Monthly Health Highlights

BAD APPLES AND BAD BARRELS, WHY PLACE MATTERS?

Louisiana suffers from a plethora of  poor statistics: high obesity, high teenage pregnancy, high infant  mortality, high STD (Sexually Transmitted Disease)/HIV rates, high  poverty, high incarceration rates and high murder rates. The South, by  and large, shares Louisiana’s poor outcomes. But even within the region  (and the state), the statistics vary greatly from place to place and from group to group.


African-Americans  suffer from a disproportionate share of our state’s poor outcomes, much  of which can be attributed to poverty and low educational levels.  Well-defined pockets of poverty and poor health outcomes remain easily  identifiable. While individual choices remain critically important, the  environment in which people live has a predictive value on their  subsequent behavior and development.


Poor  neighborhoods have fewer supermarkets and parks, poorer achieving  schools, more crime and correspondingly high rates of STDs, obesity,  hypertension, teenage pregnancy, infant mortality, high-school dropouts  and crime. The inverse is, of course, true of wealthier neighborhoods  creating a disturbing tableau of separate and unequal communities.


The  fact remains that, despite remarkable individual examples to the  contrary, bad barrels produce bad apples and good barrels produce good  apples. While not ignoring the individual apple, the trick for improving  results appears to be eliminating bad barrels. Pockets of concentrated  poverty (sometimes called concentrated disadvantage) encourage poor  outcomes, whether it is a neighborhood, a city, a state or a nation.  Professor Zimbardo, in his famous Stanford Prison Experiment, clearly  demonstrated that the situation in which people are placed (in his case  randomly assigned guards vs. prisoners) can lead to predictable  unfavorable results, what he calls “The Lucifer Effect.”


People  who manage to climb out of poverty by personal initiative should be  congratulated. But reducing or eliminating “concentrated disadvantage”  should be the goal of city planners, policy makers and community  activists. “Bad apples” require disproportionate resources, whether it  be medical care, education resources, incarceration or other expensive  institutionalization. Such resources might be better spent on improving  the barrels in order to increase the number of good apples. Place truly matter and both individuals and policy makers can work toward making all the barrels the best possible.


While  we all can and should make healthy decisions, it is much easier when  the environment in which we live, work, play and worship is conducive to  positive choices. Place really does matter.


Zimbardo, Philip. The Lucifer Effect: Understanding How Good People Turn Evil, January 2008.
Dannenberg, AL, H Frumpkin and RJ Jackson. Making Healthy Places. Island Press, 2011.