The miasma theory of disease went out of style in the 1850s. The discovery that bacteria, rather than vapors emanating from the soil at night, caused illness launched the modern public health profession. In the intervening 150 years, public health practitioners have focused on controlling disease through sanitary infrastructure and educational campaigns.
Despite these great strides, the geography of HIV illuminates the inconvenient truth that relationships between health and place persist. New York and New Jersey, which together are home to 9.3% of U.S. residents, were the site of 22.3% of AIDS cases recorded by the CDC through 2007. Not only do Oregon and Washington have a much smaller population (3.5% of U.S. residents), their burden of AIDS (1.8% of U.S. cases to date) is far lower (Henry J. Kaiser Family Foundation). If miasma isn’t behind these differences, what is

Luhr, Gretchen

McGrath, Moriah McSharry

English

PDXScholar (Portland State University)

Portland State University PDXScholar Metroscape Institute of Portland Metropolitan Studies Winter 2010 Periodic Atlas of the Metroscape: Health and Home: Neighborhood Stability and HIV Outcomes in the Metroscape Moriah McSharry McGrath Portland State University, xxmoriahxx@gmail.com Gretchen Luhr Portland State University Follow this and additional works at: https://pdxscholar.library.pdx.edu/metroscape  Part of the Urban Studies and Planning Commons Let us know how access to this document benefits you. Recommended Citation McGrath, Moriah McSharry and Luhr, Gretchen (2010). "Periodic Atlas of the Metroscape: Health and Home: Neighborhood Stability and HIV Outcomes in the Metroscape," Winter 2010 Metroscape, pages 13-19. This Article is brought to you for free and open access. It has been accepted for inclusion in Metroscape by an authorized administrator of PDXScholar. Please contact us if we can make this document more accessible: pdxscholar@pdx.edu. Periodic Atlas of the MetroscapeMetroscapeT he miasma theory of  disease went out of  style in the 1850s. The discovery that bac-teria, rather than vapors emanating from the soil at night, caused illness launched the modern pub-lic health profession. In the intervening 150 years, public health practitioners have focused on control-ling disease through sanitary infrastructure and edu-cational campaigns. Despite these great strides, the geography of  HIV illuminates the inconvenient truth that relationships between health and place persist.  New York and New Jersey, which together are home to 9.3% of  U.S. resi-dents, were the site of  22.3% of  AIDS cases recorded by the CDC through 2007.  Not only do Oregon and Washington have a much smaller population (3.5% of  U.S. residents), their burden of  AIDS (1.8% of  U.S. cases to date) is far lower (Henry J. Kaiser Fam-ily Foundation). If  miasma isn’t behind these differ-ences, what is?  Health and PlaceOur health is affected by genes and behavior, and also by our physical and social living conditions. Unhealthy living conditions could include dilapi-dated housing, a lack of  positive role models – and much more.  The differences between places can be stark, as illustrated by a recent documentary on dia-betes in Arizona.  On the Tohono O’odham Indian reservation, up to 50% of  residents are diabetic.  In a nearby working class city, the rate is 11%; in the wealthy enclave of  Scottsdale it is 5%. The tangle of  cultural, social, and economic factors that make each place unique consti-tutes what sociologists Mark LaGory and Kevin Fitzpatrick term a “mosaic” of  risk and pro-tection.  Poverty and lack of  opportunity are some of  the risks that destabilize reservation communities, while Scottsdale is ripe with protective features like recreational facilities and well-funded schools.HIV is similarly connected to social patterns. An exhaus-tive study of  New York City, Rod and Deborah Wallace’s book A Plague on Your Houses describes how systematic disinvestment in certain neighborhoods led to social instability that seeded HIV through the metropolitan area. This atlas considers how local place dynamics may affect the disease profile in and around Portland. This atlas asks how social conditions may influence the spatial distribution of  the roughly 10,000 cases of  HIV in the metroscape (Portland Area Global AIDS Coalition). Neighborhood StabilityTo explore local conditions, we mapped Census 2000 data related to neighborhood stability. We selected three relevant variables: percentage of  residents with incomes below the poverty line (figure 1), percentage of  housing units occupied by renters (figure 2), and percentage of  residents living in different housing unit five years prior (figure 3).  