It’s not just homicide. District residents on average live dramatically shorter lives than
other Americans. And the government is doing less to help keep them alive.
The slow crawl of the funeral limousine along Morse Street in Northeast Washington means 75-year-old Morine Morris will be going to yet another burial.
“Every week or so, I’m going to a funeral,” Morris said. She lived on this street in the Trinidad neighborhood for nearly half a century. In the last year alone, she has buried 13 members of her extended family.
“Somebody said, ‘Aren’t you tired of going to funerals?’ And I said someone’s got to mourn the dead.”
The succession of rites is grimly common in the District. Often overshadowed by the city’s notorious homicide rate is the fact that Washington has the highest rate of death from disease in the country, helping make the nation’s capital a place where living is deadly and life often too short.
Public fears have focused on homicide, but less noticed is that Washington residents die prematurely from illnesses including AIDS, heart disease and cancer.
And even as life expectancy shortens in the District — in opposition to national averages — the city is making less and less effort to combat the problem. The city has drastically reduced its overall public health staffing and budget. An analysis conducted for The Washington Post by the Harvard Center for Population and Development shows the health threats in the District are not confined to even a few causes.
“It is high death rates just across the board,” said Christopher J.L. Murray, who directs the U.S. Burden of Disease and Injury Study, a collaboration of the Harvard School of Public Health and the Centers for Disease Control and Prevention in Atlanta.
The District’s mortality measures are so consistently at the bottom of almost any listing that even its defenders acknowledge Washington can lay claim as the nation’s deadliest city.
And it is getting worse: The life expectancy for men here has declined by nearly three years since 1983 to an average of 62.4 years in 1995, while nationally, life expectancy for men has inched upward to an average of almost 73 years. The toll of grief from these statistics can be felt anywhere in the city. The Washington Post picked two blocks on Morse Street, an unremarkable area in the shadow of Gallaudet University, to sample the impact.
This was Morris’s street until a few months ago, when yet another death — her mother’s — forced her to move to an apartment a couple of blocks away.
In the 1100 and 1200 blocks of Morse Street, The Post talked to 86 families. Among them and their immediate relatives in the last decade was an accumulation of deaths most suburban communities would find incomprehensible: 16 homicides, eight cancer deaths, six victims of heart attack or cardiovascular fatalities, four AIDS deaths, two premature or stillborn deaths, and one suicide — all younger than 60.
Morse Street is not statistically representative; it is neither the best nor the worst. There are other places in the District where living is harder and dying easier.
But it has felt the consequences of an overall mortality rate in the District that is rarely discussed and too often dismissed as solely a problem of violence. District men have an average life expectancy 10 years less than the national average, and homicide accounts for only 2.7 years of that gap, according to the Harvard analysis.
Health experts seeking an explanation point to Washington’s composition: predominately African American and extensively poor. Hypertension and heart disease are more prevalent in blacks; drug abuse, smoking, obesity, poor diet and bad health habits are typical escorts to poverty.
Black men here are hit hardest by the one-two punch of violence and disease. But whites and black women also have higher-than-average mortality rates. The life expectancy for all women in the District has hovered about the same level for nearly two decades, and in 1995 was 74.7 years, almost five years below the national average.
And the District fares poorly compared even with other urban areas with high levels of poverty and minority communities. An analysis by the Harvard Center of the top 57 cities showed men in Washington have the lowest life expectancy of those in any city.
Despite the high mortality and daunting health care problems, overall city appropriations for public health services decreased to $ 47 million this year from $ 114 million in 1992, according to the District health department.
The number of city workers in health-related jobs also declined drastically — to 248 this year from 1,300 in 1992 — the dual effects of the budgetary crisis and increased privatization of functions such as nursing home care. The city cut four of 15 neighborhood health centers and transferred D.C. General Hospital to a quasi-independent agency. Some experts believe the problem is a lack of coordination.
