593297681
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Editorial Reviews
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“Glaeser’s Survival of the City: Living and Thriving in an Age of Isolation, written with Harvard health economist David Cutler, shares the pleasing style of its predecessor [Triumph of the City], an engaging mixture of history and analysis . . . ‘The age of urban miracles need not be over,’ Messrs. Glaeser and Cutler write. ‘Indeed, it must not be.’” —Wall Street Journal
“Survival of the City lays out a compelling vision for reasonable, doable and affordable policy changes that would improve the quality of life in cities and benefit everyone across the nation . . . This is an important book of ideas, history and policy recommendations, a book that should be read and discussed by anyone concerned with the future of cities.” —Inside Higher Ed
“Ambitious and timely . . . a valuable resource on how to make America’s cities better.” —Publishers Weekly
“A sweeping investigation of threats to urban life. . . . A thoughtful and useful consideration of the fate of cities in the age of Covid-19.” —Kirkus
“Over the past three decades, David Cutler has done pathbreaking work on the determinants of health, while Ed Glaeser has done pathbreaking work on cities and economic growth. Now they’ve teamed up to write a book that focuses on the intersection between these two areas: how cities shape our health and livelihoods amidst a global pandemic. A fascinating read that helps us understand how we got to where we are today and design policies to build healthier, opportunity-rich cities in the future, Survival of the City will be a terrific resource for the public and policymakers for years to come.” —Raj Chetty, William A. Ackman Professor of Public Economics, Harvard University
“This is a must-read for anyone interested in the health of cities and their residents. Glaeser and Cutler sift through the evidence to offer an incisive, engaging analysis of the real challenges posed by pandemics and other threats to urban life. Their clear and balanced policy prescriptions will protect cities from long COVID and help them emerge from the pandemic as resilient and vital as ever.” —Ingrid Gould Ellen, Paulette Goddard Professor of Urban Policy and Planning at NYU Wagner
“David Cutler and Ed Glaeser have written an important book on an important topic. They discuss the crucial question of how to prevent cities from becoming privileged enclaves—a development that would impoverish the world. The outline an important prescription for protecting cities around the world by addressing and learning to better address the nexus of governance, jobs, and taxes.” —Thomas R. Frieden
“In this readable yet rigorous book, two brilliant economists tackle the question of our time: How can the people and places whose energies drive our economy thrive in a post-COVID world? Their answer: put health improvement above medical care, striving outsiders before privileged insiders, and cities at the heart of a revitalized American dream.” —Jacob S. Hacker, Stanley B. Resor Professor of Political Science, Yale University; coauthor of Let Them Eat Tweets
“Survival of the City is a smart and surprising account of how the modern metropolis can bounce back from the current crisis, and a compelling argument for sweeping policy change. The authors—one liberal, one conservative—are not ideologically aligned, but their differences yield fresh ideas and bursts of insight. I found myself learning from, arguing with, and thoroughly enjoying every part of this totally necessary book.” —Eric Klinenberg, Helen Gould Shepard Professor in Social Science, New York University
“Survival of the City is a work of stunning brilliance. I learned something on every page, and these are topics I thought I understood. This book is a must read for anyone who hopes to talk intelligently about a post-COVID world.” —Steven Levitt, William B. Ogden Distinguished Service Professor of Economics, University of Chicago; coauthor of Freakonomics
“This fascinating book is about everything—the plague, COVID-19, obesity, robots, schools and more—all seen through the lens of the city, its past and future. It's a gripping read for anyone, but especially those who are wondering just what is the place of the city in their post-pandemic lives.”—Emily Oster, professor of economics, Brown University
About the Author
David Cutler is the Otto Eckstein Professor of Applied Economics in the Department of Economics at Harvard University. Honored for his scholarly work and singled out for outstanding mentorship, Professor Cutler's work in health economics and public economics has earned him significant academic and public acclaim. He has served on the Council of Economic Advisors and the National Economic Council, and has advised businesses and governments on health care. Cutler is a member of the National Academy of Medicine and the American Academy of Arts and Sciences.
Excerpt. © Reprinted by permission. All rights reserved.
