I am a diehard New Yorker. Let’s just get that out of the way immediately. Why? Because despite having lived in six US states, living abroad in Europe, and visiting 43 out of the 50 states, plus Puerto Rico and the US Virgin Islands, I am still in love with the Big Apple, but that love affair doesn’t stop me from appreciating the beauty of Santa Fe, the majesty of Cheyenne, the glorious fried peach pies of Atlanta, nor the golden sun of Los Angeles. If you have not had a chance to road trip the United States, put it immediately on your bucket list. I have done four cross-country road trips and I still cannot get enough of them. When you travel throughout America, you realize that it is alive, for better or for worse, in ways that nations with a much longer history are not, or as poet E.E. Cummings said, “America makes prodigious mistakes, America has colossal faults, but one thing cannot be denied: America is always on the move. She may be going to Hell, of course, but at least she isn’t standing still.”
However, we have an emerging problem in the United States, suggesting that the forward drive that pushed us into the West, landed us on the Moon, and turned our cities into glittering industrial and technological beacons of hope, is beginning to sputter to a halt. Mid-sized American cities are being chewed up and unceremoniously spit out. Cities once represented unlimited opportunity, and a vibrancy that outshone the sedate, rural lifestyles of most of America. There’s much to be said for the quieter, slower pace of life out in the boondocks, but to live in a city once meant to spend one’s day surrounded by an energy that drove innovation, creativity, and created a space for the dreamers to dream out loud. Certainly, the American city has always existed on a fine edge; the same vitality the erupts in the highest forms of human expression, has conversely always boiled over into crime, and the tensions of cramming so much unbridled life into so small a space, bleed into the urban problems which we have always faced. As cities, our modern economic engines, churned away through the decades, the rich segregated themselves into the high-rise penthouses of the “golden ghettos” like Manhattan and the artsy lofts of Soho, far from the city streets; the middle class, following the white picket fence mythology sold by their parents fled to the suburbs; and the poor, as the poor often do, got poorer. Cycles of migration and recession have led to a constant inflow and outflow from American cities throughout our history, but something subtle has changed. Medium sized municipalities, always more susceptible to the vagaries of the economy, began dying ugly deaths: Vallejo, San Bernardino, Stockton, and Orange County (CA), Harrisburg (PA), and Jefferson County (Alabama) have filed for bankruptcy in the last two decades, some defaulting on billions of dollars of debt. And now, we see the first signs that the big cities are beginning to fail, with Detroit’s July 2013 declaration of bankruptcy.
The bankruptcy of Detroit is not a small thing. AIG was bailed out by the government during the mortgage crisis, preserving the jobs of 63,000 employees. Detroit has a population of 701,475 (a bigger population than San Francisco, Washington, DC, and Boston). Which of these two entities sounds too big to fail? And nobody lives at AIG. Nobody was born and raised at corporate headquarters. No classic Motown hits were recorded there. Nobody started countless small businesses or spent decades manufacturing most of the American built cars on the road. AIG has always been in business for AIG. Detroit has always been in business for America. Neither are other bankrupted cities, nor those teetering on the edge of bankruptcy, just a sampling of small cities. They are of grand socio-economic consequence to our American economy and the livelihood of us all. What is going on that we should be facing these crises? One of the basic problems is that these cities saw declining revenue in the face of a declining tax-base, while pension costs rose astronomically. As a result, their infrastructure began crumbling, because you simply need money to maintain things like roads, fill in potholes, and clean city streets. Healthcare and education systems are sputtering along, holding on by the skin of their teeth as more teachers are fired, class sizes grow, and resources dwindle. Once a municipality declares bankruptcy it can cut costs by decreasing services such as garbage collection and closing libraries. These are not great things to occur in the summertime (just ask Medieval Europe about the public health consequences of inadequate sanitation). And libraries have long since ceased being solely about books. They are community centers, front-line social service providers, and the hosts of access to the miracle of the web for the forgotten underclass of America that isn’t walking around with a netbook in their backpack and an iPhone in their hand. States like Georgia that have seen huge population growth, but not much in terms of infrastructural development or a comparable influx of capital, have themselves been asking if any of their cities are next? When even the U.S. national credit rating is being downgraded, these are not idle fears.
When I lived in Berkeley, California I made the horrific social faux pas of saying that I felt safer walking in New York City at night than in Berkeley. Yes, Berkeley has a pretty large homeless population, but many of them were dressed in nicer designer clothes than I was and that was not what scared me. Mind you, I was also not particularly scared by the overcrowded hills that were often on fire. Maybe I was a little bit scared of the earthquakes, but who wouldn’t be? I was actually more scared of the abundance of dark, unlit streets, profusion of poorly lit parks, and the fact that after a certain time at night, there was nobody on the streets, because as a native New Yorker I was accustomed to streets teaming with people and laughter 24-hours a day. Even in the South Bronx where I grew up, if someone suspicious was following me, there was always a local bodega I could run into for help (and believe me, you don’t want to mess with an angry Bodega owner). Yes, I get that it sounds like warped logic. Just bear with me here. I didn’t feel safe in a fairly liberal, well-off college town. Can you imagine how it feels to live in Oakland, Baltimore or Detroit where there are infrastructural problems, unemployment and desperation are on the rise, and hospitals, schools, police precincts, fire stations, and a wide range of social services are closing their doors?
