Goldman, who is 56, gets around by wheelchair - his left leg was amputated after an infection. He gets government disability payments, but sometimes he has to beg to make ends meet.
For Glass, the issue - in Baltimore and similar cities across the country - comes down largely to the economy: "Starting in the '50s, we lost the lower and middle rungs of the economic ladder. All the solid-paying union and manufacturing jobs that anchored people to these neighborhoods, those jobs left."
Baltimore City Health Commissioner Joshua M. Sharfstein said the study "adds to the growing body of knowledge that health is more than a collection of individual behaviors."
More than anything, he said, the study underlined the deep links between health, economy and culture. "Health is in the mix, even when we might not think it's in the mix," he said.
The Health Department is working to reduce violence through a program that pays community members to work with youths to head off confrontations and attacks, and it is trying to prevent heart disease through a community awareness program.
The problem, researchers say, is that bad neighborhoods can cause problems through so many mechanisms.
"There's not one single thing," said Dr. Ana V. Diez-Roux, director of the Center for Integrative Approaches to Health Disparities at the University of Michigan. "It's a whole lot of things that go together."
One of the few researchers besides Glass who study the interaction between neighborhood and health, she said that people who live in dangerous, unstable neighborhoods not only experience constant stress, they often can't get relief that people who live elsewhere might find.
"You might sleep less, and you're not going to take an evening walk," she said. "All of these things have consequences."
david.kohn@baltsun.com
