US Mayor Article

The Social and Health Landscape of Urban and Suburban America

By Dennis Andrulis and Nanette Goodman
May 15, 2000

While most cities still struggle with issues of poverty, disease, and crime, the first compendium of data of its kind from the nation's 100 largest cities and their suburbs concludes that many of the social population patterns and health conditions once unique to urban areas are increasingly becoming regionalized with metropolitan growth.

The new book, "The Social and Health Landscape of Urban and Suburban America," brings together for the first time information on the nation's 100 largest cities, their counties and their greater metropolitan areas using national data sources, these include Census, the Federal Bureau of Investigations, the Centers for Disease Control and Prevention, the American Health Association and others which reveal dramatic changes occurring in urban populations, crime, teen births, health care, diseases and many other high priority concerns. The book also documents the significant progress made by many areas in combating longstanding conditions in the cities, and helps inform leaders in targeting assistance to improve the lives of residents.  It also presents the effects of urban spread: growing common ground in the social and health changes and challenges facing cities and suburbs.

"The findings raise questions about the wisdom of policy initiatives that are based on outdated assumptions - that cities are dangerous enclaves with intractable social problems while suburbs and exurbs are America's Pleasantvilles," according to the author, Dennis Andrulis, former President of the National Public Health and Hospital Institute. " This report may offer a foundation for collaboration between city and county agencies, and in some cases, suggests the reconsideration of categorical funding policies that do not recognize the critical link between social and health concerns in the cities and their suburbs."

The book offers individual profiles of the 100 largest cities and their suburbs as well as regional and city size comparisons, and seven narrative urban stories on the welfare of children, population growth and disease, crime, health care, rich and poor, age, and race/ethnicity. Its many conclusions suggest new and expanded perspectives on the situation of America's urban areas including:

The value of greater city-suburban service coordination. Rates of violent crime and low birth weight infants in the suburbs are directly associated with city crime, suggestion that these and other health, safety, an social priorities have become regional issues;

Documenting progress in public health. Many cities have seen dramatic downturns in rates of tuberculosis and sexually transmitted diseases that may represent important lessons for those areas struggling to address there conditions;

The need for urban areas to reassess how essential health care services will be available for rich and poor alike.  Over a sixteen year period starting in the early 1980s there has been a 43% decline in the number of suburban public hospitals placing a greater demand on urban health centers and university hospitals;

Differing patterns of poverty in cities and suburbs that require tailored initiatives. The intense concentration of poverty in cities and the diffusion of poverty in the suburbs will continue to place demands on agencies to adapt different approaches to reach the poor.

Copies of the book may be purchased through or AHA press: 1-800-242-2626. For further information about the report, please contact Dennis P. Andrulis at or by phone at 718-270-7726.

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