Chapter 1
The City Besieged
Cities can die. Earthquake and invasion doomed Knossos, the mighty Cretan city that housed the mythic minotaur. Cities often decline. Cleveland, Pittsburgh, and Liverpool are all far smaller today than they were in the 1930s. Urban triumph is never guaranteed.
The decline of a city is a terrible thing to watch. It might begin with a factory closing. Some of the factory's workers then cut back on spending at local stores; other workers, those with the most education and opportunities, leave the city altogether. The tax base declines, and the city both raises its taxes and cuts its spending on police, schools, and parks. Crime increases. New businesses stay away. More people leave. Economic trouble begets social trouble, which begets more economic trouble.
For the past half century, urban decline has mostly come from deindustrialization, the exodus of factory jobs from erstwhile municipal powerhouses like Detroit and Glasgow. That crisis occurred because urban density no longer offered much of an advantage to massive, self-contained, highly automated manufacturing plants. But uncontrolled pandemic is an even more existential threat to the urban world, because the human proximity that enables contagion is the defining characteristic of the city.
If cities are the absence of physical space between people, then the social distancing that began in March 2020 is the rapid-fire deurbanization of our world. Data from cellular phones, provided by SafeGraph, shows that the number of trips Americans took for recreation and shopping dropped by 40 percent between March 14 and March 24 of 2020.
A pandemic that travels by air poses a threat not only to urban health but also to the urban service economy that provides jobs for most modern city dwellers. For workers without an advanced degree, the ability to serve coffee with a smile provided an economic safe haven after the factories mechanized and left once wealthy metropolises. Those jobs seemed safe because no matter how much we globalize, fresh lattes will never be exported from China to Soho.
When that barista's smile becomes a source of peril rather than pleasure, those jobs can vanish in a heartbeat. Before the 2020 pandemic, 32 million Americans, or twenty percent of the employed labor force, worked in retail trade, leisure, and hospitality. One fifth of America's leisure and hospitality jobs vanished between November 2019 and November 2020. Between the third quarter of 2019 and the third quarter of 2020, UK employment in accommodation and food services declined by more than 14 percent, and 22 percent of those who still have jobs in the sector are on some kind of furlough. If all of the world's face-to-face service jobs permanently disappear, the results will be catastrophic, both for cities and for the global economy.
The irony of our pre-2020 complacency toward pandemic risk is that the triumph of the city owes much to victories over prior plagues. The semi-urban inhabitants of the first human settlements were less healthy than their hunter-gatherer ancestors, partially because communicable disease deaths were more common in denser areas. Cities long depended on net migration from the countryside to replace their dead. But by 1940, vaccination, sewers, and antibiotics allowed life expectancy in urban areas to catch up to rural life expectancy. By 2020, urbanites lived longer than people in rural areas, and that mortality gap was growing-at least before the reappearance of mass contagion.
Unfortunately, COVID-19 is unlikely to be a one-time event, unless governments take pandemic preparedness far more seriously. As global mobility has grown, actual or potential pandemics have become more common. Between 1900 and 1980, only a few outbreaks threatened all of the United States: the influenza pandemic of 1918-19, the Asian flu (1957-58), and the Hong Kong flu (1968). The first of these was terrible, but our memory of it dimmed over time. Since the 1980s, the country has experienced HIV/AIDS (1980s-present), the H1N1 flu (2009), the Zika virus (2015-16), and now SARS-CoV-2 (2020), which we will hereafter refer to as COVID-19, the disease it causes. COVID-19 is itself the third in a series of coronaviruses to jump from bats to humans, following SARS in 2002 and MERS in 2012. Then there are the near misses, like Ebola (2013-16, 2018-20) and the Marburg virus (1998-2000, 2004-05). If pandemic becomes permanent, then a good share of workers may decide never to go back to their downtown offices.
Contagious disease is the most obvious threat to urban life in 2020, but it is not the only one. A Pandora's box of urban woes has emerged including overly expensive housing, violent conflict over gentrification, persistently low levels of upward mobility, and outrage over brutal and racially targeted policing and long prison sentences for minor drug crimes. These seemingly disparate problems all stem from a common root: our cities protect insiders and leave outsiders to suffer.
