The Bureau of the Census has recently defined poverty areas or neighborhoods for the 101 standard metropolitan statistical areas (SMSA) of 250,000 or more population in 1960. (1) (8) These poverty neighborhoods are composed of census tracts which occupied the fourth quartile or poorest position in a national array of the some 21,000 census tracts in these particular SMSA's. Five socioeconomic characteristics based on 1960 census data were used to construct the index: 1. Percent of families with money incomes under $3,000 in 1959. 2. Percent of children under 18 years old not living with both parents. 3. Percent of males, 25 years old and over, with less than 8 years of school completed. 4. Percent of unskilled males (laborers and service workers) in the employed civilian labor force. 5. Percent of housing units dilapidated or lacking some or all plumbing fixtures. In determining poverty areas of each standard metropolitan statistical area, consideration was given to recent effects of local urban redevelopment. A few fourth quartile tracts isolated geographically were not included in the poverty areas.1 In Chicago, the incidence in 1963-65 of prematurity or low birth weight (2,500 grams or less) was 75 percent higher for infants in poverty areas than in nonpoverty areas. Compared with the prevailing rates in the rest of Chicago, infant mortality in poverty areas was 62 percent higher, neonatal mortality 46 percent higher and joint perinatal-postneonatal mortality 52 percent higher. (Table 7.) The contrast between residents in poverty areas and in all other areas was somewhat greater relatively for white infants than nonwhite. Close to one-third of deaths in infancy in Chicago could be prevented if the relatively low risks characteristic of the levels of living of white families in nonpoverty areas prevailed as well for all other infants. In Washington, D.C., similar but somewhat smaller differentials were found between poverty and nonpoverty areas (fig. 4). The infant mortality rate for 1962-64 was 50 percent higher in poverty areas than elsewhere in the District40.5 per 1,000 as compared with 27.0.(1) (9) The incidence of low birth weight was 14.4 percent in the poverty areas, in contrast to 10.7 percent for the rest of the city. Nearly a fourth (22.6 percent) of mothers in poverty areas had no prenatal care, as compared with 8.1 percent in nonpoverty areas. It is also noteworthy that a third of the births in poverty areas were out of wedlock, while in nonpoverty areas the proportion was 12.7 percent. In the absence of special services throughout the mother's pregnancy, mortality of infants born to unmarried mothers has been found to be significantly higher than average. (10) 1 Poverty areas as defined by the Bureau of the Census for the Office of Economic Opportunity correspond without significant difference to such areas designated according to the poverty income standard developed by the Social Security Administration. COMMENT The poverty area designation was developed by the Census Bureau to improve statistical information concerning poverty in the United States in the SMSA's with a population of 250,000 or more. Using 1960 census data, the identification of such areas permits classification of households by their neighborhood characteristics. It is thus possible for the first time to compare characteristics of families living in areas of major concentrations of poverty with those living in other portions of large metropolitan areas of the United States. (1) As illustrated in the case of Chicago and the District of Columbia, grouping of vital events such as births and deaths according to poverty and nonpoverty areas or neighborhoods, results in a marked differentiation of various health indices. Thus, neighborhood rates help to identify geographically the areas where health and related problems are particularly concentrated. Furthermore, the poverty areas, because of the national definition, are comparable among the SMA's; that is, for each area the census tracts were graded on the same five variables, and the resulting composite weights were arrayed to identify the fourth or poorest quartile. Movement of families from one residence to another since 1960 has doubtless altered the composition of neighborhoods in respect to individual families in poverty areas. However, characteristics of the newcomers may not be very different from those who left poverty areas since 1960. Pending revision of the areas following the 1970 census, local studies can appraise the current relevance of the poverty areas based on 1960 data. The sample survey conducted by the Bureau of the Census in March 1966 of families residing in poverty areas showed a continuing concentration of nonwhite families. As pointed out in the survey, other subgroups of the population proportionately overrepresented in poverty areas were families headed by a woman, families with large numbers of related children (five or more), and families headed by an unemployed person or by a semiskilled or unskilled worker. (1) Identification of small areas with excessive risks to health and survival is a vital element in effective State and local planning and implementation of the maternity and infant care projects authorized by the 1963 amendments to the Social Security Act. These projects, which now number 53, make available necessary health care to mothers and their infants in low-income or otherwise deprived families who are exposed to unusual risks. Similarly, health indices for poverty areas, in comparison with other areas of the large SMSA's, will assist the States in extending by 1975 maternal and child health services throughout their jurisdictions, pursuant to the 1965 amendments. If efforts to reduce the high infant death rates prevailing in many parts of the United States are to be successful-and at the earliest possible time a more specific definition of target groups is essential. The attack on this critical national problem must then be joined by program planning which is responsive to the widely-varying needs of this target population. REFERENCES (1) Bureau of the Census, U.S. Department of Commerce, "Current Population Reports, Characteristics of Families Residing in Poverty Areas," March 1966. Technical Studies, Series P-23, No. 19, August 24, 1966. (2) City of Chicago, Board of Health. (communication). (3) Hunt, Eleanor P. and Earl E. Huyck. "Mortality of White and Nonwhite Infants in Major U.S. Cities," Indicators, January, 1966, U.S. Department of Health, Education, and Welfare. (4) Lesser, A. J., C. P. Gershenson, E. P. Hunt, R. R. Bonato, and M. W. Pratt. "Infant and Perinatal Mortality Rates by Age and Color: United States, Each State and County, 1951-1955, 1956-1960." Children's Bureau and Maternal and Infant Health Computer Project, Washington, D.C., 1967. (5) National Center for Health Statistics, National Vital Statistics Division, United State Department of Health, Education, and Welfare, Public Health Service, Vital Statistics of the United States 1964, Volume I, Natality, Section 2; and Volume II, Part B, Mortality, Section 7. U.S. Government Printing Office, 1966. (6) National Center for Health Statistics, National Vital Statistics Division, U.S. Department of Health, Education, and Welfare, Public Health Service, Vital Statistics of the United States 1965, Volume I, Natality, and Volume II, Part B, Mortality (to be published). 30-266-69-pt. 7-53 (7) Office of Business Economics, U.S. Department of Commerce, Survey of Current Business, August 1966. (8) Office of Economic Opportunity, "Maps of Major Concentrations of Poverty in Standard Metropolitan Statistical Areas of 250,000 or More Population," Office of Research, Plans, Programs and Evaluation, October 3, 1966. (9) Okada, Louise M., and William F. Stewart. Health Indices and Poverty Areas, Statistical Notes, No. 2, December, 1966, Department of Public Health, District of Columbia. (10) Pakter, Jean, Henry J. Rosner, Harold Jacobziner, and Frieda Greenstein. (a) "Out-of-Wedlock Births in New York City," Part I, Sociological Aspects, American Journal of Public Health, 1961, 51, 683-696 (May); (b) “Outof-Wedlock Births in New York City," Part II, Medical Aspects, American Journal of Public Health, 51, 846-865 (June). |