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Perilous Places: Links Between Location and Health
“Of all the forms of inequality, injustice in health is the most shocking and the most inhumane.” —Martin Luther King, Jr. |
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| October 2, 1997. More than 80 firefighters are battling a blaze at a downtown Birmingham warehouse. Stored in the warehouse are paper products, paints, glue, and an estimated 5,000 gallons of a pesticide called Dursban—a low-level nerve agent believed to cause a host of ailments, including memory loss and birth defects.
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The water used to douse the flames becomes contaminated with the Dursban, and the runoff soon floods the sewer system and flows into Village Creek, a stream that passes through several industrial sites and low-income, mostly black neighborhoods in north and west Birmingham. In the days that follow, Village Creek residents complain of headaches and nausea from the fumes. Then, fish along a 10-mile stretch of Village Creek begin to die. Residents grow fearful of contamination, and their complaints of illness increase. Yet there’s no official response until a week later—when fish begin washing ashore in some of the wealthier communities downstream.
“Village Creek is a classic example of the relationship between ‘place’ and health,” says Mark LaGory, professor in the Department of Sociology at UAB. “The incident at Village Creek shows that certain neighborhoods are more at risk than others. It illustrates what we call the ‘urban health penalty’—the fact that health risks are unevenly distributed, disproportionately burdening the poor and lower classes. These groups, which tend to be concentrated in homogeneous residential clusters, don’t have the clout to change their circumstances.” It’s no secret that environment can impact health as much as food, drink, and lifestyle choices—yet few studies have been published on the connection between place and health, LaGory says. That’s one reason he and fellow UAB sociologist Kevin Fitzpatrick, Ph.D., decided to write a book on the subject. Just out last year, the 274-page Unhealthy Places: The Ecology of Risk in the Urban Landscape argues that if social scientists want to understand the health problems of any group of people, they must first understand the place where that group lives.
“Place is the fabric that brings people together,” says Fitzpatrick. “It’s an integral part of our identity. Even with the Internet and other technological advances that might seem to be creating a ‘placeless’ society, the environments in which we live have powerful influences on all aspects of our lives.”
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Health and well-being, in particular, are affected by a person’s place of residence, LaGory and Fitzpatrick maintain. Even within the same city, enormous health disparities exist among neighborhoods. “Prevalence and incidence of risks for various physical and mental conditions within metropolitan areas range widely from one residential area to another,” they write.
“Place, for decades, has been ignored in the health equation,” says Fitzpatrick. “But understanding the place-health connection can be important when you’re trying to address problems faced by groups of people who are bound to their places.”
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Inner-city-bound populations, such as the poor and working poor, for example, often have heightened health risks because of smog, toxic waste dumping, noise, traffic, crime, violence, drug abuse, and crumbling infrastructures. According to a 1997 report by the National Center for Children in Poverty, “2.8 million poor children face a greater risk of impaired brain development due to their exposure to a number of risk factors associated with poverty.” The report notes that those risk factors include poor nutrition, substance abuse, and exposure to environmental toxins such as lead. In fact, according to the report, 55 percent of African-American children living in poverty have toxic levels of lead in their blood. Understanding the Urban Nightmare Understanding the effects of such health risks will be crucial as more of the world’s population moves from rural farmlands into cities. LaGory and Fitzpatrick cite statistics showing that 100 years ago, only about 25 percent of Americans lived in urban areas. Today, that total has climbed to about 75 percent. Worldwide, 40 percent of all people live in cities. If the current migration trend continues, it is estimated that 25 years from now, two-thirds of the world’s citizens will reside in cities. Health officials are concerned about this growth, Fitzpatrick and LaGory say, because expanding urban populations will have an inevitable and devastating impact on the urban ecology—compounding the health risks to residents, particularly in impoverished, ethnically homogeneous neighborhoods.
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| In the neighborhoods surrounding Village Creek, almost 100 percent of the nearly 14,000 residents are nonwhite. The median household income is $11,338, and 42 percent of residents live below the poverty line, according to information from the 1990 Census of Population and Housing. The 1998 Vital Records Annual Report from the Jefferson County Department of Health shows that 30 percent of the births in the Village Creek area are to teenagers, compared to 16 percent in the county and 13 percent nationwide. In addition, 19 percent of the infants born in this population are low-birthweight, compared to 11 percent countywide and 7 percent nationwide.
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“Poverty is so place-bound,” LaGory says. “When there are many poor people living in concentrated areas, everyone is dealing with everyone else’s poverty. And residents are often ethnically and class-bound in terms of income and work status and have few ties or networks to the outside world, so these communities are self-contained and powerless.” Such conditions tend to perpetuate a culture of poverty and self-defeating health beliefs that are reinforced by the very nature and structure of the communities, says Fitzpatrick. “The poor often don’t seek out health care or preventive care,” he notes, “because it’s either too expensive or too hard to get to. In many cases, they have to travel long distances to access health care, but they have few motor vehicles and the city may not provide enough public transportation.”
To create healthier places, the authors call for a comprehensive, community-based approach to health promotion. They propose that local leaders from neighborhoods, churches, and schools work together with local politicians to identify the specific health risks in their own communities. Then they propose that community leaders work with outside professionals, such as business leaders and health-care officials, to develop strategies for health promotion. This approach, LaGory and Fitzpatrick say, is preferable to massive, federal funding programs or the “removal strategy,” which simply shifts people out of poor areas. “The community must engage itself in the process,” says LaGory. “Once you understand the nature of the local culture, you can use that knowledge to assist the community. It’s important to involve community leaders who have links to the outside world, because the more such links there are, the more re- sources will be available to the community.”
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LaGory and Fitzpatrick point to the Healthy Cities Project (HCP), which was initiated by the World Health Organization in 1987, as an example of successful community-based problem solving. The project sought to enhance the physical, mental, and environmental well-being of the residents of several European cities by promoting quality-of-life improvements, literacy and education, and disease prevention. The HCP also encouraged collaboration among local citizens, business and government leaders, and health-care professionals to address the health-care needs of their towns and communities. The successful program has since been duplicated in about 800 cities worldwide.
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Augmenting Awareness Place-based strategies are becoming more common in the United States. In Birmingham, for example, a recent community-wide project called Region 2020 encouraged city residents from all walks of life to identify needs and help develop plans for beautifying neighborhoods, providing better public transportation, and improving schools, housing, and health promotion. Other efforts, such as Habitat for Humanity, involve volunteers from churches and other community groups who help build housing for the poor. More than three years after the Birmingham warehouse fire, the Environmental Protection Agency issued a report concluding that Dursban may be even more dangerous to humans than was once believed. Soon after the EPA report, the U.S. government announced that it would ban the common household pesticide from domestic use. The lasting effects of the 1997 Dursban spill on residents living around Village Creek are unknown. But there are lessons to be learned from the incident. “We need to be more careful to think through the long-term, far-reaching health effects of anything that impacts the environment,” says Fitzpatrick. “Village Creek is an example of what can happen when we ignore potential problems just because they affect a low-income area. We need to be more democratic in thinking about these effects and dealing with them equitably and creatively.”
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