Gentrifiers move into ethnic neighborhoods because regulations have made it too difficult to build more affordable housing in other areas. The regulations that limit new construction protect the high housing values and views enjoyed by incumbents, but exclude the young and the poor who also want an urban future. Reductions in urban crime enable the well-heeled to safely enjoy a midnight stroll, but police stop and frisk lower-income minorities who try to do the same thing. If a policeman gets too rough, then his union stands up for him, but there is no equivalent organization protecting disadvantaged youth. Suburban and private schools enable prosperous parents to ignore the enduring dysfunction of many big-city school districts.
Before 2020, our cities flourished as enclaves for the wealthy, but they were failing in their great mission of turning poor children into prosperous adults. Our cities, and our countries, must be opened again for outsiders. Business and land use regulations must be reduced and rewritten. Schools must be strengthened. Policing must both prevent crime and respect every citizen. Pandemics must cease so that urban entrepreneurs can again create opportunity, even in the poorest neighborhoods.
Remaking a system built for insiders into a machine for empowering outsiders will take years if not decades. Unfortunately, the threats to urban life capture our attention fleetingly then slip out of consciousness as our minds flit to other concerns. The Occupy movement of 2011 sought to expose the inequities of the Great Recession. The killing of George Floyd led millions to feel anger and shame over the long and sustained mistreatment of African American men and women by the police. Like contagious disease, persistent poverty and racial injustice must be addressed if cities are to thrive once more. Yet fighting any of these problems requires sustained collective effort, not a short burst of outrage. To protect our cities, we must manage not just months of protest, but years of learning, implementing, and executing.
After nearly a year of social distancing, Zooming to work, and police protests, cities look even more vulnerable than they did at the onset of the COVID-19 pandemic. Almost 70 percent of American workers with advanced degrees switched to remote work in May of 2020, and 48 percent remained remote in November. Many wondered why they hadn't been dialing it in before the pandemic. In chapter 7 of this book, we will argue that even if face-to-face work returns, as we believe that it will, companies and workers have become less anchored to particular places. Better-educated Zoomers may reconsider their commitment to cities that offer expensive housing, painful commutes, and political rancor. Unfortunately, technology has not created an exit option for the less educated: only 5 percent of people who had not finished high school were working remotely during May 2020.
The Demons of Density
Physical illness plays an outsized role in this book, but this is not a book about disease. This is a book about the problems that can come with urban scale and proximity, and the fight to tame the city's downsides. Plagues spread from city to city across the lattice of global trade and travel, and then from person to person within the crowded confines of urban space. They are the most terrible demons of density. But traffic congestion, crime, and high housing costs are also common companions to city life. These ills have festered and made cities less livable.
Gulfs of inequality have been a part of urban life for thousands of years. Plato wrote in The Republic that "any city, however small, is in fact divided into two, one the city of the poor, the other of the rich; these are at war with one another." The fight against the downsides of density requires a truce in that war. Such a truce should be possible, because city building is not a zero-sum game. In most cities, both poor and rich would benefit from more home building, from better schools, from more humane policing, and from widely available health care that provides a stronger defense against future pandemics.
The impact of catastrophe is always mediated by preexisting social strength or weakness. The Black Death struck Constantinople in 541 CE during a period of instability. It led first to political chaos and then to centuries of rural poverty. In contrast, the plagues that slaughtered nineteenth-century urbanites, like cholera and yellow fever, did not stop the growth of New York, Paris, and London, partially because those cities came together and strong leadership made them resilient. Collectively, they invested in mighty infrastructure projects, like New York's Croton Aqueduct and the Parisian sewers, that made those cities safer. In our own time, New York shrugged off the terrible terrorist attacks of September 11, 2001, because the city worked together and rebuilt itself.
But the New York of 2021 is far more fractured than the New York of 2001. The pragmatic consensus that emerged after the city's near bankruptcy in the 1970s has come undone. In 2011, demonstrators seized Zuccotti Park, practically in the shadow of the memorials to 9/11. The Occupy movement and the police response to it divided the city that had seemed so united. New York was hardly alone: the Occupy movement took over public squares from Boston to Berlin.