“We have nine health departments in the metropolitan area that have no plan or way of working together,” said Richard Riegelman, dean of the School of Public Health and Health Services at George Washington University.
Health professionals say the District’s death rate from disease could be reduced if more people saw doctors more often, but 15 percent to 20 percent of city residents lack health insurance.
“It doesn’t matter how good the health care system is if you don’t get there until you are terminally ill,” said Joan Lewis, senior vice president of the D.C. Hospital Association.
Although public health services are important, individual responsibility is most effective in changing risky behaviors, according to Allan S. Noonan, the District’s former public health director.
“I think the biggest payoff is getting men to understand they are vulnerable creatures, to take care of themselves, to eat right, to wear condoms, to exercise, not to abuse substances,” he said.
Particularly worrisome to some health experts is what they regard as a fatalism, a wearied spirit in Washington, that works against healthy habits.
“We ran a round-table discussion about health at Sousa Middle School, and almost every kid there knew of somebody who had been killed,” said Bob Karch, director of the health and fitness department at American University. “In young males, there was a sort of prevailing attitude that they’re not going to live very long.”
“This is a city that is reeling under one attack after another,” agreed Patricia D. Hawkins, associate executive director at the Whitman-Walker Clinic, the leading local agency dealing with AIDS. “We have to help people have a sense of hope again because that’s what causes people to take care of themselves.”
A snapshot of the burden of grief offered up by the extraordinarily high death rates emerges along those two quiet blocks of Morse Street. It embraces both a drug corner and an anchor of longtime, devoted residents. “There still are people trying to keep this community up,” said Leonard Stover, who grew up here and now sees the cadence of funerals as a grim rhythm of the city.
AIDS
James Mathis — the middle child of Freddie and Vera Mathis — was friendly and “always liked to sing,” his mother said. But by the time he turned 17, in the mid-1960s, his mother said, he had exchanged innocence for dirty needles and heroin.
“He was a good kid, but after he got into drugs, he just went off,” said Vera Mathis, who had moved to Morse Street from rural South Carolina in 1959 with two daughters and a son.
“He went to Sousa Junior High School, but he dropped out.”
He contracted AIDS and died in 1996, at age 48.
The District’s rate of AIDS cases in 1997 was nine times the national average and in 1996 was nearly six times that of other large metropolitan areas, according to the D.C. health department. According to the Centers for Disease Control and Prevention, Washington had the third highest number of newly diagnosed AIDS cases of any large metropolitan area in the year ending July 1997, and cumulatively has had about 18,000 AIDS cases.
Patricia D. Hawkins, associate executive director at the Whitman-Walker Clinic, said the District is triply vulnerable. AIDS disproportionately affects gay men, African Americans and drug users, and the District has high numbers of each. Although the chief cause of new infection continues to be homosexual activity, the rates of infection through heterosexual behavior and intravenous drug use are rising.
“Sadly, it’s spreading,” said Jim Graham, executive director of the Whitman-Walker Clinic.
“We just haven’t marshaled the will to muster the resources to really fight this disease.”
HEART ATTACKS
George and Alma Newsome followed their dreams to a two-story red brick home on Morse Street with two small children in the early 1960s.
“It was peaceful. Everybody knew everybody else, and all the kids played together,” Alma Newsome said. But her husband did not live to enjoy his retirement there: The roofer died of a heart attack a year ago at 58.
In the District, as in the country as a whole, cardiovascular disease, which includes heart attack, hypertension and stroke, is the leading cause of death overall. But the District’s death rate in 1995 from all cardiovascular diseases was 219 per 100,000, or 23 percent above the national average, according to the American Heart Association.
“People worry about cancer, but they don’t tend to worry about heart disease,” said Martha Hill, professor at Johns Hopkins University and president of the American Heart Association. “There’s almost an acceptability to it.”
