Clean Streets and Safe Sex

Could fixing the "broken windows" syndrome help Sacramento reduce its chlamydia and gonorrhea rates?

Several years ago I led a four-year, multi-professional, public health-oriented study of the literature on violence. I learned about James Q. Wilson's work in modern criminology and his convincing connection between crumbling neighborhoods and rising crime. ¹

Wilson had written, "If a broken window is unrepaired, all the windows will soon be broken. Broken windows are a signal that no one cares." The journal article ²

The authors of the JAPH article rated housing and street conditions (broken windows, graffiti, litter, abandoned cars) and the physical condition of the high schools that served each of 55 block groups in New Orleans.

They mapped all cases of gonorrhea between 1994 and 1996 and calculated aggregated case rates by block group. Using data from the 1990 census and the 1995 update, they determined the association between "broken windows," demographic characteristics and gonorrhea rates.

They found that "the broken window index explained more of the variance in gonorrhea rates than did a poverty index measuring income, employment, and low education. In high poverty neighborhoods, block groups with higher broken windows scores had significantly higher gonorrhea rates than block groups with low broken windows scores."

They concluded that there is a dynamic relationship between physical deterioration of a neighborhood and the risk of gonorrhea, but left for further study whether the relationship is a causal one and, if so, which causes which.

The JAPH editorial found the findings "intriguing" and asked, "Would aggressive campaigns to clean up deteriorating neighborhoods encourage residents to take better care of their immediate surroundings and of their own health?" ³

It criticized redevelopment efforts that scatter poor people from their deteriorated homes rather than rehabilitating and maintaining those homes. It called for housing and redevelopment planners to add the medical principle of doing no harm to the three basic principles of housing policy.

The first principle in housing is that shelter is a fundamental necessity, providing protection from the elements, storage for food, water and other essentials, and a place for organizing the communal life of a household.

The second principle is that each housing unit is set in relation to other housing units, creating a physical infrastructure for group life. When this "clustering" is disrupted, "many changes in individual and group functioning follow," with demonstrable association with disease.

Third, housing provides a "home," an important "object of attachment and...a source of identity," even for nomadic groups.

Community or neighborhood policing in Sacramento has already involved neighborhoods in fixing windows and other unsightly structural damage, removing litter and garbage from the streets, and removing abandoned cars. If the neighborhoods with high rates of gonorrhea and chlamydia also show a high "broken windows" index, should we fix the physical deterioration along with treating and educating the neighbors about STD?

Ed_Rudin@macnexus.org

References
1. Wilson JQ, Kelling GL. Broken windows. In Critical Issues in Policing: Contemporary Readings, ed. by Dunham & Alpert. Waveland Press Inc; 1989.
2. Cohen D, MD, MPH, Spear,S, MA, Scribner, R, MD, et al. 'Broken windows' and the risk of Gonorrhea. Am J Pub Health, Feb 2000, 90(2); 230-36.
3. Fullilove MD, MD and Fullilove III RE,EdD. What's housing got to do with it? Ibid; 183-84.