In the years since, divisions have widened, creating more urban vulnerability. Two months after the COVID lockdowns had begun, a policeman killed an African American man in broad daylight in Minneapolis, by pressing his knee against the man's neck for over eight minutes. Anger about the terrible racial disparities in police violence, perhaps reinforced by angst from months of lockdown, led streets to explode as they had not since the late 1960s. In some areas, city leaders, either out of fear or sympathy with the protesters, allowed whole districts to become lawless, leading to such new neighborhood names as Seattle's "Capitol Hill Autonomous Zone." Urbanites across the world took stock of their cities' responses to racial disparities and found them lacking.
Any effective response to those inequities will require financial resources, and those have already been strained by the pandemic. Local finances are as precarious as they have been since the 1970s. Less employment and fewer shoppers mean lower local tax revenues. Schools face added difficulties providing classes safely. Transit systems receive far fewer fares, and little sure prospect of a quick comeback. Unlike the federal government, cities cannot print money or borrow trillions.
At the same time, people are in a progressive mood, as they were in the 1960s, and they want more for those who start with less. Those who have been left out want change. We understand and sympathize with that impulse: our urban inequities are terrible. Yet when cities try to play Robin Hood, as they did in the 1960s, businesses and the rich pick up and leave. Protesters want to defund the police, but wealthier urbanites will decamp for safer suburbs if crime rates start to rise, and the poor and vulnerable will suffer most.
If people decide that cities are too unsafe, either because of disease or crime or declining public services, we will move to a world not of cities, but of enclaves. The rich will live in their own luxurious retreats, keeping their exposure to the poor to a bare minimum. Middle-income people will form their own havens of stolid respectability, and the poor will inhabit what remains. Whatever mixing can be done remotely will. With less connection between rich and poor, economic opportunity will diminish. As the urban tax base declines, disadvantaged areas will have even fewer public services: schools will educate less well; police forces will be smaller, which may lead to more brutality and more crime. As violence increases, crime will particularly terrorize poor, minority neighborhoods as it has in the past.
A world in which enclaves replace cities is a world impoverished. Even for the rich, spatial isolation rarely provides long-term safety. The patricians who fled Rome's swelter for the comforts of Capri in the late years of the empire were still killed by plagues and doomed by the fall of the capital city. In our own time, one of the first hot spots of COVID-19 was New Rochelle, New York, a suburb half an hour outside Manhattan. In December 2020, some of the highest COVID-19 areas of the country included the wealthy enclaves of Beverly Hills, Palos Verdes Estates, and Hancock Park, all in or near Los Angeles.
There is a way to bring cities back stronger, but it is not simple. The path starts by recognizing that cities can only fund services that help the poor if they can also attract the jobs that pay taxes. Consequently, the answer is not to just tax and spend more. The spending must be smarter and strengthen the entire city. Taxpayers must believe that the government will use their money wisely and treat them with respect. This must happen at all levels-international, national, and local. We must also recognize that we do not have all the answers. We must have the humility to learn before we can transform.
Fortunately, for all the currents that buffet them, cities are stubbornly durable things. By and large, the greatest cities in the world in 1700 are still among the greatest cities in the world today: Beijing, London, Tokyo, and Istanbul. Cities have structural advantages that are nearly impossible to replicate. A fabulous panoply of people and firms creates plentiful opportunities for employment, especially in service sector jobs, that are just not present in lower-density parts of the world. Cities have museums and parks, architecture and restaurants.
The most important lesson from months of lockdown and protest is surely that human contact-real, in-person contact-is precious. Whenever the lockdowns were eased, people rushed back out to connect with other people, health consequences be damned. After watching a white policeman kill a prostrate African American man, people came together to air their anger, even at the risk of their own health. The most important gift of the city is that it enables us to be close to one another, to learn and befriend, to connect and collectively rejoice. Humanity will not walk away from that gift, especially if our cities can be better protected from the demons that haunt them.
