AIDS, Tuberculosis, Violent Crime, and Low Birthweight in Eight US Metropolitan Areas: Public Policy, Stochastic Resonance, and the Regional Diffusion of Inner-City Markers

In previous papers of this series we have shown how public policies of ‘planned shrinkage’ triggered contagious urban decay and massive destruction of low-income housing within poor minority communities of New York City. The resulting social disintegration exacerbated epidemics of infectious disease, including AIDS (acquired immunodeficiency syndrome) and TB (tuberculosis), and such behavioral pathologies as substance abuse and violence. We extend this work on the neighborhood-level ‘synergism of plagues’ to the metropolitan regional scale for eight US urban areas containing more than 54 million people. Several have central cities, which, like New York, suffer from what Skogan characterized as a relentless ‘hollowing out’ of poor communities. We find AIDS, TB, violent crime, and low birthweight near the worst affected cities to be markers of an accelerating regional synergism of plagues, a diffusing system of interacting and self-reinforcing pathology fueled by, but spreading far beyond, the worst affected inner-city areas. We uncover an apparent threshold condition for regional spread of this synergism, triggered through a stochastic resonance with public policies affecting the distribution of catastrophic events within central-city minority neighborhoods. Control of AIDS, violence, multiple-drug-resistant TB, and other pathologies in the United States will require regional reform and the sharing both of resources and of authority across presently ungovernable systems of fragmented administrative units: the urban centers of the late 19th-century USA, by the late 20th, are vast, tightly coupled urban and/or suburban complexes producing a regional ‘linear chain’ condition for both public health and public order in which the welfare of the whole is increasingly determined by the sickness of the least strong.