We talk a lot about economic inequality these days. We worry, among other things, that our successful cities are becoming playgrounds for the rich and that housing is becoming increasingly unaffordable for the middle class.

Without negating the importance of things such as attainable housing, I’d like to offer up two, potentially new, perspectives on economic inequality.

The first is an essay by venture capitalist Paul Graham. In it, he rationally unpacks, as he always does, the phenomenon of economic inequality. One of his key points is the distinction between rent seeking degenerate economic inequality and the economic inequality caused by rapid value creation (i.e. Two Stanford students decide to create a new search engine called Google).

“If the rich people in a society got that way by taking wealth from the poor, then you have the degenerate case of economic inequality where the cause of poverty is the same as the cause of wealth. But instances of inequality don’t have to be instances of the degenerate case. If one woodworker makes 5 chairs and another makes none, the second woodworker will have less money, but not because anyone took anything from him.”

Of course, Paul Graham is thinking about this from the perspective of a venture capitalist that funds startups and helps entrepreneurs get rich. But what about the impacts to people who live in a city where the rich are far richer than the poor?

That brings me to the second perspective.

A recent study, published in The Journal of the American Medical Association and written about in the New York Times, has discovered a surprising relationship between income and life expectancy across the United States from 2001 to 2014.

What they found was that cities with high economic inequality – such as New York and San Francisco – actually have lower inequality when it comes to life expectancy. 

Here is a chart from the New York Times:

And here is a chart from healthinequality.org:

If you’re rich, it doesn’t matter where you live. The life expectancy of a rich person in New York is roughly the same as a rich person in Detroit. (Though, as to be expected, women generally live longer than men.)

However, as income levels fall, so does life expectancy. But it falls more in a city like Detroit than it does in New York. In fact, rich cities such as New York and San Francisco are almost model cities in this regard. Why is that?

The biggest predictor appears to be health behaviors, such as smoking and obesity:

“The research seems to suggest that living in proximity to the preferences — and tax base — of wealthy neighbors may help improve well-being. New York is not just a city of rich and poor, but also one of walkable sidewalks, a trans-fat ban and one of the most aggressive anti-tobacco agendas of any place in the United States.”

So there you have it. Two, potentially new, ways to think about economic inequality.

I haven’t spent a lot of time in hospitals. So I may not be the best judge of what I’m about to say. But why do we design hospitals to be so depressing? Why do they have to look so, well, clinical?

I asked this question on Twitter a few days ago and I was recommended to listen to a 99% Invisible podcast called The Blue Yarn. If you haven’t yet heard of this podcast series, I would highly recommend you check it out (in addition The Blue Yarn episode).

What this particular podcast was about was rethinking hospital design in terms of patients, as opposed to staff hierarchy. And the way they illustrated the need for that was through some simple blue yarn.

Using yarn, management physically mapped out the paths of patients as they moved through this particular medical center. And what they found was a tremendous amount of waste. There was a lot of waiting around (in dingy rooms) and a lot of unnecessary moving around.

Instead of putting patients first, the hospital had been designed in terms of staff offices and other criteria. Ultimately, this exercise ended up triggering a complete redesign of the hospital.

After the redesign, there were a lot of grouchy doctors who had lost cushy offices. Some even quit. But the hospital became more efficient, more profitable, and, most importantly, safer for patients. So much so that their insurance expenses dropped by 37%!

But this obviously isn’t the only foray into rethinking hospital design. In fact, there’s something out there called “evidence-based hospital design”, where the objective is to leverage data and actual evidence to figure out the relationship between architecture and patient well-being.

One of the pioneering studies in this area was done in 1984 by Roger Ulrich. 

The study took patients in Pennsylvania recovering from gallbladder surgery and split them up into two groups. The first group was given a room with a beautiful nature view and the second group was given a room with a view of a brick wall.

What they discovered from this experiment was that the group with the view of nature not only recovered faster but also needed fewer painkillers during the recovery. That’s a fascinating finding.

So it’s not surprising that this sort of thinking is making its way into contemporary hospital design. And that’s a great thing.

Hospitals should be uplifting, restorative, and beautiful spaces. Does that not seem sensible?

Earlier this week it was announced that Fred Wilson and his firm Union Square Ventures have just led a $4M Series A round of venture funding in the Toronto-based startup Figure1. Figure1 is essentially “Instagram for doctors.” Here’s how it works (via WSJ):

Today, more than 125,000 health-care professionals use Figure 1 to view or share free medical imagery, including photos of patients with personally identifiable details blurred out or excluded; x-rays; charts; and still images taken from MRI or CAT scans, for example.

The app’s users include board-certified doctors, registered nurses, medical and nursing students, physicians’ assistants, and others who use the app and share images for teaching and studying purposes, or even to request community feedback about a possible diagnosis.

With this round, USV is now up to 3 investments in the Toronto/Waterloo region (I think of us as one center). The other 2 are Kik (out of Waterloo) and Wattpad, which is actually headquartered here in the St. Lawrence Market.

What’s exciting to me about all of this is that it’s further evidence of a growing and thriving Toronto/Waterloo startup ecosystem. And while to some it may not seem like a big deal for yet another mobile app to receive funding, it’s actually great news.

Because as these companies grow and become successful, they’ll not only create new jobs in the region, but also create a tremendous amount of wealth and expertise. And when this wealth and expertise gets reinvested into future startups, you end up with a powerful snowball effect. That’s how startup ecosystems are built.

It’s also great to see companies staying put, because the pull towards more established startup hubs can be significant. When my friend Evgeny raised a Series A round from Andreessen Horowitz last year, he told me that they asked him to move 500px down to California. As is the case with a lot of VCs, they like their portfolio companies to be nearby.

But ultimately 500px decided to stay headquartered here in downtown Toronto. And they did that for a few reasons: There’s lots of great engineering talent here and it usually comes at a discount relative to California (5-15%). He also finds that employees here are more loyal. There's less turnover. In California, everyone is looking for that next best startup to join. Here 500px gets to be that big fish in a small pond.

Anyways, a big congratulations to the Figure1 team. I hope they continue crushing it and that they stay put in Toronto. If you’re a healthcare professional, you can click here to download the app.