While the interconnectedness between racial public health disparities, income inequality, and education gaps has been long recognized by sociologists and epidemiologists, distressingly little has been done by federal and state governments to address it. Meanwhile, income inequality has dramatically increased over the last few years and Americans are facing a staggering lack of intergenerational social mobility.

Political power has been increasingly concentrated in ways that benefit the financial elite, driving policies that favor rich corporate interests. This unfortunate combination has ensured the continued existence of two radically different Americas largely divided along racial lines.

One City, Two Different Worlds

In many ways, Baltimore typifies the patchwork stratification that racially segregates the US. While some of its neighborhoods are home to the wealthy elite, 24% of the general population in Baltimore lives below federal poverty line. Baltimore children are especially affected, the percentage under the federal poverty line is higher at 35%. Meanwhile, 61% of children are considered to be from “low-income” families, as defined by twice the poverty level and compared to the US average of 45%.

Of particular importance is the fact that Baltimore’s depressed economy owes much to its high incarceration rate: One third of those in Maryland state prisons are from Baltimore, giving the city an incarceration rate three times the averages of both Maryland and the nation as a whole. An estimated $220 million in public funds are spent annually to house inmates from just 25 Baltimore neighborhoods (out of a total 55). This is reflected in the 2017 city budget, which sets aside roughly half the amount of funding for education as it does for its police force.

Baltimore is an especially interesting case, as it is emblematic of the intractability of structural racism. While Black men and women have a long history of leadership positions in the city — Baltimore’s first Black mayor, Kurt Schmoke, assumed office in 1983 and its current mayor, Stephanie Rawlings-Blake, has held the position since 2013 — minorities are still underrepresented in crucial public institutions, such as education and law enforcement. Additionally, the surrounding Maryland suburbs boast some of the best public schools in the country and also include affluent African-American communities. Despite these positives, cities like Baltimore still face serious social problems indicative of the need for major policy changes at the federal level.

In Baltimore, the starkest contrast can be seen between the affluent, mostly white Roland Park neighborhood and the poor, mostly Black Upton-Druid Heights neighborhoods less than 5 miles away.

A problem centuries in the making

Despite its current progressive leanings, Maryland has a history of deeply rooted racism that underlies its modern structural inequities. Like much of the US, Maryland’s economy was built on slave labor. The beginning of modern political racism in Baltimore, however, can be traced back to zoning practices. Roland Park was originally created as one of America’s first planned suburbs towards the end of the 19th century. The community’s original purchasing agreement explicitly prevented properties from being sold to Black citizens, a stipulation that was enforced for decades. Later, Baltimore was the first city to officially adopt block-by-block segregation laws, which legally barred Black families from living in certain (usually affluent) white neighborhoods like Roland Park. Later still, the practice of redlining, officially promoted by federal institutions starting in the 1930s, prevented minorities from obtaining housing loans. These early forces, combined with modern economic factors, has left Roland Park nearly as white as it was over a hundred years ago: 79.5% in a city with a white population of only 29.7%.

In contrast, the twin neighborhoods of Upton and Druid Heights (often grouped together during data collection) in Old West Baltimore are a community emblematic of the broken promises of a post-segregation America. What once grew into a prosperous, culturally significant Black community is now desolate, its well-built rowhouses stand boarded up in disrepair and historical landmarks destroyed. Its decline over the last 50 or so years has a complicated history that can be distilled into two major factors: Public policies concentrated large numbers of impoverished Black citizens into a small area while the local manufacturing jobs vital to working-class income were simultaneously moved overseas. As neighborhood crime rates rose, those who had the means moved out. As of 2011, the population of Upton-Druid Heights was 94.3% Black and facing overwhelming poverty.

Years of poor social and economic policies have culminated in a city where two neighborhoods so close in distance can seem like different planets, where there is a life expectancy difference of two decades, and where income disparities average $77,000. This is the reality that Baltimore children face today.

Already left behind

Simple economics place young Upton-Druid Heights children at an early disadvantage. According to Baltimore’s most recent Neighborhood Health Profile compiled in 2011, the Upton-Druid Heights area has a median household income of $13,388, while the average Roland Park household took in $90,492. With the average US household income in 2011 at roughly $50,000, this places each community at opposite extremes of the nation’s bell curve. Roland Park also has a very low unemployment rate of 3.4% (Upton-Druid Heights’ is 17.5%) and a startling 0% poverty rate (48.8% of Upton-Druid Heights households are below the federal poverty line). As a result, kids from Roland Park can expect to receive significantly better nutrition, health care, and pre-kindergarten education. Consequently, only 55.1% of new kindergartners are deemed “ready to learn” compared to Roland Park’s 72.1%.