Nationally, African Americans suffer a higher incidence of heart-related illness, so given the makeup of the city “the fact that cardiovascular disease is higher is not a surprise,” said Bernard J. Gersh, chief of cardiology at Georgetown University Medical Center.
But some recent research questions the inevitability of higher cardiovascular disease rates in blacks, suggesting the rates are due to socioeconomic, not racial, differences. Redford Williams, a researcher at Duke University, concluded that the stress often accompanying poverty — particularly from hostility, depression, social isolation and job pressures —
is a likely chief cause of heart disease deaths.
“The question is, how are you going to make poor people living in an inner-city, dangerous neighborhood less depressed?” he said.
But Gersh said the rate of heart disease in the District can be reduced. “There’s a huge amount that can be done,” he said. “Hypertension is treatable. Diabetes is treatable. People can stop smoking. People can exercise. People can modify their diet and obesity.”
CANCER
Despite the presence of several high-quality hospitals, the city’s attack on cancer lags far behind other areas, experts say.
For example, there is no central repository to which doctors report new cancer cases, a so-called tumor registry, said Jon F. Kerner, associate director for prevention and control at Georgetown University’s Lombardi Cancer Center.
“I travel in Africa, and one of the very first things emerging nations do there is set up a cancer registry so they know where to spend scarce dollars,” Kerner said. “They are amazed that the nation’s capital doesn’t have one.”
Such a registry would tell how much cancer is diagnosed, identify areas of high incidence and provide invaluable information about the course of various cancers. Data now compiled by the District’s health department “produces very little of use,” said Lawrence Lessin, medical director of the Washington Cancer Institute.
According to the American Cancer Society, cancer mortality in the District in 1997 was 221 per 100,000 population, higher than any state and 28 percent above the national average of 173.
Two years ago, Walter Strawder, 78, of Morse Street, lost his 49-year-old son to a brain tumor. The death was hard, but “God gives them and God takes them and you have to accept that,” Strawder said. “There is no use in worrying about what you can’t control.”
Medical experts say many cancers can be controlled or prevented. But in studying cancer here, Lessin said, hospitals have a gap of racial mistrust to overcome.
The Washington Hospital Center offered free cancer screening for Hispanics and African Americans recently, Lessin said, but only a disappointing few hundred took part. “It’s the Tuskegee syndrome,” he said, referring to notorious research on black men in Alabama in which nearly 400 were denied treatment for syphilis from 1932 to 1972.
“There’s a lot of antipathy in the community about participating in research,” Kerner agreed. “Whenever you work in an academic medical center that doesn’t have a history of close connection with the community, you’re starting from behind ground zero.”
INFANT MORTALITY
He is 37; she is 35. She has been pregnant twice in the last three years, but the first pregnancy ended in a miscarriage after six months, and the other child was stillborn. For the couple, who asked not to be identified because they did not want their neighbors to know about their losses, Morse Street has been home to heartbreak and disappointment.
In 1996, about 16 of every 1,000 pregnancies in the District resulted in fetal death, a total of 140. An additional 145 children younger than 1 died. The city’s infant mortality rate has been going down sharply this decade but remains twice the national average.
The analysis by Harvard indicated the difference between the District’s high infant mortality rate and the national rate cuts about 1.2 years off the average life expectancy here.
The city has made an aggressive effort to reduce infant mortality, but warning signs remain. There is a proven correlation between prenatal care and infant mortality, and yet one measure of visits by pregnant women to doctors last year found only about half received “adequate” prenatal care, according to the D.C. health department.
The proportion of newborns weighing less than 5 1/2 pounds also shows a correlation to infant mortality, and that proportion increased slightly from 1995 to 1996.
The husband looks around him for an answer: Maybe it’s the trash trucks that travel along Morse Street en route to a waste processing plant, maybe it’s the wafting marijuana that rises at times along the block, maybe it’s the loiterers and the anxiety they bring.
“You are dealing with a lot of stress,” he said.
