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176 9 Fifty Ways to Destroy a City Undermining the Social Foundation of Health Mindy Thompson Fullilove Introduction On the short list of factors that are fundamental to health are adequate food, proper sanitation, clean water, clean air, and social order, the topic of this chapter. Social order does not produce health in the way that Vitamin C prevents scurvy: it is not a silver bullet. Instead, social order produces health by organizing people to work together to solve their common problems. Social order—which links people with different capabilities and needs into a cohesive whole—is the result of people’s efforts to manage their conflicting emotions and behaviors so that a greater good (both personal and collective) may be achieved. People working together can move mountains, drain swamps, build colossal buildings, and unravel mysteries of the universe. It is this collective effort to solve problems and improve the human condition that ultimately creates health. Alexander Leighton,1 a leading social psychiatrist who had extensive experience working with communities in turmoil, argues that a human settlement is a “self-integrating system,” that is, “a patterned and patterning system, with functions and components. Moreover, although the whole is under the influence of its components, it has qualities and characteristics of wholeness which are the synthesis rather than the mere addition of the parts” (p. 196). But absent the patterning of human interaction, he observes, individuals confront each other in confusion , which undermines their well-being. The following proposition guided, and was confirmed by, his classic study of mental health in Stirling County: Given that human society is composed of functioning self-integrating units based on patterns of interpersonal relationship which include communications, Fifty Ways to Destroy a City 177 symbols, and sentiments, it follows that social disintegration will affect personalities in such a manner as to foster psychiatric disorder. (p. 290) While Leighton focused on the link between social disintegration and mental illness , other studies have demonstrated that undermining the self-integrating social unit can lead to increases in many diseases.2–4 The ecologists Rodrick Wallace and Deborah Wallace,4–7 in a major study of the link between social disorder and disease, demonstrated that the destruction of a section of the Bronx, in New York City, led to increases in AIDS, violence, infant mortality, addiction, and obesity. Others have noted that the destruction of the Bronx was also associated with a major cultural transformation signaled by the emergence of rap and hip-hop.8 This example is not intended to suggest that social disruption will always lead to specific diseases—these or any others—but rather to suggest that social disruption will always cause some form of social and health problems. In this chapter, I examine the many ways in which we can observe the disruption of cities and city neighborhoods. The human settlements considered here— ranging from those not usually considered cities to major urban areas—are dense and complex entities. Complexity implies parts. The parts of a city may be defined in many ways. Vertical strata, concentric circles of development, zones of activity, major paths for exchange, and the location of markets are but a few of the useful ways for organizing the components and their linkages. Each part of the city has layers and connects to the developmental process of the whole; each part has multiple , particular kinds of activity and is linked by roads to markets and other points of exchange. The differentiation of the parts creates particular kinds of antagonism , including competition for power and influence. The differentiation of parts also creates interdependencies and mutual aid, which drives the whole toward cooperation . All complex settlements are simultaneously drawn together and pulled apart by the different attractions offered by competition and cooperation. One of the ways in which people achieve coherence in complex systems is through the creation of a set of collective assumptions. As applied to cities this principle is manifest in the development of logic. Whether it is that of the city organized around a castle or temple, or that of the expansive city of the plains that extends from a town square to the horizon, the nature of the logic is less crucial for the organization of the city than is the existence of the logic. Specifically, the logic of the city holds the parts together in a specific, instrumental fashion that is dictated by the major social, economic, and political interrelationships of the people who live in the city. The...

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