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Race vs. Place

Christopher Myers

Race vs. Place

Can an integrated neighborhood in Southwest Baltimore help overturn decades of race-based assumptions about the origins of health disparities?

From both terra firma and Google Earth's satellite view of the world, census tracts 1902 and 1903 are entirely bleak, drained of color and vitality. Street after street of this impoverished Southwest Baltimore neighborhood reeks of unrelenting hardscrabble existence, of teenage mothers, cigarettes and sodas in hand, walking the same cracked pavement as prostitutes and drug dealers, all within eyeshot of millionaires' homes and Baltimore's major league baseball and football stadiums.

"Half the people out here have guns," admits a 15-year-old of this area bordering on Washington Village, known to the locals as Pigtown for the 19th-century swine that used to be herded through its streets. Such is life when the only easily available resources to the local citizenry are hazardous to their health. Smiley & Nancy's liquor store, the Gilmore Pleasure Club ... no shortage of bars here. But there's a huge dearth of beneficial fare. The bullet-proofed corner store across the street sells high-priced Spaghetti O's by the score, but "fresh" food is limited to four lonely loaves of white bread and a shoebox-sized array of cold cuts and cheese—little surprise from a food store whose only outside advertisements are for cigarettes.

National data on health disparities led policymakers and scientists to seek medical solutions where none existed, says researcher Thomas LaVeist.

Even on a gorgeous Sunday afternoon, the pain of this place is hard to miss. It sings out from every nail slammed into the boarded row houses that, on some streets, outnumber inhabited homes. It glitters in the broken glass strewn across the blue bottom of a drained city wading pool, ignored by two youngsters standing in its midst tossing a football. Buildings or people, it's all the same; neglect, benign or otherwise, has—like rain on limestone—eroded the health of this neighborhood. And no one here, black, white or otherwise, is exempt.

That's not opinion. It's fact. And the researchers who have come to this neighborhood to investigate this long-suspected but never before proven notion—that poor health is not so much about race, as place—may eventually rewrite the way health disparities are viewed and treated in this country.

The traditional approach to health disparities always left investigator Thomas LaVeist, PhD, with a half empty feeling. (NIH defines health disparities as any "significant disparity in the overall rate of disease incidence, prevalence, morbidity, mortality or survival rates" in one population compared to the general population.) On one hand, LaVeist, director of the Center for Health Disparities Solutions, was grateful to have any data at all. It wasn't until the 1980s that the government began collecting large-scale health disparities data that included information on all ethnicities. That effort, the National Health Interview Survey (NHIS), gave researchers like LaVeist their first comprehensive glimpse of how different populations manifested illness.

But the NHIS survey also provided LaVeist with a dilemma. It created reams of data pointing out racial differences in health disparities, especially when comparing minorities to whites. But that's as far as the data went—in essence delivering a whole lot of "who" and precious little "why." For a researcher who had spent his whole career trying to unravel "why," the data was, in LaVeist's opinion, leading policymakers and scientists to seek medical explanations and solutions where none existed. "It's not that the data was faulty," says LaVeist, "but rather, the way we explained how the data came to be was faulty. It's perfectly accurate to look at the national statistics and say that African Americans have three times the death rate from a certain condition as do whites. But then you have to ask why that's so." For LaVeist, the William C. and Nancy F. Richardson Professor of Health Policy, his 20-plus years of research intimated that the effects of poverty and other social factors played a huge role in creating health disparities. His first papers suggested that by addressing socioeconomic factors as well as medical issues, differences in infant mortality rates between poor African Americans and other races could be reduced. Later he would document the overabundance of liquor stores that pockmark impoverished communities, and the lack of supermarkets—creating so-called "food deserts"—in such areas. Though these were mostly African-American communities, LaVeist was working to define a problem—poverty, lack of access to healthy resources—that knew no color.

It wasn't theory alone that suggested this approach, but personal experience. Early in his career, LaVeist worked for a time in a hospital in the same Baltimore community he would later survey. For all the talk and commonly held belief that blacks were sicker and more pathologic than whites, LaVeist's eyes told him that both groups were distressed. "I got to know that part of the city pretty well," he says. "I knew that there were a lot of sick white people in that area. There was a lot of obesity; if you just walked down
the street you'd see it. A lot of smoking. I started wondering, if they're all living in these same conditions... It looked pretty unhealthy here, and I wondered, if you studied it, what would you find?"

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