Inner-City Disease and the Public Health of the Suburbs: The Sociogeographic Dispersion of Point-Source Infection

Abstract

The political abandonment of impoverished inner-city minority populations has caused the virtual physical implosion of many US urban neighborhoods, ranging from the New York City's South Bronx to Los Angeles' South Central. Resulting extreme levels of social disintegration and community disruption, in turn, have greatly intensified a nexus of interrelated pathological behaviors and conditions leading to more rapid spread of human immunodeficiency virus (HIV), production of multiple-drug-resistant strains of tuberculosis, and rising rates of many other contagious diseases which recent evolutionary theory suggests may become increasingly virulent. The standard model of the geographic spread of disease, when coupled with long-standing observations on the patterns of contact between central cities and their suburbs, suggests that the economically segregated outlying suburban townships, local suburban minority enclaves, and the collapsing inner-city neighborhoods in fact constitute a single, linked, geographically extended disease ecosystem. We find that even at the earliest stages of a contagious epidemic originating from an inner city epicenter, the rate of suburban infection will be directly proportional to the number of those already infected within the city, as modulated by the spatial ‘commuting field’ between city and suburb. Extension of this view to the patchwork system of suburban minority enclaves embedded within more affluent townships suggests that the political abandonment of minority populations in any context will significantly increase rates of serious disease within affluent suburban communities.