Lifting Boats Without Closing Gaps

Child Health Outcomes in Distressed US Cities from 1992-2002

Despite national prosperity which improved health outcomes for urban children from 1992-2002, disparities between children in distressed versus non-distressed cities, and between Black versus White urban children, did not improve.

There has been little examination of how “different trajectories of city distress” impact the health of urban populations. This study used census data to identify the 100 most populous U.S. cities and, within that group, the 30 most economically distressed. Researchers then compared select mortality and birth rates of children under age 18 in the distressed versus non-distressed cities, and of Black versus White children in those cities, in 1992 and 2002.

Key Findings:

  • There were dramatic economic and demographic differences between distressed and non-distressed cities in 1992. For distressed cities, the average poverty rate was two-thirds higher; median incomes were 26 percent lower; the labor participation rate was 12 percent lower; and the proportion of Blacks was 2.8 times greater. These differences were largely unchanged by 2002.
  • For most outcomes studied (mortality rates by homicide and non-motor vehicle accidents; infant mortality rates; and rates of birth to children from 10-17 years old), youth in distressed cities were “significantly worse off” than youth in non-distressed cities in 1992.
  • By 2002, there had been improvements in children’s outcomes in both city groups but disparities between the groups had not narrowed and, in some cases, had widened.
  • Black children suffered worse outcomes than White children in both city groups, beyond the disparity accounted for by their concentration in distressed cities.

The authors note youth are affected by services provided by local government which distressed cities are in a poor position to provide. They call for stronger federal and state leadership to address disparities among urban children, as well as for research into how economic ills of political jurisdictions impact health.

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