City-Size and Health Outcomes: Lessons from the USA

In this paper, we compare health outcomes in cities of different sizes. Using 2001 National Health Interview Survey data for adult urban-US population, it is shown that individual health is better in bigger cities compared to small or medium sized ones. This result holds after controlling for potentially confounding variables including age, gender, education, marital status, smoking, income, asset-ownership, and race. Possible sources of selection bias are controlled using many model specifications and population sub-groupings. Although, stiff challenges for healthcare delivery exist for large cities, an aggressive urban health policy should also put strong emphasis on improving health in small and medium sized cities to reduce urban health disparities in the USA. Policy implications for other developed and developing countries are also hypothesized.