Category Archives: Educational and geographic segregation

Re-Building communities: separation or sustainability

Community rebuilding as a means to separation

Urban rebuilding can be a dualistic/separatist undertaking, benefitting the rich only or one which incorporates the community and benefits all-sustainability. A recent article out of Hagerstown Maryland offers Baltimore city and its cadre of urban rebuilders some great advice: include the community in planning for our community rebuilding or continue rebuilding that leads to divergent paths: those with and those without. In regard the lack of social services for the existing community in current rebuilding plans those working at Hagerstown area nonprofit agencies said: “…they were disappointed that a Philadelphia firm that helped the city come up with a downtown revitalization plan did not address the issues with which that the local organizations deal. Ostoich said Urban Partners, which recommended an eight-part revitalization plan for Hagerstown, has certainly observed situations in other cities that are similar to Hagerstown’s challenges…Ostoich said she would like to see a partnership formed between the nonprofit organizations, the City of Hagerstown and the city’s office of economic development to address issues like homelessness and substance abuse.” link1 Each non-profit providing services for homelessness, housing access and affordability, recovery, mental health and substance abuse treatment, post-incarceration issues, employment reported an increase in their clients and the need for revitalization plans to address these needs.

This is the same pattern of urban rebuilding occurring in Baltimore and beyond: revitalization projects which turn a blind eye to the existing social conditions, many of which are brought about by unemployment and under-employment. Plans do not address the need for recovery programs, or re-entry programs, or mental health programs, or job training, or interview skills, or stress reduction. These conditions are present in Baltimore and other cities which have seen the massive loss of jobs since the 1970’s industrial revolution (substituting machine for human power) and the downturn in the economy since neoliberalism-government joining with private investors to grow their wealth using public subsidies. The outcome of such policies and practices has been the increasing gap between the rich and the poor and the inevitable way vulnerable communities become ill when facing increased stress and little resources to address it. The story in Hagerstown offers a glimpse of what Baltimore has been experiencing for decades: an increase in homelessness, drug use and recovery, mental illness and recovery, unaffordable housing, crime and incarceration. Ostoich speaks about a dual path that revitalization is bringing to the city, one which includes the well-off and those not so well-off. Here in Baltimore we continue to experience the same. Door-knocking and listening in the periphery of the 88-acre Johns Hopkins/EBDI/Casey Foundation/Forest City Bioscience and gentrification project confirms the dual pathway of revitalization. Long time residents share about a fear of not being part of the development as housing prices increase and new neighbors move in. They fear being priced out with property tax increases and rental hikes. New residents are happy with the prices of housing compared to NY or DC and like being in an area marketed for “change” for them. Those with skills and education that allow them to work in corporations and jobs which subsidize housing cost (Live near your work, etc) are mostly happy in their new homes as they wait for more change to manifest around them (one question to ask is how is government subsidizing the employer to offer such housing assistance). Families of generational East Baltimore residents talk about returning from areas north and east but lament the high cost of housing “can’t pay that much but would be nice to come back now that it’s finally changing”. Perceptions of why some locals are home during the day, why some are hanging out on the corner at nights, and the safety of the area persist for the new residents: “I wouldn’t let my mom walk in Patterson Park at night”; while the majority of long time residents don’t mention issues of safety as a concern. Both long time and new residents alike talk about the lack of a place to grocery shop: the type of store will be another tale to tell whether it is affordable for low income residents or not. The new Early Learning Center at the Henderson-Hopkins school is also an issue on people’s mind, especially for those long time residents told they have to be on a waiting list because their income is too high to qualify for admission: “all those Hopkins people have high income and they’re there”. For new residents who are fighting the city about paving an alleyway, they don’t understand why this has to be a struggle: “this is infrastructure of the city, why wouldn’t they pay?” Indeed, why wouldn’t they pay for this while updating the infrastructure for big development projects in the amount of millions of dollars in tax subsidies is normal, with no effective claw-backs or evaluation as to how the public benefits- Johns Hopkins Medical Institution/EBDI/Casey Foundation/Forest City Developers 78 million, Harbor Point 100 million, Poppleton/La Cite 58 million.

