Do cities become "urban graveyards" during pandemics? In their new paper, Dr Paula Nagler and Prof Wim Naudé report evidence that suggests that even though COVID-19 spreads faster in cities, fatalities tend to be lower, conditional on economic development, trust in government, and a well-functioning health care system. In this interview, they share their findings and why they chose this topic.
In the paper, you look into the relationship between country-level COVID-19 mortality rates and the extent of urban development. Can you explain more about the focus of your study and its motivation?
Paula: During the COVID-19 pandemic, many people fled the big cities and moved to (more) rural areas, as they perceived cities as ‘dangerous’ places. There is literature that already refers to such forms of escape during previous pandemics – for example, the bubonic plague in London, where Londoners fled the city but were stopped by country dwellers.
"Key reasons are the high urban density and the large number of people that spread diseases more easily in cities, and the fact the cities are important connection nodes to the rest of the world."
At the same time, cities may be safer places because of better medical services and technologies and better access to information. A priori, however, we cannot say which of the two aspects prevails. We were interested in studying this for the COVID-19 pandemic since there is limited evidence on the relation between urban density and mortality in the academic literature for this recent pandemic.
Wim: In our paper, we focus on indicators capturing the level of urbanization in various countries, using population density, the population in the largest city (as % of urban population), and the share of urban population as proxies. To account for fatalities, we look at official death statistics but also excess mortality, as countries do not always have the same approach to counting COVID-19 fatalities. In all regressions, we account for the number of cases, as one has to be infected in the first place.
You find that countries with a higher urbanization rate had, on average, the same or fewer COVID-19 fatalities. What is your explanation?
Paula: Indeed, we find no evidence that more urbanized countries or those with a higher population density had a higher fatality rate. The proxy variables for urbanization are either insignificant or suggest the opposite in some regression specifications – that more urbanized countries have a lower number of fatalities, which is in line with what other studies found in previous pandemics.
Wim: Important factors are instead the availability of healthcare, GDP per capita, income inequality, and the extent to which a population trusts its government.
"Our results reflect that urban development is associated with economic development and that the resources of richer countries facilitate managing non-pharmaceutical interventions such as lockdowns and social distancing as well as quickly rolling out effective pharmaceutical interventions such as vaccines. Economic development is perhaps the best medicine against pandemic deaths!"
You identify that COVID-19 fatalities are conditional on economic development, trust in government, and a well-functioning health care system. Are there any specific policy implications that could be derived from this - especially for less developed cities and regions?
Paula: Yes, definitely! The significance of trust in government suggests that communication in times of pandemic is paramount. Simple and clearly communicated policies that show transparently how decisions were taken can improve the trust in interventions and convince the population to follow these. Of course, the actions of the government must be sensible and reasonable. Governments that misuse the pandemic to consolidate power, spy on their citizens or act disproportionately may fail to gain trust. Policies further need to consider the realities in which people live and ensure that they are not pushed into adverse living conditions, making it impossible for them to follow guidelines.
Wim: The significant association between the number of physicians and COVID-19 mortality further shows that medical care matters.
"Ensuring universal basic health care with equal access to all in less developed countries will save lives."
In the longer term, countries should invest in structures that allow for a fast roll-out of medical programs, for example, vaccines or medication distribution. Reaching citizens quickly will be decisive in slowing down infections and mortality.
Learn more about the researchers
Paula Nagler
Paula Nagler is an economic researcher at the Institute of Housing and Urban Development Studies (IHS). She is the Head of the Urban Economics and Governance Department and teaches at the Urban Economic Development: Innovation & Entrepreneurship Master track. Her research focuses on entrepreneurship and labour markets, inequality and inclusive innovation. Paula has approximately fifteen years of experience with public policy analysis, impact evaluation and micro-data analysis in a developing context.
Wim Naudé
Wim Naudé is Professor and Chair in Economics at University College Cork, Ireland; Visiting Professor of Technology, Entrepreneurship and Development at RWTH Aachen, Germany; Distinguished Visiting Professor at the University of Johannesburg, South Africa; and Fellow of the African Studies Centre, University of Leiden, The Netherlands. His scholarly work is broadly in the field of human geography, where it is concerned (from an economics perspective) with entrepreneurship, technology and trade on the one hand, and the grand societal challenges, on the other.