Abstract
The main idea of Unhealthy Cities: Poverty, Race, and Place in America is that place matters and is a direct influence on an individual’s mental and physical well-being. Fitzpatrick and LaGory identify “place” as a residential dwelling unit, block, neighborhood, region, state, metropolitan area, or nation. In this book, place is the unit of analysis and the authors refer to the inner-city, high-poverty ghettos, and aging suburbs as the most contentious among these places.
Unhealthy Cities centers on vignettes about the environmental hazards caused by an accidental fire and chemical explosion in a Birmingham, Alabama, warehouse complex. In 1997, millions of gallons of water that were used to put out the fire were released into Village Creek, a stream that periodically floods low-income, predominantly African American neighborhoods on the western side of the city. The stream became highly contaminated with Dursban, a pesticide and low-level nerve agent, which was linked to the abrupt prevalence of memory losses, breathing problems, nerve and neurological damages, and other potentially life-threatening ailments among low-income African Americans who reside in neighborhoods along the creek. The residual effects of the Dursban spill left long-term physical, mental, ecological, and spatial problems to contend with. For the authors, the Village Creek incident successfully illustrates the deleterious effects of environmental racism and the urban health penalty and stands as the epitome of the harmful effects placed on “poverty stricken, minority concentrated neighborhoods” (p. 153).
In their assessment of unhealthy cities, Fitzpatrick and LaGory identify four socially disadvantaged groups who they believe suffer the most from the urban health penalty: (1) the homeless, (2) high-poverty, low-income racial and ethnic minorities, (3) the elderly, and (4) infants and children. To further understand just how much place matters for these socially disadvantaged groups, Fitzpatrick and La Gory examine and identify successful place-based approaches that have revitalized and improved the vitality and health of neighborhoods nationwide, and empowered residents to take ownership of their spatial, emotional, and physical well-being through community-based actions plans, collaborations, and outreach.
Fitzpatrick and La Gory call for more studies on “the health of places” (p. 156). In turn, they offer place-based policy recommendations that they assert will promote the health of low-income minority populations in the “whole society” (p. 158). The underlying thesis of Unhealthy Cities is that residence in certain urban neighborhoods can be a stressful and dangerous experience for “socially disadvantaged” residents.
There are several valuable aspects of Unhealthy Cities, namely, the book’s potential utility in the classrooms of both undergraduate and graduate programs in, as the authors suggest, urban sociology, medical sociology, community psychology, medical geography, and public health. The authors succeed at providing a historical perspective and context to place-based approaches, and they offer explanatory theories that can also inform law school students and legal researchers, social work students, as well as practitioners in human development, urban planning, and public policy.
Chiefly, Unhealthy Cities provides the reader with powerful vignettes centering on the Village Creek incident to show the intersections between health, income, well-being, and life chances. For example, in chapter four, “The Sociology of Health,” Fitzpatrick and LaGory discuss the long-term impact of environmental racism and include an updated research and literature review on low-income racial and ethnic urban minorities. Another strong chapter is chapter seven, “Promoting Health: Place Based Solutions to Place Based Problems,” in which Fitzpatrick and LaGory offer policy recommendations and comprehensively survey a variety of local and regional place-based programs.
While Unhealthy Cities provides a strong literature review, several concerns emerge as well. First, some of the data provided in the book is outdated or missing. In chapter three, “The Ecology of Everyday Urban Life,” the authors rely heavily on LaGory’s previous research on urban health and inequalities from almost thirty years ago. For instance, Fitzpatrick and LaGory identify Harlem, New York, as a categorically problematic and unhealthy place. However, the American Community Survey in 2009 as well as the 2010 U.S. Census revealed that Harlem is no longer majority Black, and the population is more mixed-income and resourceful than ever before. Furthermore, in chapter five, “Cities as Mosaics of Risk and Protection,” one glaring omission is a discussion on the urban trend of gentrification. Many neighborhoods across the United States are experiencing population shifts, racial and ethnic succession, and influxes of urban professionals, many of them non-Hispanic Whites who are now moving through both lease options and homeownership purchases, to the central city. If place matters, then a discussion about gentrification and all of its components must be brought into the discussion about place-based approaches and the changing landscape of populations within these places.
