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THE SOCIAL AND HEALTH LANDSCAPE OF URBAN AND
SUBURBAN AMERICA, 1990-2000
The Social and Health Landscape of Urban and Suburban America: 1990-2000 profiles the health of the nation’s 100 largest cities and their suburbs. Sponsored by the Robert Wood Johnson Foundation, the project draws from US Census Bureau data and other federal data sources, such as the Centers for Disease Control and Prevention (CDC) and the Federal Bureau of Investigation (FBI) to provide trends on the health and economic status of urban and suburban America. American Hospital Association data were also analyzed for the most recent report. Dennis Andrulis, PhD, heads the project.
A series of reports focuses on the relationships between growing commonality of cities and suburbs. The studies examine the relationship of key population, socioeconomic and quality of life factors with disease and health outcomes in urban and suburban communities.
In addition to published reports, specific city and suburban data and rankings on reported measures are available on this website.
RECENTLY RELEASED REPORTS
I. Hospital Care in the Nation's 100 Largest Cities and Suburbs, 1996-2002: Implications for the Future of the Hospital Safety Net in Metropolitan America
(Go To Report)
Among the greatest challenges for both urban and suburban communities today is the growing difficulty of hospitals to meet the needs of the poor and uninsured as part of their community mission, while surviving economically in a competitive health care environment. At the same time, political pressure is mounting at all levels of government to contain or reduce costs associated with Medicaid, the primary source of health care financing for low-income populations.
This report examines patterns of hospital care in the nation's largest cities and their suburbs using data from American Hospital Association annual surveys for the years 1996, 1999 and 2002. The hospital data were analyzed by two measures: ownership (for-profit, non-profit and public) and level of poverty (low, medium and high) for urban and suburban areas. Our review describes the volume of overall inpatient and outpatient care, including emergency department visits; hospital characteristics such as bed size, average length of stay, and occupancy rate; and three types of specialty care, including the number of level 1 or level 2 trauma centers, neonatal intensive care beds, and positron emission tomography (PET) scanners. Additionally, we examined patient payer mix, net patient revenues per hospital, and the average operating and total margins of hospitals by community poverty levels.
The findings from the analysis of data raise troubling questions about the future of the hospital safety net, particularly for central cities and suburban areas with high rates of poverty.
Publication Released: August 2005
II. Quality of Life in the Nation’s 100 Largest Cities and Their Suburbs: New and Continuing Challenges for Improving Health and Well-Being
(Go To Report)
In the 1970s and 1980s, high crime rates, large and increasing concentrations of poverty, and significantly greater levels of adverse health outcomes were associated with what became known as the "hollowing out? of major American cities. During the 1990s, many large cities and their suburbs saw a significant reversal in rates of concentrated poverty along with increases in per capita income and improvements in key maternal/infant health outcomes, including fewer teen births and infant deaths and earlier entry into prenatal care.
Drawing on data from the U.S. Census Bureau and Federal Bureau of Investigation, this report examines how well the 100 largest cities and their suburbs fared on key quality of life indicators between 1990 and 2000. Cities and their suburban are profiled on the following measures: extreme poverty and concentrated poverty; adults without a high school diploma and adults with any college attendance; unemployment; and violent crime. The cities and suburbs are also separately examined on a unique “social deprivation” index (SDI), which integrates poverty, per capita income, no high school diploma, unemployment, violent crime, and limited English proficiency into a single measure that provides a relative ranking of community well-being. The report also highlights results of correlations for a set of quality of life indicators with measures of racial/ethnic diversity and with measures of maternal/infant health that were conducted separately for cities and suburbs. This information should be useful to urban and regional planners involved with issues around public housing, transportation, urban sprawl, police and fire safety, and education.
Publication Released: June 2004
III. Before and After Welfare Reform: Progress and Remaining Challenges for Poor Families and Children in the Nation’s 100 Largest Cities and Their Suburbs
(Go To Report)
The significant welfare reforms enacted during the 1990s were intended to reduce dependence on public assistance and, at the same time, increase employment among targeted low-income populations. There was hope that this new direction would have important secondary effects such as lower poverty rates and improved quality of life, especially for children.
The varied approaches among states to implement welfare reforms offer an opportunity to provide a unique and broad assessment of the differential impact of state-national policies on the metropolitan areas of the 100 largest U.S. cities. Policy leaders can use information from this report to assess how well the largest cities and surrounding suburbs have been affected by these recent reforms. It is intended to help leaders in recommending potential programmatic or policy changes that could improve the effectiveness of welfare reforms to reach targeted populations in urban and suburban areas.
This report draws from 1990 and 2000 Census economic data (on public assistance, child poverty, single mother families in poverty), and a child well-being index that incorporates CDC data on maternal/infant health indicators (infant mortality, low birth weight, births to teens) with economic data to provide a broad overview of how cities and suburbs progressed over the last decade in light of 1996 welfare reforms.
Publication released: July 2003
IV. Dynamics of Race, Culture and Key Indicators of Health in the Nation’s 100 Largest Cities and Their Suburbs
(Go To Report)
The substantial increase in immigrants and people from ethnically and culturally diverse heritage continues to change the composition of both cities and suburbs. The acceleration of this trend during the 1990s has major implications for health care, education, and social services in greater metropolitan areas.
This report identifies similarities and differences in population dynamics between urban and suburban areas, with a focus on their increasing diversity. Specifically, the report examines the relationship between racial/ethnic population changes—including foreign-born population growth—and health-related factors such as births to teens, low birth weight and early prenatal care rates, tuberculosis, poverty and per capita income.
The information presented is intended to help leaders better understand to what extent racial and ethnic diversity may have a positive or negative impact on health outcomes. This information can supplement other available local data in helping planners determine how to apply or adjust scarce public and private investments in hospitals, schools, social services and community-based service organizations. The goal is for cities and suburbs to better coordinate their resources toward meeting the needs of more diverse communities.
Publication released: February 2003
V. Healthy Cities, Healthy Suburbs: Progress in Meeting Healthy People Goals for the Nation’s 100 Largest Cities and Their Suburbs
(Go To Report)
National Healthy People 2000/2010 goals provide valuable guidance to assess the extent to which communities are improving their health status. Using available indicators for cities and/or metropolitan areas, this report identifies and compares urban and suburban areas that have and have not met Healthy People 2000 goals, how they have progressed over the last decade, and which demonstrated the greatest positive change. City, suburban and/or metropolitan comparisons against Healthy People 2000 and 2010 goals are presented for low birth weight, infant mortality, tuberculosis, AIDS, syphilis, gonorrhea, and homicide.
The presentation of information allows city, county and state leaders, particularly in the areas of public health and health care to view how well their urban and surrounding suburban areas have progressed and currently measure up to Healthy People 2000 and 2010 goals. Leaders can gain a better understanding of which health and disease areas may require more resources to meet Healthy People objectives for 2010.
Publication released: August 2002
ONLINE PROFILES OF CITIES AND SUBURBS
Online profiles are now available that uniquely integrate health, social and economic data on the 100 largest cities and their surrounding suburbs. The website presents rates for 1990 and 2000, and decennial percent changes in population characteristics (health, social, economic, demographic) for cities and their suburbs. Rates for each city/suburban profile are compared to the averages for the corressponding region.
This extensive information resource provides the intended audiences—policymakers, community-based organizations, service providers, and research professionals—with two sets of information: 1) reference/comparison data on populations and health services for planning and monitoring at the local level; and 2) information on key indicators that can assist in describing the social and population dynamics occurring in America’s urban and suburban areas.
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