The Health of Philadelphia Photo-documentation Project
Carolyn Cannuscio, Sc.D., Eve E. Weiss, M.S., Hannah Fruchtman, B.A., Jeannette Schroeder, B.A., David A. Asch, M.D., M.B.A.
University of Pennsylvania
We asked Philadelphians to tell us about the health of their city. This is what they revealed.
Instead of calling out diagnoses like asthma and heart disease, Philadelphia residents named a host of economic and social woes as the city’s main ailments. We had expected to be shown pictures of children using nebulizers or adults in waiting rooms at doctors’ offices. Instead residents described the city’s physical decline and stories of a fraying social fabric. Perhaps we should not have been surprised: Philadelphia hemorrhaged industrial jobs in the last half of the 20th century, and the aftermath is visible throughout the city. One third of the city's residents fled, leaving the city awash in abandoned homes and shops—more than in any other American city. Rooted in history, the problems remain entrenched today, threatening the vitality of the city and the health of its residents.
“I was here, of course, in Philadelphia when there were the riots in the sixties. And the driving force with that event was…the people who were living in the community felt that they didn’t have any ownership…so they just exploded. There was a disinvestment—period. The tax revenue from the residents there was not that high because it was the area of the city where a lot of the low-income residents reside. And it was massive, and of course when you look at how devastating the effect of change can be over time, you know, it gets worse. It just multiplies. It gets worse and worse and worse.”
On our first day of fieldwork in North Central Philadelphia, our team was shaken by the area’s physical collapse. We passed whole blocks of row homes tumbling like dominoes, we peered into abandoned family kitchens through collapsed walls, and we observed the ghosts of demolished row houses, imprinted like dollhouse cross-sections on the homes still standing next door.
Residents adapt to the dearth of neighborhood resources. The lack of jobs is answered by the call of the streets. And fear of the streets drives residents into the tenuous shelter of their own homes, dissolving the bonds between neighbors and leaving the residents—especially children—vulnerable.
“Unfortunately, there's a lot of children gangs nowadays. Children now are entering gangs as early as nine years old. The Blood and Crips has made it to Philadelphia. I found that out by accident. My nephew told me that a neighbor, a grown neighbor, told him, “If anybody bothers you, let me know. I'm a Crip. I'll help you out.”
The city’s widespread devastation has proven fertile ground for violence. One in ten Philadelphians will be shot at some point in their lives, according to the Firearm Center at the University of Pennsylvania. Not surprisingly, our participants often spoke about the proximity of violence. It shapes their lives and undermines their health.
Interviewer: You saw guns and drugs and the consequences of guns and drugs. What did you make of it as a child?
Participant: Well, you liked it at the time. That was the glory of the streets. Like you see the people who do these things and they have stuff, stuff that you want, cars, money…You know, you kind of idolized the bad guy.
Interviewer: When do you first remember seeing it differently, seeing that there were consequences that you didn’t want to have happen to you?
Participant: One of my friends got killed so that was when I saw it, that’s not what I wanted to be a part of…He was just a victim of circumstances. He was just around in a place where things were going on and he just got shot. And not only that, the reason why he got shot is because one of the guys that we looked up to, they both were running in the house. And the older guy pushed him back out and he ran in the house and my friend was shot in the head.
With supermarkets an expensive cab ride away, residents often turn to the only local food choices: corner markets and Asian takeouts. Both, according to residents, are purveyors of ill health, but not only because of the low-quality food sold inside. These outlets double as vendors of liquor, single cigarettes, and drug paraphernalia—a flammable combination when considered in the context of the race-based hostility our participants report as commonplace in these establishments. Accordingly, residents routinely describe local fast food shops as a site and source of violence in a city where homicide is literally a daily event.
“This is typical of the kind of establishments where the community, they go there to get food. ... They’re open late at night and. ... the way they shutter these places is with steel fencing and when you go inside it’s like a protective glass. It’s like going into a prison or something. And so you shove your money in there and then they shove the food out to you....This is where they go—so that food comes to the house and children, little kids eat it. Everybody eats this food and—this is where they sell crack materials, drug paraphernalia.... They can also buy cigarettes, one or two or three, which is against the law. But they will go in and so this is a whole underground economy here in terms of food, and it’s pervasive.”
The city has responded to blight with the wrecking ball, investing an initial $142 million in demolishing abandoned properties. The city’s hope is that a clean slate will invite development and economic recovery. But residents are skeptical: what they see are homes and neighborhoods being razed. Not only that, but once blight is gone, with fenced green space left in its place, neighborhoods lose the potent visual symbols that testify to the underlying suffering of the community.
