Poverty and segregation: Baltimore versus Manhattan

I asked my cousin, who studies urban planning at Berkeley, the following (the question was provoked by my experiences with patients who come from desperate poverty here in Baltimore, something that I encountered only rarely among my Manhattan patients):

I keep comparing Balto. and NY. with regard to poverty and racial segregation. Can you point me to a good academic treatment of this topic? E.g.: Manhattan is segregated by income, obviously, but is it segregated by race when income is controlled for? And what is more influential in explaining Baltimore's neighborhood patterns, income or race?

I found her answer interesting.

It sounds like you're more interested in empirical evidence than theory (?), but I know more about the theory (and I think the theory is actually more interesting) so I'll start there. The classic debate about urban poverty, race, and segregation is represented by William Julius Wilson on one side, and Douglas Massey on the other. As I understand it, Wilson argues that segregation is at root a structural economic issue, not just a racial issue; Massey argues that segregation is caused primarily by racial discrimination. This debate is still simmering because - obviously - race and income segregation are so heavily intertwined that controlling for one of the other is exceedingly challenging, and even if you somehow distinguish between the two factors you still haven't really explained the black ghetto.

Wilson's first foray on this subject: The Truly Disadvantaged (1987) - also has a recent book out called More Than Just Race

Massey's response (with Denton): American Apartheid (1993)

Good survey of the literature on the causes of inner-city poverty: Chapple and Teitz, "The Causes of Inner-City Poverty: Eight Hypotheses in Search of Reality"

Empirical evidence: I don't know of a good overview or study that anyone considers definitive. A lot of the literature is historic (particularly now right before the new Census data is released). Rather to my surprise I did not find any interesting looking case studies about either Baltimore or Manhattan but maybe I didn't look hard enough.

I was interested to note that when I searched WorldCat and my favorite urban planning database (Urban Studies and Planning: A SAGE Full-Text Collection), most of the empirical studies seemed to be by public health or education folks. See two citations below that look interesting, but are old. The problem with using 1990 or even 2000 data is that we think so much as changed - i.e. the suburbanization of poverty, gentrification of the inner-city, immigration. If I run into anything else I'll let you know.

Coulton, Claudia J., Chow, Julian, Wang, Edward C., Su, Marilyn, Geographic Concentration of Affluence and Poverty in 100 Metropolitan Areas, 1990, Urban Affairs Review 1996 32: 186-216 (link)

Osypuk, Theresa L., Galea, Sandro, McArdle, Nancy, Acevedo-Garcia, Dolores, Quantifying Separate and Unequal: Racial-Ethnic Distributions of Neighborhood Poverty in Metropolitan America, Urban Affairs Review 2009 45:25-65 (link)

Authentic values and real interests: Daniel Sulmasy's new model of end-of-life decision making

These are very brief notes from a talk I attended at the Osler Center Day this past Friday.

Sulmasy presented what he calls the traditional tripartite view of EOL decision making, each part of which suffers from significant defects. The top of the pyramid, the optimum, is customarily held to be the living will (LW). However, living wills are both too vague ("no heroic measures") and too specific ("CPR but no counterpulsation"), involve interpretation of texts, and aren't done by most people anyway (current living-will rates are about 15%, per Sulmasy).

The next best choice is held to be substituted judgment (SJ). Sulmasy pointed out that SJ (a) places significant psychological pressure on families, with attendant sequelae; (b) is difficult to instruct family members in, because its meaning is not really clear; and (c) isn't what most people, when asked hypothetically, want to happen when they're non compos mentis anyway.

Sulmasy pointed out - interestingly enough - that the legal pedigree of substituted judgment goes back to English law, when questions like "What happens when a crazy person inherits a bunch of money?" or "Can a lunatic be made to donate a kidney?" had the courts looking to SJ for answers. (The case law had names like A Lunatic, but I can't remember the references. The big Columbia Law reference which got the SJ ball rolling in the 70s is here.)

Then at the bottom of the heap is Best Interest of the Patient, which no one likes because it's (a) paternalistic and (b) difficult to discern (Sulmasy didn't give (b), but I think it's obvious).

Sulmasy made the point that while LWs are supposedly optimum, everyone acts like Substituted Judgment is better.

So what's the better model? Consider the patient as a person, says Sulmasy, and think of the authentic values of that person. Then take into account, further, the clinical facts of the case. Then, keeping in mind the real interests of that person in light of their values and the facts of the case, try to come to a decision which respects all of those.

This is where my paraphase probably falls flat. But the key here that Sulmasy emphasized is (a) the neo-Aristotelian nature of his enterprise, i.e. emphasizing full flourishing; and (b) the skepticism of Sulmasy towards "Western, liberal" thinking which values autonomy above all else.

Another word for mustard

That's not how the word is pronounced, I hissed.

But the damage was done:

You tore the tongue out from every martyr

because you could not say the word for mustard

I taught you a week ago.

Torturing them over again

when we tell jokes about old men and fish

or different words for penis.

Am I wholly serious here? I'm not

serious enough. Reread the page.

Learn my name in the language

I want to speak. Silence

is the deadest tongue.

Great Literature, defined

My son* has developed a theory of what makes a book good. It is very simple.

1. A book is good if it includes a fire truck.

I tried to review my knowledge of world literature with this aesthetic in mind, but I discovered how little I remember.

Is there a fire truck in Ulysses? Probably somewhere (yes it does yes, says Google). The Bible doesn't make the cut, unfortunately, and I don't remember any hoses and ladders in Proust - not that I've finished him off. I bet there are a lot of fires in Sholem Aleichem, but in his time it was probably all about horses and bucket brigades.

This is going to be a big paradigm shift, I can tell.

*Who is two.

Larkin in Yiddish

This Be The Verse.