Other demographic factors also contribute to this early achievement gap. Upton-Druid Heights is home to a disproportionately high under-18 population at 30%, while Roland Park’s is disproportionately low at 19%. (Baltimore’s average as a whole is 21.6%.) This higher adult-to-child ratio is due in part to a single-parent household rate at 47.9% in Upton-Druid Heights vs. just 7% in Roland Park. Differences single-parent household rates, in turn, are linked to the high incarceration rates of young Black men from poor neighborhoods. Ultimately, this means that Upton-Druid Heights parents have significantly less time to devote to their children’s earliest education.

Widening grade-school gaps

The achievement gap only grows as children from these neighborhoods make their way through elementary and middle school. While most affluent Roland Park parents opt to enroll their children in private or charter schools, children who do attend Roland Park Elementary/Middle School enjoy a suburb-like learning experience from one of the top-ranked public schools in the city. Whether publicly or privately educated, children in Roland Park can expect to graduate with the tools they need to succeed: 90.6% of 8th graders in this neighborhood are at or above reading level. Upton-Druid Heights kids cannot expect the same: this area has an 8th-grade reading proficiency rate of less than half that at just 40.6%.

Last year, Baltimore’s poorer school districts were nationally criticized by conservative pundits for spending as much per pupil as more successful schools in wealthier districts. However, critics failed to mention that included in these budgets are federally funded non-educational initiatives, such as free breakfast and reduced lunches, as well as remedial services to help disadvantaged kids catch up. Furthermore, such spending would be impossible without outside funding from the federal and state levels, which constitutes the majority of the budget for poor Baltimore schools. Children in rich districts do not receive the same types of aid because it is unneeded. When per-pupil spending is comparable, that means money in rich districts is instead spent on higher salaries for more experienced teachers, more staff, and higher quality programming.

Also hidden in these seemingly equal budgets are other within-district spending inequities: School budgets in Baltimore are decided using an “average” teacher salary across the board, which includes both the low salaries of novice teachers and the higher salaries of veteran ones. Consequently, schools with more experienced teachers may end up receiving more actual funding dollars than described in the official budget, while schools with inexperienced teachers may receive less. Since Black and Hispanic children are significantly more likely to be taught by first-year teachers, there is the potential for overall less per-pupil spending for students of color. These budgets also do not account for parent-sponsored events at rich schools, such as field trips and sports equipment.

Additionally, poor Baltimore schools have shown measurable improvement since the implementation of free and reduced meal programs, indicating that such public aid is effective in boosting academic achievement. Without these programs, the gap would be even wider.

While the budgeted gross per-pupil spending at poor Baltimore schools may be the same or even more than in rich districts on paper, they provide many more services with that money.

Transitioning into adulthood

After leaving middle school, a teen from Roland Park typically graduates high school and ends up at a prestigious university. Along the way, he or she has likely received hours of private tutoring and is well-prepared for the rigors of college academics. Post-college life is likely to involve a high-paying, white-collar career with a standard of living comparable to that of their parents.

The prospects for teens in Upton-Druid Heights are comparatively bleak. Children who grow up in these neighborhoods often have their first experience with the criminal justice system before they turn 18; the juvenile arrest rate is more than twice the city average and nearly 20 times that of the affluent Roland Park. Like the US as a whole, Maryland has built more prisons in recent years and has seen a reduction in crime overall despite constant incarceration rates. Meanwhile, neighborhoods with the highest incarceration rates have seen a rise in violent crime.

With high unemployment rates and low median incomes, even the lucky residents who avoid the school-to-prison pipeline face an uncertain future. In fact, children of poor parents who grow up in Baltimore statistically make thousands less than their already impoverished parents. High school dropout rates are high and college attendance is extremely low. Without intervention, all signs point to the cycle of poverty in these neighborhoods continuing into the next generation.

Consequences that last multiple lifetimes

A child born to Roland Park parents can expect to live a long, healthy life. Roland Park residents have the highest life expectancy rates in the city at 83 years, over a decade longer than the average Baltimorean. In contrast and unsurprisingly, a lifetime of poverty is a short one. A child born in Upton-Druid Heights has the shortest life expectancy in Baltimore at just 63 years.