Product details
- Publisher : Penguin Press (September 7, 2021)
- Language : English
- Hardcover : 480 pages
- ISBN-10 : 0593297687
- ISBN-13 : 978-0593297681
- Item Weight : 12.8 ounces
- Dimensions : 6.3 x 1.06 x 9.53 inches
- Best Sellers Rank: #853,780 in Books (See Top 100 in Books)
- #322 in City Planning & Urban Development
- #407 in Urban Planning and Development
- #1,000 in Sociology of Urban Areas
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About the author

Edward Glaeser is the Fred and Eleanor Glimp Professor of Economics at Harvard. He is widely regarded as one of the most innovative thinkers around and when not teaching has spent his professional life walking around and thinking about cities.
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The book starts by looking at how pandemics of the past have damaged cities and societies. The Plague of Justinian was effectively the end of the Roman Empire in the West and the start of the Middle Ages. Then the Black Death was close to the end of the Middle Ages and drove per capita wealth and wages up which led to dramatic social change.
The impact of Covid 19 on the modern City is then discussed. Glaeser and Cutler believe that even with more remote work cities will still thrive. They see a few days in the office and a few at home becoming more common. They think that office real estate will, if it’s less needed, be converted into more housing or other uses. They would also like to see a better global institution for new infectious diseases. They say this will be a new NATO. Unfortunately for the book NATO’s effectiveness looks much less. Roughly twenty years after NATO defeated the Taliban it looks like the Taliban have defeated NATO. The challenge of a new global anti-disease body is formidable. The Chinese refusal to have a serious, independent inquiry into the origins of Covid 19 shows the political problems that a disease NATO would encounter. No doubt the WHO and various other organisations will be changed following Covid 19, but it’s not clear that they can be made to be much more effective. Later in the book they describe this new institution as being something like an Apollo project. It might be better to compare it to The War on Drugs, The War on Cancer or the War on Terror though.
On the technical side the rapid discovery and genetic sequencing of Covid 19 was very impressive, as was the extremely fast creation of a vaccine. But the political handling of the virus has not been as successful. The authors cite New Zealand has a model of good governance, but it’s also fair to look at New Zealand as a place where the geography helped enormously. Also, if New Zealand is cited as an example of great governance in a book on cities the authors might want to look at New Zealand’s incredible housing costs that are driven by a failure to allow building up and out.
Survival of the City looks at the history of how cities have survived disease in the past and the constructions of sewers and fresh water systems that made cities so much safer. There is considerable interesting information about the history of the New York sewer system.
The book then turns to how the US spends so much on health care and doesn’t have great results and in particular how public health spending in the US is lower than in most other developed countries. They point out that the US’s system made it hard to collate data on the pandemic and made the response worse.
There is an interesting chapter on how food technology made modern cities possible with pasteurization, refrigeration and much improved packaging and shipping. They also postulate that the nature of work has changed the impact of pandemics. They say that because so many more people worked on farms and in factories in 1918 rather than in the services economy that the impact of the disease was less economically in the past.
Survival of the City has an interesting chapter on remote work with various studies about the impact of it. They point out that training and building company culture is done much better in person than remotely. This extends into a discussion of the centripetal forces that bring people toward big cities and the centrifugal forces that move them out of the inner city. Work being in the center brings people in while transportation technology often allows them, or pushes them out.
The cost of cities also pushes people. Ed Glaeser has written about how zoning has caused people to leave cities due to high housing costs. Survival of the city looks at how gentrification is impacting cities and they use Boyle Heights in Los Angeles as an example. They point out that the real problem in Los Angeles is the huge cost of housing where people want to be and that anti-gentrification activists, by slowing housing growth inadvertently drive up housing prices.
Survival of the City also looks at how policing in the US could be changed in response to the Black Lives Matter (BLM) movement. They frame this in an interesting way by describing how policing shifted dramatically in the 1980s due to a number of horrendous murders by prisoners who had been released and how this led to the three strikes and your out rule which was then over used and led to mass incarceration that has also had adverse impacts. The authors suggest that an over reaction to BLM that led to defunding the police would be deleterious. Instead they suggest that better policing with less incarceration of drug offenders would be better.
Education is also discussed with the authors suggesting more teacher accountability and empirically verified changes that result in improvements. Here there is little discussion of how recent history and how people have been trying to improve education for decades with fairly little to show for it.
