---------------------- Forwarded by Dennis Raphael/Atkinson on 10/12/2003
12:34 PM ---------------------------


Stephen Bezruchka <[log in to unmask]>@u.washington.edu on 10/12/2003
11:25:07 AM

Sent by:    [log in to unmask]


To:    "Population Health Forum" <[log in to unmask]>
cc:

Subject:    Mysterious miasma affecting America's minority poor


Today's New York Times Magzine has an article on stress in the inner city
that kills, by Helen Epstein.  IT dances around some key issues of
relative disparity and contextual effects, although there are bits of this
hidden in there.  All this in a mainstream publication suggests some
hope, however.  It isn't just a miasma that affects minority poor, but she
only gets there in the last paragraph, which given her writings over the
past five years, represents progress.  If all we are going to do is get
rid of mold and roaches in public housing, we're gonna keep falling in the
health olympics.  The European press is much more forthright about these
issues.  Stephen


http://www.nytimes.com/2003/10/12/magazine/12HEALTH.html?position
=&pagewanted=print&position=

NYT Magazine October 12, 2003 Enough to Make You Sick? By HELEN EPSTEIN

Beverly Blagmon lives in the School Street housing projects in southwest
Yonkers, a once-vibrant manufacturing area just north of New York City
long mired in unemployment and poverty. Beverly has asthma, diabetes, high
blood pressure, rheumatoid arthritis, gout and an enlarged heart, and her
blood has a dangerous tendency to clot spontaneously. She is 48, and she
had her first heart attack in her late 20's. One of her brothers died of
heart failure at 50, and another died of kidney failure at 45, as did a
sister who was 35. A young cousin recently died of cancer. In the past
three years, at least 11 young people she knows have died, most of them
not from gunshot wounds or drug overdoses, but from disease.

Monica, who asked that her last name not be used, moved to the Crown
Heights section of Brooklyn from School Street a year ago. She has
diabetes, arthritis and asthma. She is overweight, and the pain from a
back injury that occurred four years ago makes it hard for her to walk or
even bend over a stove. Her elaborately braided hair is tinged with gray.
In the past year, six of her friends have died, all of them younger than
she is. When asked simple questions about her life -- when she was born,
where she grew up, when her three children were born -- Monica answers in
short phrases, wiping tears from her eyes. She is 36.

snip...

Whatever the miasma is that afflicts America's minority poor, it is at
least partly a legacy of the segregation of America's cities. These
neighborhoods, by concentrating the poor, also concentrate the mysterious,
as yet poorly understood, factors that make them sick. You'd almost think
this new miasma was caused by some sort of infection, because of the way
it seems to strike certain neighborhoods and certain types of people. I
recently came across a research article by Angus Deaton of Princeton
University, reporting that white people who live in cities with large
black populations have higher death rates than whites with the same income
who live in cities with smaller black populations. It made me wonder
whether the deprived, polluted, roach-infested, stressful conditions in
which poor blacks live aren't affecting all of us, to some degree. And
even if we never find out what the miasma is, this possibility should
scare us into treating this as the health emergency it is -- if nothing
else will.

Helen Epstein writes frequently about public health for The New York
Review of Books. This is her first article for the magazine.

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