The Geography of Injustice: A Story and Statistics from Baltimore

Co-authored by Wes Williams

The death of Freddie Gray brought immense attention to our city of Baltimore. But for many Baltimoreans the struggle against injustice runs much deeper than what national media displayed during April's civil unrest.

Let's see what life could have been like for you if you grew up a few blocks from Freddie Gray.

Picture a young black woman named Desiree. She's 21 now, living in the Sandtown-Winchester neighborhood. Walking her block each day, she passes 6 vacant homes and countless trash strewn among the neighborhood's alleys. It's not uncommon for rats the size of small dogs to saunter past, and for gunshots to be heard ricocheting off the bricks.

Sandtown-Winchester does not have a grocery store. Desiree shops at the corner store across the street. The store sells chips, canned foods, and snack cakes. Desiree tries hard to find to find the fruits and vegetables that she's told her 4-year old son needs, but she can't afford to take a 40-minute bus ride to the other grocery store a few miles away just to feed Devon.

When she was 16, she was expelled from school after one too many suspensions. Her teachers wrote that she was cursing and throwing books in the classroom. She was refusing to go to class. But what the school didn't know was that she had been homeless for five years. She'd watched her brother get stabbed in front of her and bleed to death. Her mother overdosed on heroin; her father wasn't someone she recognized. Her bad behavior was her reaction to the trauma she experienced every day. Expelled from school, she lost her most accessible healthcare option, through the school nurse.

She had a relationship with a 25-year old that year. By this man, she had Devon who she loves deeply but struggles to support. She tried every day to find new solutions to their plight. In the middle of all of this, Devon contracted lead poisoning because her landlord hadn't cleared her apartment of the lead paint that originally covered its interior. Between the lack of a grocery store and the difficulty she had trying to find a doctor close enough and not having a car, her attempts were never sufficient to find health for herself, or for her son.

The reality is that where Desiree was born determined many of these outcomes. A new map from the Baltimore City Health Department tells this story well. The geography that our new map shows is a geography of injustice.

We may think of healthcare as what medical care you get in the hospital. But what determines health is where you spend your day. It's not your genetic code that predetermines your future; it's your zip code.

On Baltimore's map, we can see that Desiree is not alone in her experiences. The Sandtown-Winchester area struggles with a life expectancy nearly 20 years lower than an affluent neighborhood just a few miles north. Less than half of residents in the Sandtown-Winchester/Harlem Park area are employed. Nearly one in 10 of students from these neighborhoods are suspended or expelled each year, versus zero of students in the adjacent wealthier blocks. These socioeconomic differences are stark. They are not just a matter of statistics, but of how people live and how their children will live.

There are those who believe that a life of poverty and poor health is a matter of personal choice. This map and the stories of countless individuals like Desiree across Baltimore should illustrate that the systemic injustice facing many Baltimore residents from birth stamp out many opportunities to "choose" a better life from the very beginning.

Efforts to level the playing field are imperative against such substantial obstacles, which is why we must invest in public health. It is our local health departments that collaborate with public and private partners across cities to acknowledge that these social determinant are key to building healthier cities. If we want a better future for Baltimore, public health must be part of our present. We need to do better--for Desiree, for Devon, and for all of our patients in Baltimore and across the U.S.