A child who grows up in Pittsburgh, PA with parents who earn in the 10th percentile, ends up, on average, in the 40th percentile based on data from Raj Chetty and Nathaniel Hendren, Harvard, and Patrick Kline and Emmanuel Saez, U.C. Berkeley (interactive graphics by the NYTimes).  These researchers are part of the Equality of Opportunity Project which finds (1) upward income mobility varies substantially within the U.S.  Areas with greater mobility tend to have five characteristics: less segregation, less income inequality, better schools, greater social capital, and more stable families, (2) Contrary to popular perception, economic mobility has not changed significantly over time; however, it is consistently lower in the U.S. than in most developed countries.

Pittsburgh has one of the highest mobility rates compared to Atlanta or Memphis.  As a whole, kids have a better chance rising out of poverty in the Northeast, Great Plains and West compared to the Southeast and industrial Midwest. 

What are the policy implications for these findings? Racial discrimination is playing a role but investment in education and community development will result in poverty reduction and higher income mobility.  Details, details, details.

"We are so desperate for jobs in West Virginia, we don't want to do anything that pushes industry out," said Maya Nye, president of People Concerned About Chemical Safety (excerpt from the NYTimes).  Last week, MCHM, a chemical used to wash coal leaked from a storage tank into the Elk River in Charleston, W. Va. depriving safe water to about 300,000 residents in the "Chemical Valley."
This latest calamity stirs up the classic clash of jobs-vs-the-environment. Drilling for natural gas by hydraulic fracking, New Jersey Pinelands natural gas pipeline and the Keystone XL are just some examples.  The debate pitches industries, towns, workers against environmental groups but jobs seem to trump everything especially when the economy is just dragging.  Of course, the health consequences to environmental degradation is palpable.  A analysis of China’s Huai River policy, which provided free winter heating via the provision of coal for boilers in cities north of the Huai River but denied heat to the south, results in life expectancies about 5.5 y lower in the north owing to an increased incidence of cardiorespiratory mortality. 

It is sometimes difficult to assess the health risks to a community or even when the risk is statistically real, the priority on everyday survival often takes precedence.  We see this in our patients making choices about prevention practices such as smoking cessation, eating healthier or quitting a job that is stressful, physically painful or killing you slowly with toxins over years.  The inertia is overpowering especially when patients have limited options or coping ability and overwhelming pressing needs.  Furthermore, our society feeds on vulnerable people who have a scarcity mindset. 

We should NOT have to trade personal health or environmental health for livelihood and opportunities.  What we need more than technological innovations is social innovations.  Perhaps the chemical spill in W. Va. could be averted with better regulations or economic development that is less dependent on coal and fossil fuel.  We also need to focus on strengthening the public health emergency response, educating ourselves about risk-reducing strategies and engender a collective responsibility for each other well-being as w communities and global growth.  In health care, we call this single-payer!