Perce tag  of Block Group Residents with Income below Poverty Level in 1999Health and Home: Neighborhood Stability and HIV Outcomes in the Metroscape     by Moriah McSharry McGrath and Gretchen Luhr0 - 5 %5.01 - 15%15.01 - 25%25.01 - 35%35.01 - 70%Figure 1Source: U.S. Census. 2000Percentage of  Block Group Residents with Income Below Poverty Level in 1999COLUMBIAWASHINGTONYAMHILLCLARKMULTNOMAHCLACKAMASPage 14 MetroscapePercentage of Block Group Housing Units Occupied by Renters, 2000We then mapped these Census data for all block groups in the Portland metropolitan area: Clacka-mas, Columbia, Multnomah, Washington, and Yamhill counties in Oregon; and Clark County, Washington. (Geographic units that roughly ap-proximate neighborhoods, Census block groups contain 1,500 residents on average. The smaller a block group, the higher its population density.) In this atlas, we first explore the Census variables individually, then combine them into a Neighbor-hood Stability Index, and finally consider the rela-tionship of  the index to HIV cases.  Poverty is highest in urban areas, especially in the center of  Portland (figure 1). While poverty is found throughout the metroscape, there are notable concentrations of  high-poverty neighbor-hoods in the Downtown and Inner Northeast ar-eas of  Portland and in Gresham along Burnside Ave.  Poverty can destabilize neighborhoods by limiting the capital available to support individual and collective undertakings.  It also feeds informal economic activity, which can include drug and sex exchanges that put participants at risk for HIV. Might residents of  these neighborhoods be espe-cially vulnerable to HIV? Another aspect of  neighborhood stability is home ownership.  In theory, homeowners want to assure return on investment by maintaining neigh-borhood quality.  Those who live in their invest-ment are doubly committed for the sake of  their personal quality of  life. In the metroscape, many of  the most densely populated areas (the small-est block groups) have the highest proportion of  renters (figure 2).  This includes Central Portland and Vancouver, as well as the core of  cities like Beaverton and Hillsboro in Washington County, and small cities like McMinnville and Newberg in Yamhill County.  In the lower right-hand corner of  the map, one large block group has a relatively high proportion of  renters.  We are not sure why this rural area, which is at the southern end of  the 0 - 20%20.1 - 40%40.1 - 60%60.1 - 80%80.1 - 100%Figure 2Source: U.S. Census. 2000Percentage of  Block Group Housing Units Occupied by Renters in 1999COLUMBIAYAMHILLWASHINGTONCLARKMULTNOMAHCLACKAMASPage 15MetroscapePercentage of Block Group Residents Living in a Different Housing Unit Five Years Previous, 2000Molalla River and Colton School Districts, is so different from neighboring block groups. If  these neighborhoods are indeed less stable, will residents be able to maintain social networks that foster healthy norms and mobilize resources to confront health problems?  Does rental housing expose city neighborhoods to the “urban health penalty” said to disadvantage urbanites?Housing tenure may not be the most important measure of  neighborhood stability.  Especially in places where renting is common, long-time rent-ers may perform the functions usually associated with homeowners.  So, we look next at the length of  housing tenure (figure 3).  Neighborhoods with highest proportion of  long-term residents are in rural areas, outside cities’ Urban Growth Bound-aries.  Within Portland, areas of  high transience include the Downtown Central Business District and the Inner East Side.  Central neighborhoods like these are often popular with young people in-terested in cultural amenities. Downtown Portland is also home to the state’s largest university and a significant student population. These groups move often.  