Health commissioner calls life expectancy study unfair Baltimore showed poorly in comparison

December 06, 1997|By Jonathan Bor | Jonathan Bor,SUN STAFF

Stung by the type of national attention no city wants, Baltimore's health commissioner branded as unfair a Harvard study that found the city had some of the worst life expectancies in a comparison of 2,077 locales across the country.

The study, by Dr. Christopher Murray of the Harvard University School of Public Health, found that Baltimore had the third-shortest life expectancy for men and the second-shortest for women. Life expectancy for men was 63.04 years; for women, it was 73.27 years.

Dr. Peter Beilenson said yesterday that the study unfairly compared Baltimore to counties that envelop cities along with more affluent suburbs. The result, he said, is that Charm City appears -- at first blush -- far deadlier than similarly troubled places such as Detroit, Cleveland, Atlanta and Newark, N.J.

"We're getting penalized because we don't have wealthier suburban areas that increase our life expectancy," Beilenson said. "It's not to say that Baltimore doesn't have problems. We clearly are in the top 25 cities in the United States in terms of problems, but I don't think we're second or third."

Rankings aside, Beilenson didn't dispute that men and women die far too soon in Baltimore. He blamed high rates of homicide and AIDS, which kill many of the city's young, and diseases that disproportionately afflict African-Americans and poor people of all races. These include cancer, heart disease and stroke.

"The biggest problem facing big cities and actually some rural areas is poverty," Beilenson said. "It's socioeconomic status, not so much race, not so much gender, but poverty."

Using 1990 statistics compiled by the federal government, Murray ranked counties with populations greater than 10,000 people. Included in the ranking, too, were a handful of cities that are isolated jurisdictions because they are not parts of larger counties.

Three of those cities -- Washington, Baltimore and St. Louis -- appear in the "bottom five" for men. Two of them -- Baltimore and Washington -- appear in the "bottom five" for women.

In contrast:

Life expectancy in Fulton County, Ga. (Atlanta and suburbs) was 66.31 years for men and 75.64 years for women. It ranked 26th and 51st, respectively.

In Wayne County, Mich., (Detroit and suburbs), life expectancy was 66.31 years for men, 75.64 years for women. It ranked 77th and 56th, respectively.

In Cuyahoga County, Ohio (Cleveland and suburbs), life expectancy was 70.47 for men, 77.57 for women. It ranked 572nd and 367th, respectively.

Beilenson's complaint appeared lost on Murray, who said he was forced to rely on the political units broken out by the National Center for Health Statistics. More to the point, he said a fairer comparison would probably find Baltimore in the company of several other cities -- but still near "rock bottom."

"We don't know, but in the worst case, Detroit might be down there at the bottom like Baltimore," Murray said. "The life expectancy in Baltimore is so low, it's really hard to imagine getting a whole lot lower."

In Baltimore, the average black man could expect to live 59.98 years -- a life span comparable to that found in India, South Africa and Bolivia, Murray said. Male life expectancy was worst in an area of South Dakota that includes two Indian reservations.

Murray said the purpose of the study was not to slam particular locales, but to provide policy makers with information that can lead to improvements. He plans to identify the particular diseases and injuries that drive life expectancy down.

"I'm not interested, and nobody is terribly interested in saying, 'Oh gosh, that's really low,' " Murray said. "We're interested in finding what the key determinants are, in saying what can be done in the future."

Murray said it would be useful to discover the reasons why men live, on average, 10 years longer in Howard County than in Baltimore, and why women live seven years longer in Howard.

In the wake of the adverse publicity, Beilenson was eager to tout several ways in which Baltimore has become healthier. In the last five years, he said, the teen birth rate has fallen 16 percent; infant mortality has declined 22 percent, and gonorrhea cases have dropped 50 percent.

In the last two years, the city has recorded the lowest number of tuberculosis cases in 200 years. And last year, new AIDS cases declined 8 percent while AIDS deaths dropped 25 percent.

Murray's statistics didn't surprise public health experts.

"I think a lot of large cities with poor, impoverished inner-city residents have similar statistics," said Dr. Paul Stolley, epidemiology chairman at the University of Maryland Medical Center. "The reason we're worse may have to do with the proportion of black residents within the city boundaries. It's not a biological phenomenon, but race is a proxy for poverty and diseases that go along with it -- substance abuse, AIDS, hypertension, alcoholism and its consequences."

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