But the marks of a dual path in the rebuilding of Baltimore city goes beyond East Baltimore and West Baltimore. The increased cost of parking across the city is another piece of this dualism as well as the extended times meters are in effect and having to pay to drive the Express Lanes on I-95 (in the White Marsh and 695 region). The Express lanes are accessible with payment only, and in the form of EZ Pass only. These are examples of the separation of those who can afford to participate in what the city has to offer, and those who cannot. If you don’t want to be late you can pay to get on the Express lanes and avoid the merging traffic but when a monthly income is stretched very thin, that extra $3.50 (round trip) can be a significant challenge: in paying your bills and in getting to work on time. This dualistic path of community rebuilding tells the same tale in DC’s 20001 zip code where one shopowner of 40 years posted a sign: “Due to ‘gentrification’ and mixed emotions Jak and Company Hairdressers will be closing”: the landlord would not renew the lease.Link2 Here the white population has grown from 6% in 2000 to 33% currently and the new residents require a different set of amenities. We see the same happening in Harbor East where new development continues while the owners of a local fried chicken and pizza take-out-Kennedy- was told their lease would not be renewed. Just across from the Perkins Homes on Eden and Bank and serving this community for over 15 years his product is not what the new race and class of people being enticed to this area are seeking to buy.

Changing the game for sustainability: community ownership and social movements

This “mixing” of the old and new is a challenge that will not go away today but can begin to be addressed if existing community is at the community rebuilding table. The needs of existing residents and businesses can be addressed in the planning, as well as the needs of the new residents usually represented by the developers whose aim is to attract a class of people able to afford moderate and market rate housing and amenities. Such separation of the old and the new is an age-old challenge of rebuilding and continues today because we continue to ignore the outcomes of previous unhealthy and unequal community building strategies and practices. This chronic disinvestment in low-income and African American and of-color communities has resulted in communities unable to compete in the current market-place for decent employment, over-burdened households with little access to resources, and health burdens that limit access to competitive opportunities. Community rebuilding involving the people as well as the place is crucial. This means assuring equity in not only housing but in employment and resources that will remediate and ready existing communities to benefit from new opportunities. It is not enough for developers like East Baltimore Development Inc. and Forest City to say we cannot hire locally because the people do not qualify (due to incarceration records, drug use, or lack of skill sets). This type of minimalist and separatist community rebuilding is unsustainable and what we have been doing for decades. Like Ostoich said, everyone must be at the table so that the needs of the existing community are incorporated into the plan and not displaced away from sight and sound of the new people. This is why the false type of advertising perpetuated by developers about their rebuilding being “game changers” is misleading and simply provides a narrative for the part of Baltimore with access to resources. In East Baltimore, developers should be ashamed about their contribution to this same ole game of segregation in line with Jim Crow and the removal of Native Americans to reservations. Our policies created our current social challenges and therefore current policies must remediate them. Now that would be a real game changer!

Of course, waiting for government to change, while important is not our only option for change. Organizing and building small and large social movements that challenge the current way we address our most vulnerable is important. Local organizing is key. Many new and old residents alike are unaware of their neighborhood organizations in East Baltimore which is a significant risk factor for not having strong neighborhood cohesion. It is this neighborhood cohesion that offers strength and power to resist government’s plans to rebuild communities without local input. Community fragmentation is an outcome of past and current segregation tactics of community rebuilding. However, it is also a cause of continued segregation and a big obstacle to community power. For example, when a 20-block area has neighborhood associations that don’t communicate with each other or when foundations such as the Annie E. Casey Foundation publicly announces it will only fund one of them (the one with whom it has close relations) collective community power is difficult. Difficult but not impossible. In fact, these same conditions existed in East Baltimore in 2001 and allowed Hopkins/EBDI/Casey/Forest City to come into East Baltimore and expect easy exploitation of land and people. Their expectations were not realized only when the number of people organized exceeded the handful which claimed representation -gate-keepers- of the entire community. The gate-keepers who were willing to stand aside and allow mass exploitation of people and place in the form of unhealthy demolition practices, minimal relocation benefit, minimal payment for existing property were simply outnumbered. The creation of a new organization-Save Middle East Action Committee- then allowed a new vision and practice of community leadership, sisterhood and brotherhood, and mutual respect. Strategies and practices for the people by the people resulted in a powerful force which presented the desires of the impacted people, not a handful with close relations to those with power. We are at a critical impass again almost 15 years later, in East Baltimore, greater Baltimore and beyond.

