Sunday, November 8, 2009

Why Would Anyone Tolerate Poor Health And Early Death?

One of the most common criticisms I hear about our efforts to deconcentrate poverty by redeveloping public housing projects as mixed-income communities is that the revitalization process "destroys the existing community."

That refrain can be heard among well-intentioned elected and appointed officials as well as from so-called resident advocates (often self-appointed).

It is not, however, generally a mantra one hears from the majority of the residents who live in the public housing projects.

Surveys show that more than 97 percent of the families living in Atlanta's public housing projects wanted out, wanted a chance for a better life. What these survey respondents were saying – and what I'm saying – is that obsolete housing developments that foster social dysfunction are so awful, so toxic that the buildings should be razed and the public policies that prop them up should be abandoned.

Previously, I wrote about the corrosive influence concentrated poverty has on the education received by children living in the public housing projects. If there is one issue that goes even deeper than schools, it is health.

There is an easily observed link between poverty and poor health. The Encyclopedia of Public Health bluntly states: "People with low incomes, particularly those who live in poverty, face particular challenges in maintaining their health. They are more likely than those with higher incomes to become ill, and to die at younger ages. They are also more likely to live in poor environmental situations with limited health care resources—factors that can compromise health status and access to care."

Those of us who work in the affordable housing arena know those facts all too well. We know that all of the primary characteristics of concentrated poverty – low educational attainment, low employment rates, lack of access to quality medical care, frequent proximity to environmental hazards such as waste dumps, the prevalence of criminal activities such as the drug trade, violence and prostitution – make it inevitable that residents of public housing projects are more likely to become ill, more likely to suffer from chronic ailments and more likely to die young.

You can add to that dismal picture this economic reality: If public housing projects equals poverty, and poverty equals lack of disposable income, then low-income mothers and their children have limited access to quality food stores.

Why is this so? Simply put, all commercial services, amenities and private investments follow "disposable income."

University of Georgia Professor Angela Fertig in 2006 co-authored a study that found: "[E]vidence suggests that residents of poor neighborhoods lack access to grocery stores that stock fresh fruits, vegetables, and other perishable goods critical for maintaining positive nutritional status."

Fertig's study also quoted a report by the Chicago Department of Public Health on residents of public housing projects that concluded "more than a quarter of the residents [of public housing projects] live half a mile or more from the nearest food store with fresh produce – and nearly 40 percent don't have cars to get there.... Access to fresh produce was even more limited [near another project] where there was one large food store for every 19,000 people."

A study in San Francisco showed residents in affluent areas could reach three different grocery stores within 10 minutes roundtrip, while those in low-income communities spent about an hour roundtrip traveling to the nearest supermarket.

It is no coincidence that neighborhoods with high concentrations of poverty lack adequate grocery stores, restaurants and other commercial establishments. Businesses depend on the disposable income of their customer base to drive sales and, therefore, financial sustainability. No amount of government subsidy can overcome the lack of disposable income in an impoverished neighborhood.

Residents of the housing projects also tend to engage in less physical exercise (fear of crime is a major factor in deterring healthy outdoor activities). A Kansas City study found public housing developments to be severely lacking in physical activity resources.

There are plenty of fat-laden, fast-food joints in low-income neighborhoods. A 2006 Center for Disease Control (CDC) study indicates that obesity prevalence is higher among lower income individuals, minorities, women and persons with disabilities than among the general population. The American Journal of Public Health reported last year that in Boston more than 30 percent of residents of the public housing projects reported being diagnosed as obese as compared with 18 percent of the residents from the general population in the city.

Equally well documented are the impacts with regards to specific diseases. Consider:

1. "Poor adults, particularly those living in public housing, have higher asthma rates as a result of environmental factors as well as problems managing the disease once it has been diagnosed," according to the National Center for Health Care for Public Housing Residents. The center also reports that families living in public housing are about twice as likely to have a child with asthma as the general population.

2. A significantly higher percentage of residents of public housing are current smokers than non-residents of public housing, according to a study by Boston University, the Boston Housing Authority and other groups.

3. The Boston University / Boston Housing Authority study also found that residents of public housing are burdened with hypertension at levels that exceed those found among the general population.

4. According to the Boston University / Boston Housing Authority study, a significantly higher percentage of residents of public housing reported having been diagnosed with diabetes than non-public housing residents.

5. Mental health, too, is a factor. In an ongoing study since 1999, The Boston Public Health Commission reports approximately 1 in 5 residents of public housing experiences 15 or more days per month when their mental health is not good.

The facts are indisputable and I trust my point is obvious:

Why would a caring society want to condemn any family to so-called "communities" where the physical and mental health of the occupants is severely threatened and their lives are undoubtedly shortened?

In the final analysis, who would responsibly advocate raising a child in such unhealthy conditions?

We know from experience and from tomes of academic studies that a low-income child's chances of success improve dramatically when that child is enrolled in a middle-class school – it is not the funding or class size that makes a difference but the enrichments that almost always accompany a mix of income groups. We also know that when an unemployed/under employed person moves into a socially viable community and receives job training and education the chances are that person will enter the mainstream economy and become economically self-sufficient.

Most importantly, we know that one of the most urgent reasons to end the policies of concentrating low-income families in obsolete public housing projects is that the public housing projects are inherently unhealthy. That is something we cannot deny or tolerate.

Atlanta's low-income families are relocating from such housing projects to healthier communities. We are demolishing the obsolete, distressed housing projects and then redeveloping the vacant sites into healthy mixed-use, mixed-income communities. The families are living in substantially improved environments and are rewarded with the consequential health benefits.

No longer is "poor health and an early death" the only option for low-income people.


  1. Great article and your findings are very similar to what Solodad reported about highly concentrated black/brown communities.

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  3. A very good post. We often hear about the choices of those in lower income brackets and how those choices contribute to the continuation of poor health, economic, and social living standards.

    However, we don't typically hear (enough) discussions of common-sense understanding of these choices given the lack of access to opportunities and education that many of those with greater disposable income may take for granted.

    I for one applaud the nation-wide transformation from centralized low income housing to mixed income communities. We can only hope that all involved parties strive for an understanding of the benefits to this approach on net balance.


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