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.

Translating even one sentence is hard! A case study.

A story by Chaim Grade (yes, her husband) excerpted in this week's Yiddish Forward doesn't seem all that interesting from a narrative point of view, or innovative stylistically, but it's lovely writing all the same.

Here's the first sentence.

אונטער די קאַלטע שטיינערנע געוועלבן פֿון קלויז ישן זיצן זקנים בײַ דעמבענע שטענדערס.

Unter di kalte shteynerne gevelbn fun kloyz yoshn zitsn skeynim ba dembene shtenders.

Under the cold stone vaults of the * the old men sit at oaken *s.

Kloyz yoshn is a macaronic phrase, yoshn meaning - of course - old in loshn-koydesh, and kloyz being a smallish prayer- or study-house. "Old study house" doesn't get at it, because yoshn is part of the name here, not an adjective. Maybe Old Study House, but that seems like we're talking about a Society of Friends meeting place. Venerable? Ancient? Neither of those work.

Shtender - that's a common Jewish, or at least Yeshivish word. I think that when Grade is talking about the skeynim (old men, for lack of a better translation) sitting at the shtenders, he doesn't mean the podiums that people daven at, but rather the bookstands that rest on a table. "Bookstands" doesn't sound right, though.

Foreign minister, an office that doesn't really mean much

But Beinart never mentions that Lieberman’s party won only 12.5 percent of the vote.

Right-o! Only 12.5 percent. Because that's . . . wait a minute! That's a significant proportion of the population! Voting for a racist demagogue! (Sorry! A "populist.")

More (if you care) here. From the always entertaining Commentary.

Adventures in Error Bars, Cell Phone Edition

So if you're worried about an exposure, and the exposure is difficult to measure (because, oh, you have no idea what the causal link would be between the exposure and the disease, so you don't know what you're measuring), and you keep doing studies about the exposure, you are eventually going to find a positive result (or weakly positive) because of the nature of chance.

That doesn't mean cell phones cause cancer. It means epidemiology is inexact.

Annals of Yiddish Lexicographical Video

From the talented Leizer Burko, a series of videos based on the life and work of Nahum Stutchkoff, thesaurus-maker and radio-playwright.

What's the benefit of diabetes screening?

Asymptomatic guy, obese, no high blood pressure. Do you screen him for diabetes? The USPSTF says the evidence is Incomplete. "Would a hemoglobin A1C [diabetes test] change your management?" I ask. Always my first question - I'm a skeptic to a fault. "Sure," comes back the answer. "If it was 8, you'd start metformin, right?"

Well, maybe. But that's the problem of the screen. If their number is 8, we put them in the Diabetes box. Then we "know" that we need to get their A1C at 7 . . .

But why do we know that? The evidence isn't so great that 8, say, is all that much worse than 7 with regard to clinical outcomes in an asymptomatic patient without evidence of micro- or macrovascular disease. Yes, if the number were 9, 10, 11, 12, then the answer becomes more and more definite, but you're going to start seeing symptoms somewhere in that range anyway.

[links to come, I hope]

I know I should be angry

We get comparatively low pay for more work than other specialties. The health care system is broken (even with the death panels!). But just today I saw two patients of mine in the hall, and I was happy to see them. I think they were happy to see me. And I get paid for this - a lot more money than other professionals get paid. Maybe I should get angry, but I'm not sure that would help.

Boing Splat Boing Splat

The fish is famous! (But buy it here, not on Amazon.)

X marks the spot

I take issue with Jay Michaelson's premise, well expressed though it is:

Fundamentally, religion works by saying that “if X, then things are okay."

Jay's a spiritualist, so wherever he drills in the rock of religion he finds spirituality. The gut shall rule forever and ever. But plenty of religious people actually believe X. They think X is the real thing. It's called eschatology.

You can psychologize their claims all you want, but there are people out there who believe what they say they do. It would be great if Locke's claim were in accord with the facts on the ground, and we could stick our heads in the sand until the nutsos go away. But - whoever the nutsos are - some of their claims are to be debated on face value. Gay marriage is great. The world was not created in six days. Our Israel policy is not determined by Revelations. And so on.

Tweet, whither wilt?

Half the time I can luxuriate in social media, buoyed by the multicolored sea of human interests & talents. The other half I scroll glumly through lmfaos and #wakeupyourfaceisonfire, thinking that all this is dust.

Hey! Over here! Poetry! Hey! Cold beer! Peanuts! Programs!

I feel like the Academy of American Poets' website focuses on poems and poetry, while the Poetry Foundation website is a bright poodle which has got hold of your pant leg. The Poetry Foundation twitter feed is a poodle which yip-yaps away distractingly at all hours about any text string which includes the word "poetry." A Google poodle.

Just because a thing can be well explicated

...whatever the thing is (poem, movie, course of treatment, political philosophy) doesn't mean it's any good.

Snake!

I turned the stick into a snake.
He said There must be some mistake.

I sang the suffering servant song.
He licked my heel with flicking tongue.

I rent my robe and loudly laughed.
He said I'd rather be a staff.

He crawled away and hissed So long.
I don't know what I'm doing wrong.

What happens if the Sabbath is boring?

Judith Shulevitz says in her new book - and everywhere else she makes her thoughts known - that the Sabbath is an island of tranquility, balm to the torn soul, etc., etc. Yes, but what happens when the Sabbath is boring?

I wonder if the Sabbathian (that's the person who can operate within Shulevitz's permissive, suggested boundaries) has a better answer to the question than the Sabbatarian (that's a more law-bound Sabbath observer, like me). The Sabbathian can say: if you're bored, that's the point! Boredom is something modern people try to escape from, while the Sabbath reminds us that boredom is the absence of things that should not be there anyway. We should not be buzzed and pinged, and their absence should leave space for a mysterium tremendum, not a grande ennui.

But - on the other hand - maybe the Sabbatarians have a better answer. If the Sabbath is boring - well, that's your fault! (Im davar reik hu - mikem: if it's an empty thing, whose fault is that?) The point of the Sabbath is finally eschatological, not sociological. There can be societies which are just, pure, and balanced, and wholly secular, without any need whatsoever of some artificial day of rest. (Indeed, secularists in America and Israel might legitimately scoff at Shulevitz's Rousseauvian naivete.) But no society - on the mystical Jewish view - can have the piece of eternity which the Sabbath affords. Only eternity itself, which is entirely Sabbath.

If you are mystical enough, that eternity could be vouchsafed even if you are on Blogger and Twitter and all the rest of them all the time. As long as you have a direct connection Upstairs.

Why matzah is tasteless

From the Sfas Emes (translated & paraphrased by your host):

How can the wise child ask for the reason behind a Biblically ordained law? It does say in the Bible, "He gives his sayings to Jacob, his laws and ordinances to Israel." There are cases in which one does not understand the reason behind a practice, but by the very practice itself one comes to know the reason nevertheless. Thus is matzah without a taste [טעם]* - so that it can fade into the background, leaving the eating of the matzah itself as the reason. Similarly, the last food eaten at the Seder should be matzah.

*This word can also mean "reason." - ZB

I'm sad...and I don't speak English!

Never fear! Though the New York City Department of Health and Mental Hygiene seems to have pulled the translated PHQ-9 (depression diagnosis) forms off their site, Albion saves the day.