Public Health and Feral Cities

Washington D.C. is not a healthy city. According to an article recently published in the Washington Post, it suffers from the highest cancer death rate for men and women, one of the highest rates of AIDS, and syphilis and gonorrhea infection rates that are more than three times the U.S. average. Its infant mortality rate is among the worst in the country, and life expectancy for black males is less than 60 years.

The “good news” for Washington D.C. is that it fares better when benchmarked against other big cites rather than the other 50 states in the union. However, it points to the worrisome fact that health in our big cities is not uniformly good. This is analyzed in the “Big Cities Health Inventory, 2003: The Health of Urban USA”, published by the Chicago Department of Public Health (CDPH). This report presents comparisons of leading measures of health for the 47 largest cities in the U.S.

According to the Big Cities Health Inventory, almost a third of the United States population lived in metropolitan areas with at least 5,000,000 residents, in 2000. These areas were among the fastest growing, with an 11% increase from 1990.

At the same time, residents of large cities are at greater risk of morbidity and mortality than residents in suburban and rural areas, particularly among minority populations. The increased health risks are associated with indicators such as access to quality medical care, socioeconomic status and discrimination. Other factors such as income disparity and uneven distribution of social and economic resources are also significantly related to poor health outcomes. Poverty poses a risk to human health.

Public health status could be an indicator of more worrisome trends in big cities. Along the same lines as a “failed state”, I’ve been recently introduced to the concept of a “feral city”. The “feral city” would be a metropolis with a population of more than a million people where regional, state or national government has lost the ability to maintain the rule of law within the city’s boundaries – yet the city incongruously remains a functioning actor in the greater international system. In a feral city social and health services are all but nonexistent, yet, the city does not descend into total chaos. Control over various portions would be exerted by criminal gangs, armed resistance groups, clans, tribes, or neighborhood associations.

As befits an essay published by the Naval War College, this topic has been explored to understand the challenges to the U.S. military (of course, we’re watching those challenges being played out today in Iraq). Beyond being a magnet for terrorist groups and criminal gangs, feral cities would be potential sites for pandemics and massive environmental degradation.

This might be is a speculative tale, but perhaps it represents a warning that failing to improve public health indicators in our large cities could be a first step to going feral.