Health, Behavior, and Society

Asking the larger questions of prevention

by Darriel Harris

The church I pastor is located at the intersection of the Upton and Sandtown neighborhoods of Baltimore, Maryland. The Sandtown neighborhood is infamous for being the neighborhood of Freddie Gray, a young man who died in police custody by what the coroner ruled a homicide. It is also the site of much of the 2015 violence that occurred in response to Gray’s death.

By most measures, the neighborhoods where I pastor have grave concerns. The life expectancy there is among the lowest in the city, more than 20 years lower than the affluent neighborhoods a couple of miles away. The liquor store density in Sandtown is almost twice the city average, far exceeding the Baltimore neighborhood with the most notable bar district. The tobacco store density is also almost twice the city average. Landlord lead paint violations are almost four times the city average, resulting in three times the city average of children with lead poisoning. The number of vacant lots is more than twice the city average, and the number of vacant buildings is nearly five times the city average. Rat service request rates, where residents call the city to help control rat infestations, are nearly twice the city average. The percentage of the neighborhood without access to healthy food is more than five times the city average.

In addition to these troubling excesses, Sandtown is also lacking in significant ways. It has roughly half the city average of green space. There are no bikes lanes. There are no grocery outlets that regularly stock fresh produce. There are plenty of carry-outs and corner stores, but there are no fast food restaurant chains, generally an indicator of neighborhood economic viability. There are no banks or credit unions within the neighborhood, and ATMs are scarce, expensive, and rarely functional.

Just writing about the systemic realities forced upon my people is exhausting. Could anyone reasonably expect positive health outcomes in such an environment? These conditions, in contrast to the pleasant conditions found elsewhere in the city, are not without consequence.

Putting Prevention in Context

Low-income, black, and urban Christians find themselves in a sort of physical Alcatraz, marooned and locked into an island of destitution where the joys of life so readily available to the general population are kept out of reach but within eye and earshot. The racial component cannot be overstated, for it is the result of deliberate actions and inactions of society. The ghetto is not organic; it is created and sustained. Like a prison, it is the end design of someone never intending to dwell within its confines, the work of collaborators hoping to be kept safe from its contamination.

This is the environment to which I am called. The assignment is simple. It’s to preach abundant life where life diminished is the norm. It’s to speak a true word from God, being a witness to God’s grace and God’s provision. The requirement of truth is the hardest. It requires me to say and do uncomfortable things. Truth forces me to be vulnerable. It compels me to confront my own fears and weaknesses, to speak uneasy critiques to people I love, and to stand and speak boldly before those who benefit from the status quo.

Considering the condition in which my people are forced to live compels me to lament in the fashion of Jeremiah: “Is it nothing to you, all you who pass by? Look and see if there is any sorrow like my sorrow, which was brought upon me” (Lamentations 1:12). Jeremiah wrote “brought upon me” because he didn’t control what was happening, he didn’t control the conditions in which his people suffered. Neither do I. I do not control the neighborhood. I did not design it. I did not cluster poverty in one place; neither did I establish Sandtown to be a place where non-African Americans fear and flea.

I am, however, asked to love it, to admire its strengths and work through its weaknesses. Despite the deplorable conditions which leaders, policies, and society at large have rendered upon the neighborhood, Sandtown is not a valley of dry bones into which I, or some other person of God, must speak life. It is a valley of life struggling to exist in a world that has not heard its cry, has not heard God’s cry, as burden after burden is heaped upon the already burdened. Rather, perhaps Sandtown should speak life to the dry bones surrounding it, bones that have neglected the fundamental moral and Christian call to love neighbor.

Somewhere between the conservative teachings of salvation alone and the liberal thoughts of a realized eschaton is where I find my ministry; embracing orthodoxy while not rejecting wholesale the ideas that God wants something different, something better, something liberating for people in this life.

For my community this is critical. Too many of us have no recollection of freedom, having been in some form of bondage for as long as we can remember—not just for years but for generations. Too many of my people are living in a bondage similar to the bondage of their parents and grandparents. The worst of its implications are that it produces a type of complacency with no expectation of freedom, of health of the whole person—of abundant life.

As well as being a pastor, I am a public health PhD student at Johns Hopkins University. One of the first lessons I learned was that 80 to 90 percent of health outcomes are the result of our surroundings. We call these environmental influences “social determinants.” Social determinants explain the ways our surroundings understandably, and predictably, influence us, oftentimes despite our best efforts. Many of our individual behaviors, ranging from food choice to word choice to clothing style are reflections of our environments. These social determinants extend beyond superficial measures to more serious ways of meaning-making and survival. For instance, children who grow up in surroundings of heavy smoking are significantly more likely to begin smoking than children who do not. Likewise, the long-term well-being of children who grow up in impoverished conditions, where the basics of life are missing or attained through struggle, reflect such an upbringing. To prevent the negative outcomes associated with neighborhoods of high poverty, the conditions of the neighborhoods that cause such outcomes must change. Charity and social programing that does not address the social determinants producing desperation and disease is a Band-Aid over a wound that needs stiches.

The Centers for Disease Control and Prevention (CDC) and Kaiser Permanente conducted a study that developed a childhood trauma scale called ACES—Adverse Childhood Experiences Score. ACES is scored by answering 10 questions about various childhood experiences that may have caused trauma. Adults with scores of two or above show statistically significantly higher instances of physical and mental illness. Many impoverished Baltimore children have scores of six or greater. Perhaps this is why young adult black males who grew up impoverished in Baltimore, on average, make less than their impoverished parents. Baltimore is leading the country in this harrowing income statistic, ranking more closely with war-torn countries than with other American cities.

A Dual Prophetic Role

Perhaps this was why ministering in Baltimore feels familiar to me. My first ministerial assignment was in South Sudan, a newly independent country that was, at the time, recovering from 50 years of internal conflict with Sudan. I created a health education program there explaining the need for pit latrines and mosquito nets in hopes of saving lives. In neither Baltimore nor South Sudan does the church have the luxury of speaking an irrelevant gospel that does not speak to the conditions that suffocate the people. Dr. Martin Luther King, Jr. wrote, “Any religion that professes to be concerned with the souls of men and is not concerned with the slums that damn them, the economic conditions that strangle them, and the social conditions that cripple them is a dry-as-dust religion.” The streets in South Sudan are dusty, but like Baltimore, the religion must not be.

Ministry in such context requires a dual prophetic role. The church must speak life to both the people who suffer and the people who do not.

To those who suffer, the church must be a reminder of God’s love and God’s ability to transform. Congregations must take every opportunity to demonstrate God’s transformative power, praying for miracles and expecting them, striving and sacrificing for small and big changes to bring about abundant life.

The greater challenge is speaking to those who do not suffer. Churches must hold forth reminders that God is just, and that God has not forgotten those whom society may have. As Mary, the mother of Jesus, attests, God “scattered the proud in the thoughts of their hearts … and lifted up the lowly” (Luke 1:51–52). Leaders in health ministries must remind those who do not suffer of the plight of those who do, using all available means to prick their consciences, and pry from their grasp the opportunities which those who do suffer have not been afforded. Our ministries must remind those who do not suffer that sharing resources was the climactic end to the first Pentecost after the ascension of Christ. We ask those who do not suffer to allow God’s will to be on earth as it is in heaven, that all God’s people be able to sup and live together, regardless of income or race, noting that Christ Almighty has loved us all, graced us all, saved us all, and called us all God’s children.

The end goal is a transformed neighborhood and two new persons—a more confident person who has suffered, and a more humble person who has not.

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