Excess Mortality in Harlem

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Abstract
We applaud the article by McCord and Freeman (Jan. 18 issue)* detailing excess mortality in Harlem and wish to plead for an examination of the root causes of the progressive deterioration of health and living standards in the predominantly black inner cities. The escalating use of drugs, the acquired immunodeficiency syndrome epidemic, and inadequate access to primary health care are not surprising in view of our fragmented society, in which this affected segment of the population has not only health statistics inferior to those of Bangladesh, but also minimal opportunity for advancement. Evidence of a failing system of public schools, with low levels of basic numeracy and literacy, is matched by the failure of this population to expect or receive appropriate health education and preventive and curative health services. Low expectations, coupled with poor education and disordered family structure, make using the present inadequate and fragmented health services both difficult and dangerous, because of poor continuity of care, with low compliance and follow-up.

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