HOMICIDES
Two grandsons of Morine Morris joined the grim homicide statistics in 1993 and 1995.
The first, a 20-year-old, was gunned down in Northeast Washington when, she said, he “was with the wrong people at the wrong time.” Police say the second, at 18, died after he was shot while attempting a holdup.
Their funerals came early in what has since become her frequent pilgrimage to cemeteries. Some of her relatives “had cancer, some had diabetes, some had long illnesses.” But the young men’s deaths were especially troubling. Morris said she has watched young people from her neighborhood succumb to some of the same temptations that
claimed her grandsons.
Although the District’s homicide rate has dropped recently, so has the population, and the rate per 100,000 remains high.
“These young people are beyond our help; they are set in their ways,” Morris said. “This generation has been left alone for too long because their parents have often worked two jobs just to keep a roof over their heads and something in their bellies.”
A resident of the District was nearly seven times as likely to be a homicide victim as an American in general in 1995, the last year for which such comparisons are available. More than 90 percent of victims are male, significantly higher than in any other of the eight cities with the highest homicide rates studied by the National Institute of Justice.
“Homicide is a public health issue, not just a criminal justice issue,” said Allan S. Noonan, the District’s former public health director.
Life in the Nation’s Deadliest City
District residents face daily risks of violence and disease higher than the national average. The cumulative effect of these factors shaves 10 years from the average life expectancy of a District man and five years from a District woman.
Leading causes of death
District
1. Heart, stroke, cardiovascular disease
2. Cancer
3. AIDS
4. Homicide
Nationwide
1. Heart, stroke, cardiovascular disease
2. Cancer
3. Pulmonary disease
4. Accidents, including traffic
Life expectancy (years)
District
Men 62.4
Women 74.4
Nationwide
Men 72.2
Women 79.3
Many of the nation’s top killers strike the District with a vengeance. Homicide and AIDS, in particular, have a crippling
effect on the city.
. . . AIDS is the leading killer for ages 1-4 and 35-49.
* The District’s rate is nine times the national average.
Rates per 100,000 people
AIDS cases
District 220.2
Nationwide 24.1
. . . Homicide is the leading killer for ages 10-29.
* D.C. residents are seven times more likely to be murdered than people elsewhere in the country.
Rates per 100,000 people
Homicides
District 56.3
Nationwide 8.6
. . . Cancer is the leading killer for ages 45-64.
* The District’s cancer mortality rate is higher than that of any other state.
Rates per 100,000 people
Cancer deathS
District 221
Nationwide 173
. . . Heart disease is the leading killer for ages 65 and older.
* Cardiovascular disease is the leading cause of death in the District, just as it is in the nation.
Rates per 100,000 people
Deaths
District 219.2
Nationwide 177.7
. . . Infant mortality amounted to 145 deaths in 1996.
* The current death rate for the District’s infants is twice the national average.
Rates per 100,000 people
Deaths per live births
District 14.4
Nationwide 7.2
Notes and sources: Leading causes of death: Data from Centers for Disease Control and Prevention; National Center for Health Statistics; D.C. health department; State Center for Health Statistics. Life expectancy: Life expectancy is a theoretical statistic that calculates, for all babies born now, what the average life span would be if death rates for all diseases do not change. That statistic and virtually all other numerical health measures are subject to criticism and debate. Data from Harvard School of Public Health. AIDS: Data from Centers for Disease Control and Prevention, July 1996-June 1997. Homicide: Data from Centers for Disease Control and Prevention, 1995. Cancer: Data from American Cancer Society, 1997. Heart disease: Cardiovascular disease includes heart attack, hypertension and stroke. Data from American Heart Association, 1995. Infant mortality: National Center for Health Statistics, D.C. health department, 1996.
BYLINE: Doug Struck; Hamil R. Harris, Washington Post Staff Writers
SECTION: A SECTION; Pg. A01
LENGTH: 3187 words