Cities' neighbourhoods have long been ranked, like Hollywood stars, according to their beauty and magnetic personalities.
But cities are now being increasingly divided into healthy and sick zones. If you live in downtown Vancouver or New York, where the tree canopy is lush and you can easily walk to an organic café or a yoga class, you belong to a privileged class not only because of the real estate values in your neighbourhood but because you're likely to have a higher life expectancy.
This is the new crisis of cities: Badly designed neighbourhoods are literally sapping people of their ability to live fully.
If, as a newly arrived immigrant, poverty has driven you to the inner or outer suburbs, where you live in a basement apartment or high above the concrete ground in a residential tower, you are far more likely to suffer from type 2 diabetes and its related consequences such as blindness and amputation. Most of Canada's growth comes from immigrants, but the troubling fact is that Hispanics, blacks and South Asians are genetically predisposed to diabetes. Because of the compounding of these forces, you and your neighbours can expect a lower life expectancy.
A poor diet, high in saturated fat and low on fruits and vegetables, causes excess weight. Once obesity sets in, especially if it develops at a young age, type 2 diabetes usually follows. A sedentary lifestyle fuels the problem. That's why some medical researchers and health offices are joining forces with urban planners to design neighbourhoods that are more conducive to activity. Healthy eating combined with increases in physical exercise - walking with the kids to school or biking to the cinema - would help to mitigate the rise in the prevalence of obesity over the last two decades. They say that Canadians need to embrace the Danish model of urban wellness, or suffer a health disaster.
There is a worldwide epidemic of obesity and type 2 diabetes. Canada's two million cases of diabetes are expected to double over the next decade, according to a 2008 report from the Canadian Diabetes Association. Three times as many young teenagers are overweight now as there were 25 years ago, according to a 2006 Statistics Canada health report. Up to 14 per cent of the populations of Toronto and New York City live with diabetes, a rate that far exceeds World Health Organization predictions.
It's a cruel fate.
People who live in the northern, unwalkable fringes of low-income Toronto, or across the border in the marginalized, dehumanized neighbourhoods of New York's East Harlem and South Bronx will live about 20 fewer years than those in downtown, vibrant neighbourhoods, according to a 2007 report by the City University of New York's Campaign Against Diabetes and the Public Health Association of New York City.
In the past 10 years, the number of New Yorkers diagnosed with diabetes has increased by 250 per cent. Meanwhile, in the beautiful neighbourhoods of Manhattan, the rate of diabetes is six times lower.
New York and Toronto share another harsh urban reality: Both cities top the charts in North America for numbers of high-rise residential towers. Half Toronto's population lives in vertical towers, a citywide phenomenon that touches every ward.
When a tower sits amid a variety of housing types in high-density neighbourhoods, where restaurants and retail can thrive, tower residents can engage with the street life. But in the northeast and northwest quadrants of Toronto, in neighbourhoods such as Malvern and Rexdale that have few sidewalks and no sensory enticements such as the Art Gallery of Ontario or the dramatically lit CN Tower, there's little reason to engage in the outside world.
"Diabetes is extremely costly to manage. It places a huge burden on individuals and on the health-care system," said Gillian Booth, a lead author of the Diabetes Atlas created by St. Michael's Hospital's Centre for Research on Inner City Health and the Institute for Clinical Evaluative Sciences.
The first Canadian study of its kind, published in 2007, the Atlas investigated 140 Toronto neighbourhoods over three years to examine the role of several factors - including community design, population density, access to healthy and unhealthy food - on the diabetes epidemic. Poverty and ethnicity were found to be key in the development of type 2 diabetes. The researchers also concluded that walking and transit times to recreation facilities in the city's outlying neighbourhoods were as long as 40 minutes and 20 minutes, respectively, each way. It takes only 30 minutes of walking or moderate exercise, combined with a healthy diet, to cut the risk of diabetes in half. But a walk through a bleak or potentially dangerous neighbourhood is hardly inspiring, especially if the only nearby landmark is a highway.
"Among all the people being admitted for heart attack or stroke, one-third have diabetes. Two-thirds of all amputations that are caused not from trauma occur in people with diabetes," Dr. Booth said. "Clearly, we need to start thinking about prevention."
We used to call them ugly, but now social geographers and medical practitioners label the disconnected sections of the city "obesogenic," meaning environments that promote obesity.
Given the crisis of deadening urbanity, medical health officers such as Peel Region's David Mowat are not only dealing with water fluoridation and smoke-free zones, but also the crucial need to design better-connected, more walkable neighbourhoods with access to healthy food at grocery stores and restaurants.
Double alleys of trees, dedicated bike lanes and wider sidewalks promise in the future to be written into zoning bylaws for communities such as Brampton, Ont., the population of which has an acute incidence of diabetes.
Given that health care absorbs 40 per cent of Ontario's budget, it seems only economically savvy for the provincial Ministry of Health to start funding the radical redesign of inner and outer suburbs. It's cheaper to plant a row of trees, after all, than to put somebody on dialysis for life.
Psychologically and physically, the impact of isolation is brutal. Not long ago, I met a woman newly emigrated from Russia standing in line at the Hockey Hall of Fame with her two elementary-school-age boys. She told me that when they first arrived in Toronto, they lived in an apartment downtown but, hearing of a large Russian community north of the city at Bathurst Street and Steeles Avenue, she and her husband decided to move. She described how unhappy they were, said that people were unfriendly, that conversation in the towers and on the street was rare, and that there was nothing to do. The ward she lives in is defined by its 72 high-rise towers and proximity to highways.
What was especially distressing was to hear that her boys wanted desperately to play hockey, but the rinks were simply too far. Public transit was impossible and they were without a car. As we shuffled along in the line, I was struck by the harsh reality of the new urban order: My friends and I live in a healthy neighbourhood of affluence while, about eight kilometres north, other parts of the population are being increasingly doomed by urban wastelands.