Little Italy and Canton are two nearby neighborhoods in Baltimore. It's about 1.5 miles from one to the other, either seven minutes by car or a half-hour walk.
But for a newborn baby, the neighborhoods couldn't be further apart. Kids born in Little Italy are more than 10 times as likely to die before their first birthday as those born in Canton.
The death of 25-year-old Freddie Gray has touched off a new conversation about urban inequality, the huge economic and health disparities that can exist within a few miles or subway stops.
Chris Ingraham at the Washington Post recently looked at life expectancy in Baltimore, showing that there are 15 neighborhoods in the city in which residents can expect to live shorter lives than people born in North Korea.
But another, and in some ways more disturbing, disparity emerges when you look at infant mortality, a measure of how likely infants are to die in their first year of life.
Nationally, the United States does quite poorly. For every 1,000 babies born, 6.1 babies will die before their first birthday — the highest rate among wealthy countries. But that average hides shocking disparities between states, cities, and even towns. The infant mortality rate in richer Baltimore neighborhoods like Canton is barely distinguishable from, say, the infant mortality rate in Finland. But according to 2013 data collected by Baltimore Neighborhood Indicators Alliance, in Baltimore's Little Italy neighborhood, about two out of every 100 children die before their first birthday — which puts infant mortality in Little Italy roughly on par with Nicaragua and Uzbekistan.
Some neighborhoods in Baltimore have higher infant mortality than the West Bank
Emily Oster, an economist at the University of Rhode Island, looked at infant mortality in the United States last year. Her research shows that high-income areas of the United States have infant mortality rates similar to European countries.
This shows up in Baltimore, too. If you look at the strip of lighter-colored neighborhoods in the northern part of the city — places like Roland Park and Mount Washington — they have an infant mortality rate just around 3.4 deaths per 1,000 births — slightly lower than France, but higher than Germany.
These are the wealthier neighborhoods in Baltimore; Roland Park, for example, has an average income of $106,770. Less than 2 percent of residents there live below the poverty line.
But there are two neighborhoods in Baltimore — Little Italy and Greenmount East — with infant mortality rates above 20. This means that for every 100 babies born there in 2013, two died before their first birthday. That's a higher rate than you find in the West Bank, Honduras, or Venezuela.
Unsurprisingly, Little Italy and Greenmount are some of the poorest neighborhoods in Baltimore. Average income in Little Italy is $31,547, and 41 percent of families live below the poverty line.
Oster has studied what separates high- and low-income populations in the United States — what might cause the disparities that exist here, but not in Europe. It's not, for example, worse vaccination rates; those tend to be similar among all kids in the United States, regardless of how much their family earns. Heath insurance status could matter, as low-income Americans are less likely to have coverage — and some data does show a correlation between no health plan and higher infant mortality rates.
Infant mortality isn't just about health care
One reason infants might face worse odds in low-income neighborhoods could be that they have worse access to health care at birth. But when Oster compared same-weight babies during the first month of life, she found little difference in outcomes. During those first four weeks, low- and high-income babies had equal odds of survival.
"You might think that lower-income babies have access to worse neonatal care, but we find that the place where there is higher mortality is actually the later part of infancy," Oster says. "When babies get home — when there are accidents and different sleep environments and those types of things — you see differences show up."
Oster's research shows that the most common causes of infant mortality tend to be accidents and sudden infant death syndrome, or SIDS. These are challenges that are difficult to target with specific policy responses — or least those that easily fit within a city budget.
"One thing that has gotten discussion is home visiting, and an effort to follow up with them when they're at home, to think about behaviors to create a safer environment," Oster says. "That's one kind of intervention where there's been some evidence that it works, but it also tends to be resource-intensive and expensive."
Discussions of poor neighborhoods often get caught in debates about responsibility. Some argue that disparities in longevity, for instance, are the result of young men making criminal choices, while others point toward failing urban policies, the destruction of manufacturing jobs, or the devastating effects of childhood lead poisoning. The culprit is contested because, depending on who is to blame, society may or may not morally be obligated to help.
Focusing on infant mortality clarifies the situation considerably: these children did nothing except be born on the wrong side of town, and many of them are losing their lives for it. The children born in Greenmount did not make bad choices, and they should not, in the richest country in the world, be abandoned to an infant mortality rate on par with a violent, developing nation.