Water bills are increasing across the city with little accounting as to why by the city government while private corporations are dictating to government what efficiency looks like, here and across the world. Link3 Private and non-profits are increasingly poised to take over the role of government programs in public education as the new head of Baltimore’s education is leading the way with the promotion of charter schools and privatization. Link4 Using public funds in charter schools skims the little resources away from public schools while private funders manage and dictate educational reform according to their political view. Social service programs are increasingly operated by private and non-profits companies even while race and class-based equity is lacking and little accountability and transparency exists due to their status. This re-distribution of the public wealth into private and the non-profit industrial complexes’ pockets should bare close scrutiny and transparency. We require social movements from below to balance the growing social movements from above and from those with unchallenged power: we need to change the game, truthfully and not leave it to being co-opted by non-profits and private corporations competing for public subsidies. The upcoming social movements gathering/ forum in May in Detroit is one to check into as it will bring together different movements addressing housing access/affordability and water privatization and water as a human right in the US. Link5 Equitable and sustainable community rebuilding requires everyone at the table: to bring about balance and accountability in planning, processes, and implementation, to redistribute power long favored by the few, to move us toward a peaceful co-existence that will heal our segregated communities, and to end old strategies and practices that lead to greater separation and dualism of those with and those without.

Role of public health institutions in public health justice

PDF of slides from talk at Johns Hopkins School of Public Health.
SPH2015march.2
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…In these times of historical and current accounting of the effect of anchor institutions in community, at home and abroad, how do we speak truth to power and forge new alliances toward justice? As the field of public health grapples with the social, political, and economic determinants of health, how has a powerful institution like JHU been influential in determining neighborhood health in East Baltimore? Has the development of the institution (and others like it) contributed to the growing wealth and health gap in East Baltimore (and elsewhere)?

Come join us for a discussion with Dr. Marisela Gomez this Wednesday, April 1st at 12pm in Room E6159 for a challenging discussion critical to the past, present, and future of health equity in Baltimore and beyond.

The history of prestigious institutions and their power to exploit those most vulnerable to grow power is vast. To be truthful participants in changing this history we must account for this history and repair it. Transparency begins to hold accountable the past transgressions and find solutions beyond what our fragile human nature has succumbed to thus far. Inequitable health outcomes, arrest rates, educational achievement, income and housing value are symptoms of inequitable communities, of power and privilege. Bridging within and across all our systems-community and economic development, education, criminal, housing, recreation- of society is a large task. How do we forge a path towards equity, while assuring everyone is at the table, and contributing?

Establishing values of inclusivity, accountability, transparency,and reflection/reflexivity in all processes is important. These values must infuse and be embedded in the tools of planning/policy development, practice/praxis, evaluation, public relations/media. And most, most importantly, WE THE PEOPLE, must be involved in all steps of the process toward justice…

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If interested in any slides of presentation, send a contact.

Contemplating peaceful and skillful means to justice,
Marisela

Connecting our struggles across identity politics: a powerful force for justice

Broad-based political organizing

While only 3 months into the Western year of 2015, we have experienced more discussion of the reality of anti-blackness in America than the entire year of 2014. For that matter, 2013 as well. The new media engagement and willingness to report on racism suggests a couple of things: they finally “get it” or there are enough folks standing up and testifying to racism openly. It is unlikely, though wishful, that the media has experienced an abrupt period of enlightenment. We are hearing more about anti-blackness because of the heightened attention of the epidemic of police brutality after the Trayvon Martin case and more recently Michael Brown and the #BlackLivesMatter movement.(1) The movement immediately offered a broad platform which galvanized support from different segregated identity politics: police brutality, criminalization and discrimination of women and children, poverty, community dis-investment, lesbian/gay/bi-sexual/transgendered rights, immigrant rights. The recent outcry from several colleges on black student isolation/segregation is the most recent witnessing of the individual and institutional anti-blackness legacy in the US. But the attention to a culture of anti-blackness is broader and deeper than we may realize: the conservative bastion of medicine in America, the New England Journal of Medicine, published a commentary on “Black lives matter”; faculty members at academic institutions are speaking out about their institutional evidence of anti-blackness; pro-black equity speakers are highlighting at various universities across the US; health departments are documenting the effects of racism and poverty as factors detrimental to health equities. This broad net of protest against the dehumanizing ways society has treated black people and other marginalized communities witnesses-state sanctioned violence, the chronic dis-investment and segregation, the anti-blackness of America. Through policy and practice anti-blackness has enforced segregation and inequity which continues today. The #BlackLivesMatter campaign, formed by three women, invite a coalition of historically oppressed populations to uplift the struggle of each other to build a stronger network of support for each struggle.

