October 16, 2008
In West Baltimore's impoverished Hollins Market neighborhood, where the average life expectancy is about 63 years, residents shared beers and cigarettes on their front steps at midday yesterday while pedestrians using canes gingerly avoided two dead rats on the street.
Across town in wealthy Roland Park, where residents live on average to be 83, the scene predicably changed. One gray-haired woman rushed to swimming lessons, while a family rode past on bikes and a man with an iPod jogged nearby.
The two-decade difference in life expectancy between Hollins Market and Roland Park was revealed in data released yesterday by the city Health Department, which for the first time has compiled comprehensive death data on a neighborhood level.
The results are striking. In some impoverished neighborhoods, the death rates from heart disease and stroke are more than twice as high as in wealthier places just a few blocks or miles away. At the extreme, the difference in mortality rates between some neighborhoods is as wide as the disparity in life expectancy between the United States and a Third World nation such as Burma.
"The scale of the differences is definitely eye- opening," said city Health Commissioner Dr. Joshua M. Sharfstein.
The numbers reveal that the chronic illnesses of heart disease and cancer are killers everywhere, regardless of income and race.
The data also show that there are some neighborhoods where homicide steals the most collective life-years from communities.
Sharfstein hopes the new numbers will help attract grant money to the city and spur outrage in the lower-income neighborhoods where life expectancy is lower then average.
"If communities can get as engaged about their health indicators as they are about abandoned housing and the need for new road construction projects, that would be a tremendous force for change," he said.
While people rail against boarded-up homes because they see the blight, "you don't see the health statistics," Sharfstein said. "Until now, we haven't had them."
Mayor Sheila Dixon, who has made health one of her signature issues, stressed that the city's overall health has improved.
In the past eight years, the average life expectancy in the city increased from 69.2 years to 71.8 years, according to the figures
Still, "in the midst of these developments we have very sick communities," Dixon said, ticking off a number of factors for the gap, including economic development, education, outreach and food choices.
"You could go to a bar or a grocery store and purchase a single cigar easier then a cheap piece of fruit," she said.
Researchers from the city and the Johns Hopkins Bloomberg School of Public Health spent 11 months reviewing and analyzing 37,000 death records from 2002 to 2006 to compile the data. Using lines drawn by the planning department, they separated data into 55 areas that cover two or three neighborhoods - and produced individualized reports for each. Researchers adjusted the data for age so that areas with more senior citizens would not skew the results.
The study does not address why some communities have higher death rates than others, and why causes of death vary. Sharfstein said in some areas that work has been done to determine those causes and, where that work has not been done, he hopes neighborhood leaders will share their ideas.
He expects the data to guide decisions about where to concentrate health programs, and to help communities apply for health grants. Councilwoman Helen Holton, who has a strong health interest, said yesterday that she plans to use the data to seek national money.
Mirroring national trends, the results show that in most neighborhoods, heart disease and cancer are the biggest killers, regardless of income. "These are deaths that are in many cases preventable," Sharfstein said.
Life expectancy tends to rise with median income, the data show. For every increase of $10,000 in a neighborhood's median household income, residents lived 3.4 years longer, according to Sharfstein. But he noted that even among neighborhoods with similar incomes there are ranges of up to 10 years in life expectancies.
Though the city's poorer neighborhoods tend to be predominantly African-American, the data did not show as strong a relationship between density of black residents and lower life expectancy as other factors such as income, said Caroline Fichtenberg, the Health Department's chief epidemiologist and the project leader.
But since the city is 64 percent African-American, Sharfstein said that all health issues in the city can be viewed through a racial lens.
Researches also examined the years of life lost in each area - a calculation arrived at by assuming that each resident should live to be 75 years old (the statewide life expectancy is 78), and then subtracting the average death age. Viewed this way, there are 10 communities where homicides are the single largest cause of lost years of life - robbing neighborhoods of productive years. In Madison and East End, on the city's east side, homicides account for 22 percent of all of the years lost to death in the neighborhood. In Westport, homicides represent 18 percent of the years of life lost, and in Cherry Hill it was 17 percent.
"You can really see why we are treating homicides as a public health issue," Sharfstein said. In other areas such as Seton Hill and Reservoir Hill, HIV/AIDS is either the highest or near the highest cause of potential lost years. Such information, Sharfstein said, will be critical in looking for grant funding.
Sharfstein was quick to note that the neighborhood studies represent what he called a "snapshot" and do not reflect progress made in neighborhoods over time, including this year's drop in homicides.
Hollins Market, listed as part of an area with the lowest life expectancy in the city, has benefited in the past two years from more police attention and development. Yesterday, the sounds of saws buzzed from an alley where developers are rehabbing former crack houses to create units of low-income housing. A new Vietnamese fusion restaurant called Pho draws residents from all over the city.
But the residents weren't surprised to learn that their neighborhood had one of the lowest life expectancies. "I'd say there are a lot of unhealthy people here," said Jimmie Pearson. "Its drug-infested. Its rodent-infested. It is trashy."
Diana Cummings, 58, a former drug addict, complained that her tap water is brown and rats boldly gobble up food she puts out for her dog. She said she's clean now, but that she still likes to have her beer. A bottle was half-empty on the ground near her.
About 1 p.m. yesterday, Pamela Michelle Scott, 37, had just finished her monthly shopping to purchase 30 days' worth of meat from Hollins Market. She goes to the nearby Giant to buy canned vegetables. She's reared five healthy children and said that she made good use of the free clinics and food banks.
"They've given us what we need," she said. But others with fractured families don't always take advantage of those resources.
Across town in Roland Park, many residents going in and out of the Eddies supermarket didn't have time, or desire, to talk about the city's health problems. Jane Davis was shopping at Eddies of Roland Park and said she was not surprised by the disparity. She declined to give her age but said she's in the Social Security collection years and explained that she has a condo in Guilford, a neighborhood where residents have the second-longest life expectancy. However, she said she spends most of time at her West Virginia cabin, where she likes to hike.