An unhealthy home

November 11, 2003|By Thomas A. Glass and Dr. Brian S. Schwartz

BALTIMORE HAS sick neighborhoods. And our public housing policy is making people sick because it places them in these neighborhoods.

Scientists have known for years that poor families are much more likely to get sick and die prematurely than the middle class or well-off. Why? We have traditionally focused on individual factors such as smoking, diet, lack of exercise, or genetic inheritance. Now we have started to look at the bigger picture.

An article in the Oct. 12 The New York Times Magazine, "Enough to Make You Sick," describes in vivid detail how people in poor neighborhoods get sick and die young, but not just from violence and drugs. Rather, families in these neighborhoods are dying of chronic diseases of old age - heart disease, diabetes, stroke - and lung diseases such as asthma.

In our search for an explanation, public health is turning to the study of socioeconomic factors (such as poverty), the physical environment (abandoned buildings, noise, traffic), social conditions (crime rates) and services (How close is the nearest grocery store? Are there banks and other basic services nearby?).

More scientific studies support the idea that people's lives and health are shaped by things going on in their communities.

For example, living in a dilapidated neighborhood may cause families to fear crime on the streets so they don't go out often, which leads to lack of exercise and obesity. Living in a constant state of fear can cause the body to be in "stress" mode all the time, which leads to the overproduction of chemicals in the body that can damage vital organs and lead to disease.

How does this affect Baltimore?

Baltimore is a city of stark contrasts - rich and poor, black and white. There are segregated neighborhoods with extreme concentrations of poverty, especially large public housing projects that ring downtown. These poor areas are unhealthy places.

Abandoned buildings (Baltimore has among the most in the country), crime, too many fast-food outlets and liquor stores, lack of positive neighborhood attributes such as parks, libraries and health-food stores - all are markers of the social ills of unhealthy places.

In fact, despite more than 200 murders in Baltimore last year, diseases of sick neighborhoods are thought not only to kill far more people than murder but to cause poor health and quality of life for many years before death.

Concentrations of poverty are easy to sweep under the rug, but poor areas hurt everyone in Baltimore and the surrounding region. We are all connected to the health of our neighborhoods. Sick neighborhoods demand expensive social services and increase the risk of chronic diseases, which, in turn, require late-stage medical services for which all of us pay.

What can we do about this?

Healthy places are created by economics, policies and laws. If unhealthy places make people sick, then one answer is to redesign places using policies to help improve the health of all Baltimoreans. If we tear down a problem building and replace it without changing the things in the neighborhood that caused it to become "sick" in the first place, we can only expect the same problems.

For many, the best prescription for better health may be moving to a healthier neighborhood. Moving to Opportunity, a national demonstration program of the U.S. Department of Housing and Urban Development that moves public housing families to better neighborhoods, is yielding unexpected insights into the health problems in America's cities, Baltimore among them.

Researchers expected to find long-term gains in employment and educational levels after families moved to good neighborhoods, but instead found that families were held back by the serious health problems they brought from their old neighborhoods, preventing them from taking advantage of job and educational opportunities.

To the researchers' surprise, what did improve immediately was that families sharply improved their mental health after moving to better, safer neighborhoods. Parents reported sharp declines in depression and anxiety, while children suffered fewer asthma attacks and injuries. That is, the chronic "stress" of sick neighborhoods was quickly reduced by the move. Now changes in individual health are a focus of the long-term evaluation.

Housing policy in Baltimore is health policy. Until we act on that, we all lose.

Thomas A. Glass is an associate professor in the Department of Epidemiology and Dr. Brian S. Schwartz is a professor in the Department of Environmental Health Sciences at the Johns Hopkins Bloomberg School of Public Health.

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