The first healthy metropolis in Europe's history? Urban-rural differences in health status in ancient Rome and the Roman Empire

The current notion that life in ancient Roman cities was distinctly unhealthy is based primarily on theoretical inferences and qualitative descriptions of life in the city of Rome. Quantitative evidence to assess the health experience of urban and rural residents in the ancient Roman Empire has only become available very recently, through the publication of skeletal studies of markers of ill health. This paper will investigate this new material. It draws together evidence from 29 burial sites, mostly from Italy, to investigate differentials in exposure to ill health between urban and rural populations in the 1st-3rd centuries CE. Focus is on two indicators that are widely considered to be good general, non-specific indicators of health: cribra orbitalia and linear enamel hypoplasias. Preliminary investigations that control for several potential biases in the material yield counterintuitive results. Urban communities score better on both health indicators than rural communities do. In discussing why we might observe this anomalous pattern, I consider various context-specific conditions that may have given Roman urban populations health advantages over their rural counterparts. These include the urban system of aqueducts and that of state-subsidized or free food rations for inhabitants of Europe’s first true metropolis.