Another broad-based social movement has been growing in North Carolina since 2006, increasing public protests after the Republican take-over of the legislature in 2013: Forward Together Movement/Historic Thousands on Jones Street (HToJ). (2) Their platform includes: high-quality public education, living wages, healthcare for all, racial justice, voting rights, affordable higher education, fairness for state contracting, affordable housing, criminal justice reform, environmental justice, collective bargaining and worker safety, immigrants’ rights, a new civil rights act, and bringing the troops home. Their focus has been to challenge and change the state legislative and executive body and political machinery which recently passed legislation inhibiting voter rights and slashing of public funding for social, educational, and health programs. Their movement has spread to Georgia, South Carolina. Tennessee, and Missouri and has impacted the legislation and voting turnout. Consisting of more than 150 coalition partners they continue to stage protests called Moral Mondays at the state assembly in North Carolina.

Identity politics, their connections, and why

These broad-based coalitions emphasize the interconnectedness of identity politics: injustice and oppression mediated through those with power against those without. Communities are segregated by race, income, education, housing, employability and access to recreational and transportation resources. The chicken and the egg argument can be used to describe the segregation of communities of color and its resultant economic segregation. Cities continue to gentrify and segregate by housing cost and education. (3) Here in Baltimore we rank 13th out of 50 large cities in gentrification and the resultant segregation between those with low and higher incomes; Washington, DC took a stunning 3rd place. Even though we see the direct negative outcome on funding for public education from recent public subsidies to wealthy developers who invite more racial and economic segregation, our local and state governments continue to directly and indirectly discriminate against the marginalized. These neoliberal practices of community development: policies and practices which grow the gap between the rich and the poor, drive development in the US and beyond leading to greater segregation. As reported by The Atlantic’s CityLab recently “It is not just that the economic divide in America has grown wider; it’s that the rich and poor effectively occupy different worlds, even when they live in the same cities and metros…Race is a significant factor. Economic segregation is positively associated with the share of population that is black, Latino, or Asian, and negatively associated with the shares of white residents.” (4,5)

The growth in income inequality and the resultant segregation over the last 10 years has raised awareness for some, but most are still asleep to the causes and effects. Scientific American recently commented on the reason for this “dream-like” state that Americans are in: “At the core of the American Dream is the belief that anyone who works hard can move up economically regardless of his or her social circumstances…Sure enough, people think that moving up is significantly more likely than it is in reality…..By overemphasizing individual mobility, we ignore important social determinants of success like family inheritance, social connections, and structural discrimination…We may not want to believe it, but the United States is now the most unequal of all Western nations. To make matters worse, America has considerably less social mobility than Canada and Europe.” (6)

In the 21st century, we continue to live the myth of meritocracy, that we are equally rewarded for our hard work, there is a level playing field that values each person and community similarly. One glaring example of this is the difference in housing value in black and white neighborhoods. The Brookings Institute published a comparison of wealth in white and black neighborhoods showing “wealthy minority neighborhoods had less home value per dollar of income than wealthy white neighborhoods”…“poor white neighborhoods had more home value per income than poor minority neighborhoods.” Of the 100 metropolitan areas studied, even when homeowners had similar incomes, black-owned homes were valued at 18% less than white-owned homes. In effect, the higher the percentage of blacks in a neighborhood, the less a home is worth. This correlation begins when there is greater than 10% of black residents in a neighborhood. (7) Another example of race-based development and housing value is evident by public and private investments targeted to communities which are not majority black (less than 40%) as documented in a recent study by Harvard researchers. (8) This study confirms previous studies on race-based discriminatory community development practices. Development of areas with majority residents of color do occur. However, the displacement of the existing residents and racial gentrification usually result in the neighborhood achieving a majority white status. These practices are well documented through urban renewal in the 1950’s and subsequent government housing programs like HOPE VI and Promise Zones. The 1950‘s and current Johns Hopkins Medical Campus expansion in Baltimore into almost 150 acres are examples of mass removal of more than 1500 black families using eminent domain and tax subsidies as public support. The re-population with a different race and class was the intention of both projects, further displacing low income and black residents for majority middle and market rate residents.