Beaverton and Hillsboro in Washington County, which have experienced recent develop-ment and population influx, also have high turn-over.  In Clark County, similar patterns of  hous-ing tenure and flux can be found in Vancouver and Camas along the Columbia River, and further north in Battleground.  Such changes in population may inhibit the formation of  social networks, and the benefits people gain from drawing on this col-lective social capital.  The various causes of  tran-sience, however, may have very different effects on neighborhood well-being.  How might be the health consequences of  student neighborhoods, declining neighborhoods, and newly-developing neighborhoods vary?  Creating a Neighborhood Stability IndexAfter looking at individual variables, we used sta-tistical techniques to create a measure of  relative neighborhood stability that incorporated them all. 0 - 40%40.1 - 50%50.1 - 60%60.1 - 70%70.1% - 97%Figure 3Source: U.S. Census. 2000Percentage of  Block Group Residents Living in Different Housing Five Years Previous, 2000COLUMBIAYAMHILLWASHINGTONCLARKMULTNOMAHCLACKAMASPortlandGreshamHillsboroBeavertonTigardAlohaTualatinMcMinnvilleLake OswegoWest LinnOregon CityWilsonvilleCanbyNewbergOatfieldTroutdaleFairviewSandySherwoodOak GroveGladstoneCorneliusMilwaukieForest GroveCedar MillSunnysideHappy ValleyCedar HillsClackamasRockcreekDundeeOak HillsWest Haven-SylvanWest SlopeCarltonEstacadaJennings LodgeDaytonLafayetteMetzgerGarden Home-WhitfordRaleigh HillsWood VillageNorth PlainsYamhillBanksDurhamKing CityGastonWest SlopeRivergroveBarlowJohnson CityButtevilleAuroraPage 18Metroscape Page 19PortlandGreshamHillsboroBeavertonTigardAlohaTualatinMcMinnvilleLake OswegoWest LinnOregon CityWilsonvilleCanbyNewbergOatfieldTroutdaleFairviewSandySherwoodOak GroveGladstoneCorneliusMilwaukieForest GroveCedar MillSunnysideHappy ValleyCedar HillsClackamasRockcreekDundeeOak HillsWest Haven-SylvanWest SlopeCarltonEstacadaJennings LodgeDaytonLafayetteMetzgerGarden Home-WhitfordRaleigh HillsWood VillageNorth PlainsYamhillBanksDurhamKing CityGastonWest SlopeRivergroveBarlowJohnson CityButtevilleAuroraNeighborhood Stability Indexand HIV Casesin the Portland RegionFigure 4Number of HIV CasesPer Block Group1 - 23 - 45 - 89 - 1415 - 23Stability Indexby Block Groupmost stablevery stablesomewhat stablesomewhat unstablevery unstablemost unstableM  tableV  stableS ewhat stableS ewhat unstableV  unstableM  stableHIVcasesCOUNT_1 - 23 - 67 - 1415 - 231 - 23 - 67 - 1415 - 23NeighborhoodSta ili(U.S. Census, 2000)Number of HIV Cases per Block Group2002-2007Sources: Public Health Division, Oregon Dept. of Human Services; U.S. Census 2000MetroscapePage 20I405I5 I84I5I582ND82NDBURNSIDESANDYLOMBARDPOWELLMARINE39THNAITOBARBURINTERSTATEYEONFOSTERMACADAMBROADWAYMCLOUGHLIN18THHAWTHORNEWEIDLER  CORNELLAIRPORTST HELENSDENVERTACOMALLOYDHWY 30BEAVERTON HILLSDALETERWILLIGERMARTIN LUTHER KING JR I205KILLINGSWORTHMADISON3RD82NDSUNSETNumber of HIV CasesPer Block Group1 - 23 - 45 - 89 - 1415 - 23Stability Indexby Block Groupmost stablevery stablesomewhat stablesomewhat unstablevery unstablemost unstableM  tableV  stableS ewhat stableS ewhat unstableV  unstableM  stableHIVcasesCOUNT_1 - 23 - 67 - 1415 - 231 - 23 - 67 - 1415 - 23NeighborhoodSta ili(U.S. Census, 2000)Number of HIV Cases per Block Group2002-2007Sources: Public Health Division, Oregon Dept. of Human Services; U.S. Census 2000Neighborhood Stability IndexandHIV Cases in Portland's Central CityLaurelhurstDowntownBeaumont-WilshireFigure 5EastmorelandPage 19MetroscapeFor each block group, we computed a score ex-pressing the neighborhood’s stability relative to other block groups in its county (figure 4).  We call this the Neighborhood Stability Index.  While each county has the full range of  Neighborhood Stability Index scores, like neighborhoods cluster together.  Some of  the most stable areas include historically desirable neighborhoods like the Southwest Hills. Low-stability clusters include Downtown Portland and Old Town/Chinatown, which are known for single-room-occupancy hotels and street people with high social service needs.  Large highways travel through many low-stability areas.  For example, most of  the block groups along Interstate 5 have low stability scores.  This is particularly notable in North Port-land: could the instability be a long-term conse-quence of  disruption by highway development and disinvestment in the historically Black Albina corridor?  