Survival of the City is an interesting book but like this review it rambles. There is also an assumption by the authors that things can be improved with new government programs that are smarter but there is perhaps a lack of acknowledgement of the failures of past programs that were as good as people could actually make them. Hopefully though better programs will be created and no doubt there will be some improvements. No doubt that cities will also muddle though.
Survival of the City contains much of interest but it isn’t as good as Glaeser’s ‘Triumph of the City’. It’s worth a read though.
In the Middle Ages, the most effective city goverments sought to avoid the bubonic plague by forcing travelers to quarantine themselves, much as Israel did in 2020-21. In the 19th century government financed sewers and water filtration systems to protect people from drinking polluted water, thus eliminating water-borne diseases such as cholera. The authors cite one study showing that clean water was responsible for 3/4 of the infant mortality reduction in 19th-c. urban America, and half the overall mortality reduction.
Although the authors discuss COVID-19, much of their analysis is out of date. For example, they write "With contagious disease, even living near a city puts one at risk"- but as of right now (Oct. 2021) COVID-19 is more widespread in rural areas than in dense cities. The authors write that low levels of obesity protect India from high COVID death rates- a generalization that turned out to be false in 2021. The authors assume that COVID-19 first arose among bats; however, some commentators now believe that it may have originated in a lab in China (a view indirectly supported by this book, since it details how Chinese officials misled the World Health Organization in January 2020 about the dangers of COVID).
The rest of the book is a set of essays related to urban policy; although they have some interesting historical tidbits, they generally don't seem that useful. Their chapter on education concludes that experimentation is important, which although certainly true is hardly worth a lengthy discussion. Their chapter on housing emphasizes the harm done by restrictive zoning, but doesn't seem to me to add anything to Glaeser's earlier work.
Top reviews from other countries
- Provides great case studies on COVID response across the world.
- Proposes solutions that are innovative and intertwined to prevent new pandemics and to help us heal and connect as a society.