Another omission is an expansive discussion on the health risks of segregation. Throughout the book, Fitzpatrick and LaGory point to “an ecology of disadvantage” (p. 5) perpetuated by residential segregation. The evidence that residential segregation has become an almost permanent fixture even in the most diverse of cities should have warranted a deeper discussion. A full chapter might include the following subsections: residential preferences versus racial/ethnic steering in segregated places and the ecology of health; issues of gentrification and displacement on health outcomes; neighborhood effects on health outcomes; segregation, density, and disease; accessibility to quality healthcare in segregated places; comparative case studies of racially integrated versus racially segregated places and health outcomes; and opportunities for community health collaborations in segregated communities.
Another major concern is the generalizability of urban low-income racial and ethnic minorities in Unhealthy Cities. The way that most urban residents are depicted in chapters five, “Cities as Mosaics of Risk and Protection,” and six, “Health Risks among Special Populations in the City,” in particular, might incite readers to believe that all inner-city, minority residents are poor, uneducated, irresponsible, drug addicted, and without any agency, left to reside in the most unsavory of neighborhoods. Both working- and middle-class racial and ethnic minorities reside in low-income neighborhoods both by choice and circumstance. They may choose to reside in these places for access to low-cost housing or proximity to work. Others may reside in low-income neighborhoods because of the circumstances of racial segregation, gentrification, residential preference, caring for an aging or sick family member, and lack of affordable housing in their city. Both circumstance and residents’ own human agency is highly relevant and therefore should have been better highlighted in chapters five and six. Findings from the resilience literature could have been especially helpful in chapter six, in order to provide a balance in explaining the health outcomes of urban minorities and other populations.
There are other problematic generalizations present in Unhealthy Cities. For example, in chapter two, “Humans as Spatial Animals,” Fitzpatrick and LaGory say that “lower income urban children spend more time outside in the streets—and hence less time under surveillance” (p. 40). What about latch-key arrangements, quite common among single and working parents in urban settings, where children are told to come home after school and not leave the house? In this case, there is less chance that these children are outside, and are taking on many of the responsibilities of domestic work and child rearing for their younger siblings for their presumed single- or dual-wage earning, but low-income, parents.
Finally, residence in the suburbs is inferred as safer, healthier, and treated as an idyllic alternative for urban minority low-income residents in Unhealthy Cities. However, the authors fail to mention the additional expenses that residence in the suburbs can bring, such as car ownership and its subsequent maintenance costs—and the residual environmental damage that results from its use. In addition, there are uncalculated costs such as social isolation, racial, ethnic, and socioeconomic discrimination, and suspicion or lack of acceptance from residents with different demographic profiles and long-standing tenure in these places. Furthermore, there is evidence that suburbs can be quite dangerous to low-income populations, especially to socially disadvantaged groups, such as the elderly and the Latino or Asian undocumented population. While there is value in the evidence and findings of suburban advantage and the problems related to the urban health penalty, the authors should have provided a more balanced discussion about the health outcomes of urban minority residents.
In sum, Fitzpatrick and LaGory’s literature review in Unhealthy Cities is suitable for classroom and practitioner use. However, some of the literature surveyed is outdated, seems to generalize the sickness of urban minority populations, and therefore should be read with caution. Indeed, the authors could have further explored the voices of the urban populations they are so concerned about to balance out their review of the literature. While the authors note that “ the most viable neighborhoods are those where residents control the social order, set goals for the collective neighborhood life, and implement programs that help to achieve those goals” (p. 170), this reviewer left wanting to see more cogent examples of this strategy to support their inclusion in the growing health literature of urban neighborhood studies.