At the other end of the spectrum are Baltimoreans, who "face the lowest life expectancy of almost any jurisdiction in America," according to a new Harvard study.
Similar disparities persist in many of the nation's high-risk urban settings even when the effects of high rates of homicide and HIV/AIDS are removed, the study found. And the problem does not appear to lie among the very young or the very old.
Instead, the researchers say, the disparities are best explained by chronic health problems among those ages 15 to 59, including cardiovascular and lung disease, diabetes, the effects of smoking and alcohol use, and injuries, all of which are well- understood and preventable.
Joshua M. Sharfstein, Baltimore's health commissioner, said the city "is not where we want it to be." Despite recent gains against HIV, venereal disease and homicides, he said, the city has "very serious health needs."
"The intermediate ages face special risk in Baltimore, and the safety net systems to care for them need to be strengthened," he said. "It's an age group that traditionally gets less support from both government and the nonprofit world, which is naturally inclined to look at kids and the elderly."
The Harvard study "does sharpen the focus on the need to look at the great number of people in the middle," Sharfstein said. "It's a pretty interesting finding."
When the first Harvard study appeared in 1997, Dr. Peter Beilenson, then the city health commissioner, acknowledged serious public health problems. He also said the city was being compared unfairly with cities such as Detroit, Cleveland, Atlanta and Newark, N.J., that, unlike Baltimore, are part of larger counties with more affluent suburbs.