Power of collective resistance

Indeed the marginalization of various political identity communities do not occur in a vacuum, separate from each other. The #BlackLivesMatter and Forward Together movements remind us that the legacy of state-sanctioned violence in all its forms continue to segregate and penalize the less powerful residents of our society. A higher percentage of black-descendant people are poor and live in communities disinvested of healthy foods, competent schools and health facilities with salaries to attract competent staff, healthy environments, safe and sanitary homes, and recreational centers. Low income people of all races/ethnicities are living in similarly disinvested communities. Low income people are employed in high-turnover jobs with little job security, career opportunity, living wages and paid sick leave or time off. The criminalization of people living in low income communities far surpass those living in moderate and higher income communities. The oppression of women, those with disabilities, and sexual minorities occur across all social and economic systems. The power of coalitions to connect across the commonality of discrimination and oppression is great. When each struggle is aware and directly and indirectly support the struggle of another, there is a stronger force moving forward against all oppressive norms and practices. From state-sanctioned segregated and disinvested communities, to disinvested schools, recreation centers, public and social services, health services, to mass incarceration, the thread is a systematic violence against people deemed inferior, of diminished worth. Broad-based movements can offer a platform for various local and national issue-specific or identity political movements to connect and coalesce. Then each small act of daily individual resistance becomes the foundation for building resistance and organizational power across multiple issues; individual organizations/movements collect together to build larger networks of resistance connecting all vulnerable and historically and currently oppressed groups. This type of network of resistance reinforces resilience – I am my sister’s keeper and she is mine. This network of resistance is necessary to resist and change the network of violence currently enforced against all our marginalized communities.

1. #BlackLivesMatter

2. Forward Together Movement, North Carolina

3. Governing. Gentrification

4. The Atlantic.City Lab. Economic segregation

5. New York Times. Income inequality is bad for your health

6. Brookings Institute. Segregation and housing value

7. Scientific American. The myth of the American Dream

8. Jackelyn Hwanga and Robert J. Sampsona. Divergent Pathways of Gentrification: Racial
Inequality and the Social Order of Renewal in Chicago Neighborhoods. American Sociological Review 2014, 79(4) 726–751

Educational and geographic segregation, generational racial poverty: can we build something different in Baltimore?

The gap between the educated and uneducated, segregated by place or geography, is not new to America. This new study by Diamond out of Stanford University however confirms that there is greater geographic segregation between those with and without education and access to resources over the past 20 years. (1) Per the report the current income gap between those with and without a college education is 75% and results in an affordability gap, in housing, education, and other amenities. This results in neighborhoods and cities becoming more segregated by education and income. “Rising college share then improves local amenities and productivity, leading to a more desirable city, which again benefits the college educated at the expense of lower skill workers forced to relocate elsewhere. These types of policies force the local policy maker to decide whether he or she wants to improve the city at the possible expense of less skilled inhabitants’ economic well-being.” The study confirms that the lack of sufficient resources in low-income neighborhoods and the resultant place-based inequities that predict health disparities. (2) What is lacking in the analysis is how racial dynamics affects this current and future segregation/gentrification of our neighborhoods and cities.

