What’s the healthiest city in the US? (and what does that even mean?) (Ethical Technology)

(Spoiler alert: it’s not Detroit, and it’d be a relatively simple question if it weren’t for cancer.)

The human body has multiple ways of not working well; at its broadest, the CDC’s 500 Cities project data set lists fourteen different health outcomes, from arthritis, to stroke, to the wonderfully phrased mental health not good. But, just as for an individual having a certain condition raises the probability of others (e.g., high blood pressure and stroke), there’s also a high degree of correlation between how prevalent different conditions are in each city.

For example, and unsurprisingly, cities where high blood pressure is more frequent tend to see more strokes:

But we can do more than plot specific pairs of conditions; we can use this data to build a “family tree” of diseases, with closely related diseases tending to show up together in the same city:

Just as high blood pressure and strokes are closely related, so are diabetes and chronic kidney disease, or coronary heart disease and chronic obstructive pulmonary disease. Interestingly, pretty much all conditions are correlated with each other, except cancer. Leaving the prevalence of cancer aside for a minute, the other thirteen conditions in the CDC data set are correlated closely enough that a direct PCA process gives us a main component that explains almost 80% of their variance.

In simpler terms: we can build a single “general health index” number that predicts relatively well the prevalence in a given city of different kinds of health outcomes, from strokes to asthma.

Calculating this number using PCA and rescaling it to have zero mean and unit variance, we get a pleasantly well-distributed index:

This allows us to sort cities in order of “general healthiness”:

  • 1. San Ramon (CA)
  • 2. Sunnyvale (CA)
  • 3. Mountain View (CA)
  • ...
  • 498. Gary (IN)
  • 499. Flint (IN)
  • 500. Detroit (MI)

No big surprises there. Twelve of the top fifteen healthiest cities in the US, by this definition, are in California — habits, demography, income, everything helps, and the “California health nut” stereotype has, unlike most, data to back it up. The mirror image of this situation are cities like Detroit and Flint; one corollary of the fact that we do have a large body of public health knowledge is that, unlike in other historical periods, differences in population-level health outcomes are a function of economics and politics (in their broadest senses) rather than, or more than, biology.

However, recall that to build our elegantly simple “general health index” we had to put aside the not-so-small matter of cancer. It turns out that cancer plays by very different rules, as it becomes obvious when we plot its (similarly normalized) prevalence against our generic health index:

Cities like San Ramon (CA) and Mountain View (CA) have an average prevalence of cancer with respect to the rest of the country, but higher than much less healthy (in the everything *but* cancer sense) cities like Laredo (TX) and Brownsville (TX). Here youth seems to beat experience, income, and technology: Laredo and Brownsville have median ages of 28.2 and 27.7 years respectively, while San Ramon has a median age of 37.6 years, almost matching the US’s overall metric of 37.8 years.

The lack of correlation between the prevalence of cancer and that of most everything else shows not only the profound differences in their physiological mechanisms, but also in the state of our medical technology. We know quite a bit about how to prevent things like diabetes, strokes, high blood pressure, etc. — by and large, they are different expressions of the same set of underlying physiological issues, which is part of the explanation of why they are so closely correlated across cities. Cancer is a different matter. It’s less a single disease than a bewildering array of cellular insurrections, one on which we’ve made astounding strides during the last years, but still comparatively poorly understood.


This is an stark example of the difference between technological possibility and political outcomes: given the state of our technology, Flint and Mountain View should be equally healthy, as they differ in things we know how to improve, and are equal on the condition we are most powerless against.

The state of technology, of course, isn’t static: inexcusably late but at last, medical researchers are beginning to approach aging as a root disease, and having practical ways of reversing some forms of basic physiological damage — the common mechanisms behind the “everything-but-cancer syndrome” — will lead to improvements in how we treat and prevent most conditions. And if cancer is the one we know the least about, it’s also the one where our improving computational capabilities might help the most. But there’s little difference between not having a technology and choosing not to use it; we have reasons to hope for significant improvements in technological possibilities during the next few decades, but a hazier plan for their public health impact.


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Urban sensors are for the fog of (climate) war (Ethical Technology)

Silicon Valley pitches for smart cities and military descriptions of future battle environments are awfully similar. That’s not entirely coincidental.

Deep historical and institutional links aside, you can chalk it up to convergent engineering. Most people live in unevenly urbanized, socioeconomically unstable, and ecologically unsustainable cities. They are variously labelled as users, potential enemy combatants, or citizens by the different types of organizations setting up increasingly dense systems of algorithmic monitoring, prediction, and control, but the technologies, methods, and even goals are fast becoming impossible to distinguish (nowhere faster than in China, perhaps, although not for lack of trying elsewhere).

The main scenario tech companies have in mind is one of a prosperous, gleaming city filled with deeply monetized and continuously engaged inhabitants; for military organizations, large, poor cities populated by the networked restless with nothing to lose. Neither is implausible — they are instead, like every scenario, selective ways of looking at a complex reality.

Here’s another selective way of looking at a complex reality: going by the current trends in technology, economics, and geophysics, the typical large city of the mid- to late-21st century is going to be one of lethal heat waves every year, chronic water difficulties, and food insecurity of the kind that shaped, say, Roman politics during the Late Republic and Early Empire (that’s on top of, and ignoring for the sake of argument, not at all unrelated issues of economic and social inequality and instability). With three or more degrees Celsius of overall warming, New York will more or less live or die by its storm walls, but high densities in places like India and the South of China will be monstrously difficult to sustain, and require powerful technologies to monitor, predict, and interact with urban populations.

The most likely use case for all those sensors, drones, and programmable (but not end-user-programmable) infrastructure won’t be administrating an ecologically and socially healthy urban environment, but rather making the permanent crisis easier to manage.

Getting comprehensive telemetry of massive multi-causal urban collapse, in the not-quite-the-best scenario.

The future, sometimes, works out better than expected (but not without a lot of hard work, and that rarely by the same people who made up the mess in the first place). A combination of a faster than expected transition to a zero-carbon economy, humane and orderly migration away from whatever areas become impossible to maintain, large investments in sustainable infrastructure wherever it’s needed: we have or can develop the means to do all of that, and more. The more knowledge, resources, and technology a civilization has, the more ecological disasters become matters of sociopolitical failure rather than capricious fate. We (for far from uniformly responsible values of “we”) made the current and oncoming mess, but it’s within our ability to handle it with a minimum of ensuing horrors.

But whatever future we end up building, the hardware and software we’re threading through our cities — which by then will be as boring when working as sewage or food logistics, and almost as necessary — will have its greatest impact not through the placement of interactive ads or the airborne delivery of pizzas, but as part of the basic toolkit that will define how — and for whose benefit, or following whose vision — we interact with each other and with the world.

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