If you look at the Wall Street journal’s latest prognosis for the cities of Oakland, Portland, Santa Fe, and Philadelphia, they appear to be facing similar financial crises that could ultimately lead to a Detroit-like bankruptcy. Yet, at the same time more and more people are moving to cities and leaving rural areas behind. This is a perfect public health storm about which we should be sounding alarms. To further exacerbate the situation many of these cities that are in financial trouble have high populations of ethnic minorities who already face many health disparities and issues of access to resource. Overcrowding, marginalization of the poor, a dwindling social safety net – these are the things that we associate with countries we like to declare as “Third World”. And they are happening here.
Here is a public health question for us to ponder, how do we reach an AIDS-free generation if the cities are being chewed up and laid bare? I work in the HIV field and I hear on a daily basis how we are getting near the dreamed of goal of an AIDS-free generation. Tell me how you get people on treatment early when all the healthcare providers have packed up and left? How do we ensure people get and stay virally suppressed if there is not even a rudimentary public transportation system that many urban poor need simply to make it to needed medical appointments? When people are unemployed and hungry, with other mouths to feed…well you get it. Ok. I cannot let it go. Or how about when there are 54 missing women in the mid-sized city of Cleveland with an apparently overwhelmed police force–how do you address health issues and prevention in general? I am somewhat shocked at the state of Cleveland’s infrastructure and declining sense of safety. Somewhat. I actually spent the first five years of my life there and we left because our house was set on fire, as Hispanics were not particularly popular there in those days. The irony being that we left to go to the Bronx, that is the Bronx that was burning as a whole. When fear is coursing through the residents’ vein on a daily basis, safety becomes priority number one.
I know an emergency room medical doctor in Baltimore who speeds through red lights on his way to the night shift in order to reach work safely. No joke. He runs red lights because he is afraid of stopping. I know someone who was on a business trip to Detroit and got a little lost in his rental car. He stopped a policeman for instructions and was immediately instructed to roll the windows up, stay in the car and to follow the police to his destination. He got an impromptu police escort to his business meeting. Fear is pervasive in many of our mid-sized cities. In terms of Maslow’s hierarchy of needs, there is no way we are climbing that ladder to address prevention issues and behaviors if we cannot ensure that people are safe walking down their neighborhood boulevards.
But I ask how can we help address these infrastructural problems? Job creation seems to be a no-brainer. A just released study shows that 4 out of 5 U.S. adults struggle with joblessness, near-poverty or reliance on welfare for at least parts of their lives. A need to invest in education at an early age is paramount. The share of children living in high-poverty neighborhoods (poverty rates of 30% or more) increased to 1 in 10, putting them at higher risk of utilizing drugs, teenage pregnancy or dropping out of high school. Furthermore, the share of black children in high-poverty neighborhoods dropped from 43% to 37%, while the share of Latino children in high-poverty neighborhoods went from 38% to 39% (Rank 2013 analysis published by the Oxford University Press).
Many of these chewed up cities feel downtrodden and left to fend for themselves. Economic insecurity is pervasive. Noted Harvard professor William Julius Wilson noted to the Boston Globe (July 29, 2013) that “that many of the nation’s biggest disparities, from education and life expectancy to poverty, are increasingly due to economic class position.” Going forward we need to create clearer paths to better education systems. Things such as financial management 101 can also be helpful. Weren’t there home economics classes back in the day (I know a different type of home econ)? In conjunction with programs that address these community needs we need to create national and local monitoring and evaluation systems that help measure and understand how well public programs do.
How about the psychological concepts of honor and resilience? But a sense of community resilience and honor for that resilience can help in the lifting up of our cities and consequently of our future generations. Resilience at the community level can be a fuzzy concept at times. Most people are familiar with resilience at the individual level and how children exhibit fountains of it. But there is resilience in terms of community health-related behaviors and there is community social capital (Breton,2001). Resilience and social capital at the community level can be manifested in everything from the creation of parent groups to fixing broken street lamps to creating neighborhood lunch programs. There is great honor to be had in valuing the community’s resilience. Resilience cannot be manufactured, but it can be helped along, as it is through resilience that we may be able to bring many of our communities back from the brink. There are no perfect places, even (gasp!) my beloved New York, but what author Laura Lippman, said of her hometown Baltimore could be applied to any city you call home. She observed, “Anyone can love a perfect place. Loving Baltimore takes some resilience.”
Breton, M. (2001). Neighbourhood resiliency. Journal of Community Practice,19, 21-36