Finding the Right Diagnosis on D.C. Health

Lagging Behind States, District Rates Better Among Cities

At the Developing Families Center, assistant Samaya Jones weighs Makhi Moore. Mother Jamice Hammonds is at right.

By nearly every indicator of disease or condition, Washington is an unhealthy city.

Every year, the District comes up critically short in national surveys. It suffers from the highest cancer death rate for men and women, one of the highest rates of AIDS, and syphilis and gonorrhea infection rates that are more than three times the U.S. average. Its infant mortality rate is among the worst in the country, and life expectancy for black males is less than 60 years.

But look deeper than the surface statistics, which many health officials and epidemiologists say unfairly measure the city against the 50 states. A more nuanced picture emerges when Washington is compared with the nation's other major cities.

"You'll find we're not as bad as we thought," said Gregg A. Pane, director of the D.C. Department of Health, whose job is to make things better.

Pane isn't making excuses. Though on the job barely four months, he knows what he is up against. So yes, the city's syphilis rate is disturbing -- but it is lower than those of Detroit, Atlanta, Nashville and New Orleans. Yes, heart disease claims far too many lives here. But the incidence is even greater in a dozen other cities, including Sacramento, Tucson, Fort Worth, Miami and New York.

According to the 2003 Big Cities Health Inventory, infant mortality has been worse in recent years in Cincinnati, Memphis and numerous other places, while the District's cancer mortality rate placed it 13th among 47 localities.

Nanette Benbow, a public health epidemiologist for the city of Chicago, edited the inventory and believes it is "the only way" to evaluate cities. As she wrote in her introduction, reports that present local data at even county or regional levels "mask the health experiences of the large cities within them."

"There's a certain urban phenomenon -- of poverty, employment, education, access to health care, racial inequality -- that is diluted," she elaborated last week in a telephone interview.

Not all cities value such comparisons, Benbow has discovered. The data can bring unwanted scrutiny. "It's a double-edged sword," she said. "Does everyone want to know the truth?"

Pane answers yes. He maintains that judging the District against its peers -- their problems as well as their solutions -- is not a diversionary tactic. "I want to find out what's in other cities and, if it's working, bring it here," he said.

Since taking office in September, Pane has talked about partnerships with community clinics and the usual health care providers, as well as churches, schools and less obvious groups. He worries that complacency "tends to creep into your psyche" when a situation is consistently bad.

"We have to create a sense of urgency," Pane said.

Because, even by narrower benchmarks, the District has major health problems.

Day after day -- "minute after minute," as physician Aysha Corbett knows -- they walk in the door at the Congress Heights Health Center on Martin Luther King Avenue SE. Pregnant teenagers, drug abusers, men and women suffering from a constellation of infirmities and needing nearly as many prescriptions.