However, what we do know from the recent study by Alexander and colleagues out of Johns Hopkins University (The Long Shadow: Family Background, Disadvantaged Urban Youth, and the Transition to Adulthood) is that while those born into poverty are likely to remain in generational poverty in adulthood, African Americans born into poverty are much more likely to remain in poverty than their white counterparts born into poverty. (3) This data confirms anecdotal reports through almost 30 years of tracking of 800 children born in neighborhoods of low-income in Baltimore and represents a pattern across similar cities in America. Such patterns include a 30% employment gap between white and black men in the little remaining blue-collar jobs in Baltimore; 49% employment gap between whites and blacks who had dropped out of school; 100% income gap between low-income whites and blacks even while low-income white men had the lowest rate of college attendance or completion compared to low-income black men in the study. Findings from the study also confirm that low-income black neighborhoods were more likely than low-income white neighborhoods to be negatively impacted by urban renewal practices, resulting in displacement and severed social networks.

Many of us like the neighborhood feeling of Baltimore. But our neighborhoods are segregated and difficult to ignore, if we are a little awake. The Baltimore Neighborhood Indicator Alliance 2012 data confirms that our city is segregated:

Neighborhood Families living in poverty (%) Income (K)
Greenmount 38 21

Perkins/Middle East 27 19

Roland Park 0 90

Mt. Washington 0.8 72

Canton 2 77

Southeast 20 29

Yes, we have some historic and present day challenges. We know this from talking to folks who hold the history and we know this from research, in and outside of the city. How are we going to build a new Baltimore that is less segregated and not continuing a well-documented and current history?

The Mayor recently declared that its ‘institutional partners’ of universities will change Baltimore for the better through bringing new residents to Baltimore. We are wondering who it’s being changed for? (4) According to these studies, without clear intention to assure affordable housing, access to quality education and the resources to support a child ready to learn, and employment opportunities for low-skilled and non-college educated residents of all races, Baltimore will continue the current path of gentrification and racial inequity. One look around the gentrifying areas of Harbor East and Middle East Baltimore provides us a vision of the future of a rebuilt Baltimore: $10 latte in Harbor East and $200K luxury condominiums in Middle East tells us who we are marketing the city to.
The recent negotiations between low-wage workers at the Johns Hopkins Hospital which resulted in some workers still unable to afford health insurance and homes in neighborhoods supporting well-being, hints at a continued path of income and geographic inequity via a leading employer and institutional partner who refuses to set an example to all new businesses that Baltimore is a city that demands the right to a living wage.(5) (According to research out of MIT, a livable wage in Baltimore Maryland for one adult with one child is $22.88, with two adults and one child, $20.51; the hospital agreed to a top $15 for employees of 20 years (6)) The privatization of public housing in Baltimore with no assurance that they remain affordable in perpetuity and new development with limited time-periods for affordable housing prices places current low-wage earners at risk of future displacement. (7)

The plan to rebuild Baltimore by increasing the population- by attracting a different race and class which separates out based on education, income, and race- without a plan to prevent gentrification and further segregation commits the city toward a continued gap between the haves and have nots.

With no real government oversight to assure affordable housing and access to quality education is permanent, local hire and livable wages as mandatory rules of engagement with current and future development, it is hard to imagine how low-skilled and non-college educated residents will be able to afford the new Baltimore. We have not assessed the current rental needs of existing residents to assure that sufficient affordable housing is available. WIthout knowing the needs it is difficult to plan to assure that sufficient affordable housing is built. Targeted development dollars and tax subsidies which assure sufficient affordable housing, local business opportunity which matches the market needs of low-income residents, access to quality education and training to assure competition in the changing workforce, adequate social and health programs which prepares the workforce, and living-wage employment that assures self-sustainability must be part of a plan to rebuild a different Baltimore. Until town hall meetings, city legislation, the media outlets, neighborhood groups, education and health groups, private and government policy and funding address these vital anchors of equitable community rebuilding to assure all its residents can stay and participate in a changing Baltimore, we are simply orchestrating the disposal of the most vulnerable to attract the more powerful. Basically, we are not doing anything different.

There is wisdom in learning from history and yet our elected leaders and resourced elites, blinded by the camouflage of bright lights, new buildings, and greed, seem to have missed this opportunity for change. Is it too early to predict that another generation is being ushered into poverty even while the intellectuals continue to churn out data, theorizing the exact percentages that may escape, and why? We have the data, we have people telling their stories; we simply need the political will and the compassionate understanding that until we all have an opportunity to participate for change, nothing fundamentally changes for those absent from the negotiations. And yes, we have the resources!