“The city came in and tore that property down so now it’s just a vacant lot. And there was no opportunity for the community to have maybe a discussion about properties coming down in the community and okay, when they come down what happens to the space? Can we have classes that could have came through the community center to teach kids how to do landscaping, teach them how to take care of an empty lot, how the lot can be used for learning experiences. None of that stuff happened; they just came down. It’s still an unkempt piece of property, which has now become like an alleyway for drugs and substance abusers who kind of use it at their convenience.”
“We look like we are at war.”
Residents told stories of reclaiming public spaces for the health of their communities. In one powerful transformation, an urban block was taken back from drug dealers and recreated as a thriving community garden. The upside was the neighborhood now had a vital gathering place. The downside: developers also recognized its appeal.
"I have lived there through a period where most of the people in the community were Hispanic ... and when I came to live there in the Seventies, we had that sense of community. In the late Eighties, there was a drug epidemic in the area, and that brought a lot of changes. I mean, we had open-market drug sales. A lot of people were indicted. A lot of people that I knew went to jail. And then, we saw this new wave, this change, this interest in that area. And that was partly private development and also the City trying to address the drug problem. The City and the private developers saw that this was an area, very close to Center City, and that they could capitalize on the location. So they started relocating a lot of the people that lived in that area, 'cause most of them lived in public housing. And that was the type of housing that I grew up in. So a lot of the people were forced out. They were given an alternative, either go to where we send you, which would have been a development or housing project, or you can go and find yourself another house. A lot of people decided to move out of the neighborhood all together. So that chemistry, that sense of community, changed.”
Parts of the city are in an economic upswing, but even “progress” has its costs. Residents repeatedly describe the ways in which places and people are central to their health and wellbeing. In one predominantly Puerto Rican community, residents spoke of their loyalty to the neighborhood, even as they saw it rapidly gentrifying and pricing them out. One woman described the way she saw her “people being pulled out like sweet potatoes, roots and all—and their health has never been the same since.” Some have resisted the change, ardently.
“If you look over there on that wall there is a tree and the words 'aqui me quedo' and that was their saying 'you’re never going to take me out of here—I am going to stay here’.”
Even in a troubled city, residents find their sanctuaries—often literally in houses of worship and sometimes in unexpected places. One woman described the Free Library as her chosen refuge, a place where she retreated to learn English as a child and steel herself against the challenges of immigrant life.
“I think the reason why we came here was for us to have a better chance at life. And that was instilled in me—drilled in me—that’s why I chose to be into books, not a nerd, but to study and better myself. “
Race-ethnic tensions are laced throughout residents’ conversations about the health of the city. Often, the focus is on hostile relationships between proprietors of local shops and the residents they serve (but do not employ). Reactions range from resignation, to “blood boiling anger”—which one resident named as a direct cause of his hypertension—to the resistance described below.
“I remember the store, [the owner] was this big-bellied African-American guy. He knew all the kids in the community. When I came back from college....he had sold the store to some Korean families. They put a Stop and Go to sell beer; and one of the major complaints about the community is that when they do that, then it starts bringing the drug traffic in and they sell the paraphernalia in there. And then it’s just a bad situation all the way around and then the violence starts to increase. What the community did, they rallied together and they boycotted the store and the store never opened. And so that was good for me to see that that was a way that my community took their power back.”
“My dream would be for it to be like natural, the way it was when I was a kid riding my bike up and down the street, running in the trees and stuff like that. My dream for it would be to be at least the way it is now, at least; but at best, where everyone could have a sense of community, where … it’s okay to be cool and be down, but be clean. It’s okay to educate your children … It's okay to let your children interact with other children. It may just be same race, just a little bit different. Or not even the same race because at one time you had even the different, intercultural children would play. You literally could come past the store and see Asian kids or Hispanic kids all out, little kids out throwing the ball or something. My dream would be that everyone could coexist with the same goal, the same mind, even though economically everyone is different. … Keep our children safe, keep our streets clean, vote, do things that we need to do to keep our community intact. That would be fantastic for me. That would be my dream.”
The authors would like to acknowledge the contributions of the following student research assistants:
Nora Becker, Elias Friedman, Rachel-Xialou Hann, Michelle Holshue, Jerome Kaplan, Amina Massey, Aaron Walker and Admed Whitt