Or are these neighborhoods unpopular because of  the noise, traffic, and air pollution that characterize life near highways?  And how might the recent gentrification of  the area be altering these dynamics?Neighborhood Stability and HIVOur final maps combine the Neighborhood Sta-bility Index with HIV case data.  By summing the number of  cases reported in each block group from 2002-2007, we computed a rough measure of  neighborhood HIV incidence (figure 5).  Clark County, Washington incidence data are not in-cluded in these maps because they were not avail-able from Washington State. Officials did not routinely collect address data for HIV cases until 2006 and do not publish the small number of  cases recorded in order to protect the confidenti-ality of  county residents. As in other areas of  the U.S., HIV cases in the metroscape concentrate in the most urbanized areas.A closer look at the heart of  the metroscape reveals a correlation between the Neighborhood Stability Index and HIV incidence (Map 6).  Pres-tigious neighborhoods like Eastmoreland, Beau-mont-Wilshire, and Laurelhurst are highly stable and have low HIV incidence. Downtown and Central East Side neighborhoods are relatively unstable and have the highest HIV incidence. This correlation is statistically significant for the five Oregon counties included in the maps. But through what pathways does neighborhood stability affect HIV incidence?  In high-stability neighborhoods, do strong social institutions help educate people about HIV and stem its transmis-sion?  Or do neighborhoods’ reputations for ex-clusivity discourage people at risk of  HIV from living there?  For low-stability neighborhoods, do the strain of  poverty and anonymity of  tran-sience create a laissez-faire culture that tolerates or encourages high-risk activities?  Or are these neighborhoods refuges for the down-and-out, embracing people with social and health challeng-es?  Or is the embrace less than warm, with dis-enfranchised neighborhoods saddling the burden of  people and facilities that are distasteful to more stable and politically powerful neighborhoods? Whichever is the case, the neighborhoods have disproportionate disease burdens.If  HIV concentrates in certain places, how can understandings of  place be used to quell its devas-tating effects?  “Meeting people where they’re at” has long been a mantra of  public health outreach workers, but the scope of  public health practice may also extend to changing these places.  In ad-dition to red ribbons and behavior change cam-paigns, how might public health interventions confront poverty and other destabilizing condi-tions?  Could economic tactics like advocating for a family wage and responsible expansion of  home ownership the health consequences of  place? How might strengthening local institutions and fostering successful public spaces build social re-lationships that stem the spread of  disease?  While the novelty of  a place-based approach to public health is invigorating, it also has its risks.  Some of  the less stable neighborhoods are already known for their travails; could targeting them reinforce bad reputations or stigmatize place or people?  As always, public health practitioners have their work cut out for them.  MThe authors are grateful to Vivek Shandas (Urban Studies and Planning, Portland State), Sean Schafer (Oregon Public Health Division), Lauren Larin (Urban Studies and Planning, Portland State), and Meg Merrick (Institute of  Metropolitan Studies, Portland State).Moriah McSharry McGrath is a PhD candidate in Urban Studies at Portland State University; her areas of  interest include sexuality, substance use, and infectious disease in the urban context.  mm2348@columbia.eduGretchen Luhr is a PhD student in Urban Studies at Portland State University; her areas of  interest include aging and health in the urban context. gluhr@pdx.edu

Periodic Atlas of the Metroscape: Health and Home: Neighborhood Stability and HIV Outcomes in the Metroscape

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Periodic Atlas of the Metroscape: Health and Home: Neighborhood Stability and HIV Outcomes in the Metroscape

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