1. Educational and geographic segregation
2. Segregated neighborhoods and health inequities
3.The Long Shadow
3b. The Root: White privilege extends to the poor
4. Institutional partnership to rebuild Baltimore
4b. Institutional partner rebuilds for the privileged
5. The Real News Network: Unfinished negotiations between Hospital workers and Hopkins Hospital
5b. In These Times: Hospital union claims victory in Johns Hopkins Contract Fight
6. Living Wage in Baltimore, Maryland; MIT
7. Privatizing public housing in Baltimore: RAD speak-out

Social health, neoliberalism, and gentrification

What is meant by social health? And what does neoliberalism and gentrification have to do with health? In rebuilding communities through neoliberal practices that result in displacement, homelessness, and gentrification the health of the community is affected (1). The fact is that the social, political, and economic systems in a society such as the US affect the health of individuals and populations. These systems separate and place economic, social, and political values on populations according to categories of race/ethnicity, income level, education level, gender, immigrant status, religious affiliation, sexual orientation, place of birth, dominant language, physical and mental ability, and age. The socioeconomic and political economic systems use these hierarchies to determine our place in society which in turn determines our health.

Using race and class identity as examples, individuals who discriminate based on these two factors will negatively affect the psychological and physical health of low income people of color through the stress experienced daily by the effects of their implicit bias (2, Implicit Attitude Test, Experience of Discrimination). On an institutional level, the health outcomes of low income communities of color during redevelopment is partially determined by the discriminatory neoliberal policies and practices-a norm of the socioeconomic and political economic systems of the US. Such practices/policies include: policies which allowed disinvestment of low-income neighborhoods, mayoral-governments partnered with private developers, legislators passing and funding racist laws, lack of policies/laws which demand affordable housing and local hiring, city and state officials enacting education, housing, transportation policies and practices which benefit wealthy developers and displace community residents, developers building only market-rate housing in low and moderate-income communities, planning boards lacking community participation, corporate university and philanthropic boards who approve cleansing of low income and of color communities. Besides the collective stress experienced from being forced to move, the lack of affordable housing and products, the fear of eventual displacement, lack of ability to have decision-making in your community, displacement to other under-resourced communities (in school, livable employment, access to healthy and affordable food, infrastructure that allows physical activities, safety) are risk factors for poor health outcomes. Such neoliberal rebuilding practices which lead to displacement and gentrification can only occur in societies where the political economic and socioeconomic systems support them. This is the concept and action of social health, neoliberalism, and gentrification.

The mechanisms of neoliberal processes in community rebuilding such as tax subsidies and exemptions, rezoning, lack of transparency and accountability, ‘shadow governments’ of developers and corporate foundations navigated through public:private partnerships, state redistribution of land to private entities, propaganda media, greed, devaluing of non-productive members of society, non-participatory planning in community rebuilding and its social health impacts must be identified, reported, challenged, prevented-again and again. Such practices unleashed in communities of low and moderate income and color find little resistance due to the political economy of development capital and state politics. This process of community rebuilding is supported by strong ties between the developer and government which overwhelms the power of the local community to demand equitable development and community participation-there are minimal ties between the local community and government (3). Newly organized communities are displaced to different parts of the city, some county, loosing the growing power-base and social capital which could challenge the powerful developers and public partners. Because of the unfair advantage of such public:private partnerships social capital/economic and political benefit is accumulated disproportionately by the powerful developers.