A tragic and frequent cause of premature death for Upton-Druid Heights residents is homicide. There were 344 murders in Baltimore in 2015. The vast majority of homicide victims (93%) were Black, and of these mostly young men. Compared to Roland Park residents, citizens of Upton-Druid Heights are 15 times more likely to die from homicide.

Roland Park residents are also significantly less likely to die from chronic preventable diseases, thanks to greater access to proper nutrition, preventive medical care, and adequate health education. In comparison, Upton-Druid Heights residents are 3 times as likely to die from heart disease, 8 times as likely from diabetes, and 20 times as likely from HIV/AIDS.

The intertwined problems of disparities in income, education, and health have a clear and dramatic negative impact on the quality of life for Baltimore residents at the lowest end of all three. Unfortunately, the effective public policies most able to reverse this triple negative feedback loop are rare in the current toxic political climate.

Politics and public health

While a long history of poor public policies have gotten us to where we are today, recent partisan gridlock has ensured that we stay there. In this age of strongly divisive politics, bipartisan support is increasingly rare. An uncooperative conservative Congress has limited the federal government’s ability to address structural inequities in education and health.

Representative of this issue is the 2010 Affordable Care Act spearheaded by the Obama Administration. Although just a small step, the ACA sought to address some aspects of racial health care inequity as part of an overall plan to make health care more accessible to low-income citizens in general. These programs proved successful, and between 2013 and 2015 the uninsured Black population has decreased from 19% to 11%, while the rate of uninsured Hispanic citizens has dipped from 30% to 21%.

However, conservative politicians have repeatedly attempted to repeal or otherwise neuter the ACA, despite the Obama administration’s conscious attempts to create a bipartisan bill. As the ACA drew from legislation written and previously supported by Republicans, such opposition has been rightly viewed as obstructive and contrarian. While a dysfunctional political system has stalled progress, our nation’s most vulnerable citizens continue to suffer from poor health and a low quality of life.

Rethinking Strategy and Refocusing Political Efforts

Conservatives have touted a narrative that the government is unable to address these complex problems, but looking at other developed nations this rings untrue. Historically, successful public health initiatives have required synergy between science and government. Research without resources cannot solve societal problems. Likewise, uninformed public policy is ineffective at best and actively harmful at its worst.

Treating symptoms while overlooking causes

Current strategies are bandages that do not heal the root cause of these issues. To the contrary, they often create more problems down the road by irreparably disrupting lives.

The biggest policy changes that must be made are those related to a criminal justice system that focuses on punishment rather than prevention and rehabilitation. Such strategies have been shown to benefit only those who have a financial stake in the current for-profit prison system. To fight the structural inequities that are the true root of most social problems, we must divert the runaway spending of the prison-industrial complex back to programs that actually work. After all, the per-inmate cost of the current prison system is often greater than drug rehabilitation, GED education, job training, and housing combined. We must stop wasting public money and resources on policies that perpetuate the cycle of poverty damaging the Black and Hispanic community. Programs promoting health and education would do more to reduce crime and increase the average citizen’s quality of life than the current punitive model.

The federal government has taken a step in the right direction with the Justice Department’s recent announcement that it will not renew many of its current private prison contracts. The Justice Department also plans to significantly reduce the scale of continued contracts with the ultimate goal of eventually eliminating the federal government’s use of private prisons entirely. However, this still leaves state prisons able to work with private companies, and these measures may be reversed by future administrations.

Alternative solutions and early interventions

The intense focus on improving high school achievement and college enrollment among Black and Hispanic students to the exclusion of other strategies is another misstep. While such programs are obviously important, the gap needs to be closed earlier, ideally before kindergarten. This can be potentially achieved through earlier childhood health and preschool education initiatives. Access to health care and affordable food for families with young children would be a crucial component of such a strategy.

Curtailing current austerity measures may be the best place to start. Such practices are not only bad for the economy in general but by nature disproportionately hurt the poor who rely on government programs. Austerity policies have also specifically been found to have a negative impact on the health of economically disadvantaged children.

Finally, new programs designed to reduce current gross income inequality have the potential to tackle these issues by giving low-income individuals, especially Black and Hispanic parents, more resources and greater economic power. The most practical tactic would be tax reform to bring America’s post-tax income inequality to levels similar to other wealthy nations. Increased tax revenue from the most affluent citizens would then provide funding for much-needed social programs.

Regardless of specific strategy, the structural inequities that hurt the Black and Hispanic community will remain in place as long as disparities in income, health, and education are treated as discrete issues. To be effective, future social policies must instead use a holistic approach that simultaneously address all three.