We're No. 1 . . .

But did you also know that Philadelphia has the unfortunate distinction of being No. 1 in poverty? That's right, Philadelphia is the poorest big city in the United States — a whopping 27 percent of its population and more than one-third of its children live below the federal poverty level. These are extraordinary numbers, and the impact on poor children is devastating. In Pennsylvania's 1^st Congressional District, which cuts through some of the city's poorest neighborhoods, half of residents struggle to purchase enough food to meet their basic needs,  a story that the Inquirer told in a series of articles last year. In our city of seeming abundance, kids are going to bed hungry and undernourished every night — a situation that has serious consequences for physical and cognitive development.

How could we let this happen? After all, it's yesterday's news that poverty has a devastating impact on both individual and population health.

It was almost 100 years ago that the United States Public Health Service sent surgeon Joseph Goldberger to the American South to uncover what was causing an epidemic of pellagra, an awful and once common disease that progressed from a deforming rash (see photo below) to diarrhea to dementia and sometimes even death. Goldberger discovered, contrary to popular medical opinion, that pellagra was not infectious, and, in fact, was caused by the unhealthy corn-based diet of poor tenant farmers, sharecroppers, and their families. Although Goldberger would not live long enough to learn that pellagra was the result of a vitamin B3 deficiency, he did understand that the disease's cause had more to do with the conditions of poverty than with biology.

I wonder what Goldberger would think of Philadelphia in the early years of the 21^st Century?

Overall, health outcomes in Philadelphia are poor, and it is low-income Philadelphians who suffer a disproportionate burden of these unacceptable results. Philadelphia Department of Public Health statistics confirm that the poorer you are, the more likely you will suffer premature death, and that as a group, low-income African-Americans tend to be worse off than other groups. Another city health department report indicates that Philadelphians living in neighborhoods with a high poverty rate (as compared to those living in low poverty areas) are twice as likely to have low-birth-weight babies, twice as likely to die prematurely, seven times as likely to die from HIV/AIDS, 10 times as likely to suffer from lead poisoning, and 11 times as likely to be the victim of a non-fatal gun shot wound.

To return to the pellagra story: In the 1920s, Goldberger found that brewer's yeast could cheaply and easily prevent the disease. This discovery would eventually help banish pellagra from the annals of human suffering. However, his solution did not resolve the intricate problems of poverty and health that continue to plague our city (and our society more generally) today. In a political atmosphere in which poor people are increasingly stigmatized, can we still muster a response to what might be called the Goldberger Phenomenon — the recognition that poverty and disease are intertwined and can be remedied with considerable resources, ingenuity, and perseverance?

For more on Goldberger and pellagra see Alan Kraut's wonderful book Goldberger's War: The Life and Work of a Public Health Crusader.

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