For example, displacement of communities of low-income and color disinvested by government and neighboring institutions, for expansion of a prestigious institution like Johns Hopkins results in stress for residents and poor health outcomes: gentrification and health. The disruption of social networks, root shock, results in acute and chronic trauma to residents as they loose their familiar base and try to anchor themselves in new neighborhoods (4). Such continued serial displacement is a major social determinant of continued poor health outcomes. Children are particularly susceptible to these changes and have difficulty establishing new peer groups (5). In this example, neoliberal practices through public:private partnerships of the university, Annie E. Casey Foundation and others, and the city planned and carried out displacement, demolition, and construction of a new place/community unaffordable to previous residents and the peripheral communities. After more than 800 households were displaced less than 10% low income and minority families have been allowed back to inhabit the more than 700 units rehabbed or newly constructed to date. Construction of a new contract school, managed by JHU and supervised by a board of directors led by Hopkins assures that the neoliberal agenda of dispossession of education occurs-another risk factor for health (6, 7). This new school which selectively engineers a ratio of white and non-white, poor and non-poor for their neoliberal formula of experimental ‘urban’ education continues. The right of existing residents to attend the school is ignored, preference is offered to the powerful university and affiliates, while the department of education requires no meetings for transparency or accountability, and the wealthy developer and corporate philanthropists of Casey and other foundations continue on unimpeded. The school is a magnet for gentrification, attracting the race and class of people comfortable to the powerful Johns Hopkins University. Whether the children of the surrounding neighborhood have access to this new school is a determinant of health. Access to early childhood development resources and education is a determining factor for health of children as they grow to adulthood. Neoliberalism, gentrification, and the new urban education are factors determining the social health of East Baltimore and Baltimore because the neighborhoods displaced residents are forced to move into may be similarly disinvested, contributing to diminished health. Residents must be able to stay in the neighborhoods undergoing revitalization and participate in all the amenities (education, parks, housing, health, employment, transportation): this is a more participatory model of community rebuilding-one which emphasizes community participation before development to ensure that participation continues during and after, and does not result in gentrification, displacement, segregation and poor health. How do we do that?

Alameda County Public Health Department (ACPHD) along with Causa Justa:Just Cause’s (CJJC) recent report shows the negative health effects on communities in the Bay Area undergoing gentrification (8). Among others, they recommend Health Impact Assessments (HIA) before development occurs to determine potential negative health outcomes caused by gentrification and displacement; their recommendations emphasize the necessity of community participation in all processes of development. In 2009 similar recommendations were made by the Association of Bay Area Governments and Policy Link. However the current recommendations by ACPHD and CJJC is the first to directly show quantitative changes in population health during all stages of gentrification processes, clarifying the health consequences of displacement. HIAs can also be used to substantiate the need for community-driven rebuilding processes as done by the Los Angeles Community Action Network. They used a HIA to leverage a commitment for more than $20 million to limit displacement through affordable housing, local hiring, support for tenant rights and preventive health programs.

In 2003, Save Middle East Action Committee, Inc. requested that Hopkins/East Baltimore Development Inc. conduct a HIA before demolition and rebuilding began. This was particularly important because the majority of the housing stock was built during the period of lead-based paint and because previous studies of demolition by the university showed contamination of the surrounding air with lead. Even with this evidence, the timeline of the university’s first Biotech building was more important than the health of low income and African American residents. This type of public:private development project ignored the health of residents then just as a current development project in Los Angeles targeting public housing conversion into a mixed-income development is attempting to ignore the health of low income people of color (9). Such racism and classism driving neoliberal community rebuilding chooses to ignore existing communities where the majority of residents are people of color with little resources and the lowest life expectancy. These and previous examples confirm that the value placed on low income and racial/ethnic minority communities are minimal compared to that of higher income and white communities, and that the growth of inequitable power in majority white and higher income communities will continue to drive these unhealthy socioeconomic and political economic practices.

Gentrification and its neoliberal agenda has arrived in full force in the 21st century. New York’s Brooklyn and the Bronx, Sommerville, Portland, Chicago, Denver, and DC are facing the effects of gentrification and unaffordable housing, all risk factors and outcomes of displacement and negative health outcomes (10-16). Cities implementing new transportation systems face similar risk of gentrification and displacement as reported by a 2010 report: Maintaining Diversity in America’s Transit-rich neighborhoods: Tools for equitable neighborhood change (17). Neoliberalism’s new attire of greater public:private partnerships with the propaganda of equitable public benefit supported by the media drives gentrification through accumulation of land by the wealthy and dispossession of civil rights of the disenfranchised- in the US and abroad (18). Such inequitable societies lead to inequitable health of individuals and populations as seen with life expectancy differences between the rich and the poor of up to 19 years (19). Confronting and ending these violations of human rights through coalition building across struggles for equity of race, income, housing, food, education, environment and all other social factors is necessary and possible. It may be the only possible way to reclaim a collective right to occupy the city, making it balanced, healthy, and whole.