都市は創造性の塊だ。でも、内部の人を守り外部の人を放棄する傾向がある。コロナの影響でリモートワークが広まり社交も減ってしまった。本書は都市生活の存続と繁栄に必要な条件を探っていく。重要なのは説明責任を果たす政府と都市の成長を阻む規制の撤廃と学ぶ謙虚さだとみている。
疫病のせいでアテネはスパルタに負けた。ローマ帝国でも起きた。共同体から病人を隔離したり、家族で隔離したり、共同体の周りに防壁を作ったり、病原の周りに防壁を作ったりして人類は抵抗してきた。病気の蔓延を防ぐには正しい医学知識と有効な政府が必要だ。WHOは感染症を早期に抑え込める組織ではない。NATOのように、構成国を少数にして目的と統制を明確化し、科学を重視し、潤沢な予算のある国際組織が新たに必要である。
黄熱病やコレラと闘う上で上下水道の整備は政府がとれる非常に有効な対策である。隔離を担当する法の執行者は効果を上げるためには信頼されている必要がある。人と野生動物との接触を減らすために国際的な取り組みを作るといい。貧困国で疫病が蔓延すると結局は先進国にも被害が及ぶのだから、水道整備などを援助するのは先進国の利益にもなるだろう。
平均寿命は発展している都市の住民の方が長い。これは年収が低い人についても同様に言える。都市化するにつれ人は運動をせずともまた時間をかけずともカロリーを得ることができるようになった。フライドポテトのような大量生産品がすぐに手に入るようになり人は誘惑に負け肥満になっている。薬品会社はオピオイドの新製品を開発するたびに安全だという虚偽の主張をしてきており、薬物中毒者を大量に生み出した。教育程度は肥満にならなかったり薬物や酒や危険なセックスを避けたりと健康に直結するが、健康に悪いことを知ることができるというよりは我慢強さや健康促進製品を買う余裕を生んだりするという影響の方が大きい。感染症を避けるにはそもそも健康であることが重要であり、そうなるような行動変容が求められている。
アメリカは膨大な予算を医療制度のために割いているが効果は芳しくない。これは、私的な医療に焦点を置き、健康促進ではなく病人をケアすることを重視し、多くの保険未加入者がいるため。前もって感染症に対応するシステムを組んでおく必要がある。テストや封鎖を素早く行う能力も重要。
黒死病は生き残ったものを豊かにした。独占者は競合を潰すために規制を利用することがあるが、紡績工場の安全規制はその初期の例。滅菌と冷凍とパッケージ技術の向上のおかげで都市は拡大することができた。スペイン風邪は経済に悪影響をほとんど及さなかった。コロナと違いは、その頃は農場と工場で働く人が多くまた人々は必需品を消費していたこと。いまは対面が重視されるサービス業が中心であり疫病の影響をモロに受けるのだ。コロナ前からも米国の起業は減っている。第三者から規制の費用便益分析をして不要な規制は撤廃したり、規制を担当する政府の部局を一本化する必要がある。
技術革新には、車やテレビのように人口密度が高いことの魅力を減らすようなものもあれば、蒸気機関車や高層ビルやエレベーターのような増やすようなものもある。19世紀は後者が多く20世紀は前者が多かった。情報通信業が発展しても人は都市に住んだままだが、これは人と話すとアイデアが生まれたりするしまた楽しいため。テレワークは生産性を伸ばすが生産性の低い労働者を引き寄せる。すでに住んでいる人を守り引っ越してくる人を防ぐような規制を止めることが発展には必要。
ロサンゼルスのボイルハイツは米国都市の持つ問題を示す良い例。19世紀末に優れた市長がいて公園や教会や学校が建ち人気となった地域だ。自動車が発展して移動しやすくなってからは富裕層がそれまで使っていた古い住居を利用する多くの低中所得者が流入した。そして実質的な人種的隔離が起きた。優れた政治家と運動家が生まれ、ヒスパニックの多い地域としては収入は恵まれるようになった。しかし地下鉄が通るようになってからは移動して来ようとする美術館と、それはジェントリフィケーションであるとみなす住民との間に激しい対立が生まれている。しかしこれは新しい建築に対する規制が生んだ悲劇であり、真の敵は制度である。アメリカ内で引っ越しは減っている。フリーライド問題は小数名の間では解決できるものなのでそのような少数の政治集団が生まれる。この集団は既存の人員を守り新参者は防ぐ。これがまさに米国の都市で起きていることだ。
収監と犯罪発生の間には三つの関係がある。まず、収監を恐れて犯罪をしなくなる可能性があること。次に、犯罪を犯しやすい人間を閉じ込めること。最後に、牢の外で合法な職に就くのを諦め犯罪を犯すようになることだ。3ストライク法は確かに犯罪は予防しているがその費用はかなり高い。そして犯罪者を閉じ込めれば犯罪発生も減る。バランスが重要だ。レイ・ケリーというNYPDの能吏はパトロールを増やしてDV被害を減らし、テロの対策も優れていて賞賛された。しかし彼が導入した停止と捜検(stop and frisk)という方法はあまり効果を上げていない。犯罪が起きやすいところを重点的に警護するのは効率的だが、方法が良くないということだ。警官の組合は内部者を守るように動き、問題のある警官でも守ってしまう。しかし警察の予算を削っても結局悪影響が大きいのは貧しい人だ。治安と尊厳を守るよう明確な指標を導入していく必要がある。教育制度は警察よりもその目的を明確化するのは困難だ。人口密度が薄かったり都市の中心から離れていたりと優れた環境で育つほどのちに高収入になれ、教育は重要だ。しかし優れた教員や学校を表彰しようとテストを行っても教師により不正がなされるだけでうまくいかない。職業訓練を組み込んだりしていくと良いのかもしれない。
感染症に対応する科学的な国際機関を組織し、慢性病よりも感染症に主眼を置いた公衆衛生への予算を作りすぐにワクチンを作り広める公的機関を作り、感染症の犠牲になりやすい貧困者を助けるような教育改革を行い、企業と手を組み職業訓練をするような学校を試したり、公正な法機関を作ることが米国には求められている。都市は希望の源であり人々の強さを示す場所なのだ。
