When Mayor Francis Slay announced plans in 2003 to tackle the scourge of lead poisoning, lots of city residents yawned, having heard that promise from previous administrations. But, thanks to Slay’s persistence, the prevalence of childhood lead poisoning in St. Louis has fallen by 80 percent on his watch. Though lead harms children across racial and economic lines, the problem is one example of a health disparity because it is more common among city residents living in older homes in black neighborhoods.

Granted, the Lead Safe St. Louis campaign got an assist from former Sen. Christopher S. Bond, R-Mo., who drummed up federal money to help finance it; and from Grace Hill Health Centers, which did some of the lead abatement work. But the mayor’s initiative is highly regarded for bringing to the table a competent city hall team and a level of success that had eluded some of his predecessors.

Still, his critics are asking what has the mayor done since his lead initiative.

They argue that he hasn’t put similar energy into other health inequities  concentrated more heavily in pockets of north St. Louis. The city’s director of health, Pamela Walker, responds that "we have work to do," but she adds that any city with a high concentration of poverty in one part of town is likely to have more health disparities and more difficulty reducing them.

“It’s not necessarily race related,” she says, “it’s poverty related. The mayor is really concerned about these problem. He and I talk about them nearly every day.”

Although blacks in St. Louis (and across the nation) continue to experience higher rates of death than whites from various diseases, Walker insists that the picture is improving. She reels off lots of data showing positive changes in the city’s black population between 2000 and 2009:

• Heart disease deaths decreased 23 percent.

• Stroke deaths dropped 30 percent, while diabetes deaths were 23 percent lower.

• Prostate cancer deaths dipped 12 percent, and HIV/AIDS deaths fell 34 percent.

• The death rate decreased 14 percent; teen pregnancies fell 26 percent; and gonorrhea infections dropped 53 percent. (Overlooked in her analysis of sexually transmitted infections, however, is the fact that St. Louis continues to have among the nation’s highest rates of chlamydia.)

Walker noted that one indication that St. Louis is doing a better job overall in addressing health needs efficiently is that emergency department services for non-emergencies have decreased 26 percent among the uninsured. That, she says, is due partly to more people having access to care at community health centers during the past 10 years.

Walker also responds to critics by noting some of the city’s health disparities will be addressed more easily if Missouri expands access to Medicaid.

“That is critical,” she says, noting that a special Medicaid pilot program, called the Gateway Health Plan, already had allowed health clinics in the city (and county) to enroll thousands of needy people in Medicaid. But without Medicaid expansion, she says, “this whole thing is in jeopardy. There is no guarantee that we are going to be able to continue the Gateway Project. That’s $23 million coming into this region. That’s also why Medicaid expansion is my No. 1 priority right now.”

Prevention as a priority

Slay has also tried to address disparities, including food deserts, by supporting neighborhood fruit and vegetable markets, such as the one in Old North St. Louis, as well as the Old North food co-op. The administration also is promoting the idea of stocking corner stores with health foods and snacks.

While the north side has more than its share of health disparities, the problems are most acute in just 17 neighborhoods in two ZIP codes -- 63106 and 63107.  They suffer a myriad of social and economic woes, including high crime, too many pregnant women getting little prenatal care, and children whose parents are behind bars.

But hope is about to bloom in those ZIP codes. Several child welfare groups are about to share in a $4.2 million federal grant awarded through the Missouri Department of Mental Health for services to help keep the estimated 1,300 youngsters in these ZIP codes out of harm’s way.

Reversing disparities in those neighborhoods is a big challenge, says Brian Schmidt, a researcher who heads a consulting firm called Mowonk, which is doing research for NorthSide Regeneration, part of the redevelopment proposed by developer Paul McKee. Schmidt argues that the problems in the two ZIP codes are so widespread and harmful to the city’s well-being that addressing the ailments in those two ZIP codes alone would go a long way in reshaping the picture of health disparities in the city.

“These areas rank worse in the city in avoidable hospitalizations, the worst rates of cases of chlamydia and asthma,” Schmidt says. “Bringing jobs to the area is important because the area has the highest unemployment rate in the city, 22 percent. In addition, 47 percent of the residents who are 16 and older don’t own automobiles, which means they don’t always have access to transportation to get to a job.”

He says a project like McKee’s would help address the disparities by bringing jobs and other amenities to the struggling neighborhoods.

Slay's critics say he misses the big picture

Walker concedes that the administration’s work to reduce health disparities has many critics. One is Aldermanic President Lewis Reed, one of Slay's opponents in the mayoral race. Reed says Slay and the health department have been “asleep at the wheel” instead of working harder to close the gaps between the haves and have-nots in St. Louis.

Reed says boosting employment is part of the answer. “Economic development and jobs are key in any community, but this current administration is doing nothing to stimulate our job base,” he argues.

Reed says health disparities are aggravated for those lacking steady jobs. “It means families have less money to buy food and resort to buying high carb, high starch, high sugar foods because those are cheaper and more prevalent. But this consumption can also lead to health problems and end up playing a role in health disparities.”

Some of the working poor also have been hurt, says Reed, by a policy adopted during Slay’s administration to ease the city’s requirment that a portion of entry level jobs under tax increment financing projects go to city residents.

“What that means is that there are fewer jobs available to folks in our community,” Reed says. “I look at this situation as part of the rise and fall of our city. It doesn’t matter whether the health disparity involves the Hispanic population, the African-American population or the white population, we need to make sure that the disparity is addressed.”

The third Democratic mayoral candidate, former Alderman Jimmie Matthews, has criticized both Slay and Reed, saying they both cater to developers and donors who, Matthews say, don’t care about the well-being of ordinary voters.

“Any way,” Matthews adds, “the real problem in St. Louis is economics.” Take care of unemployment, and the disparities will take care of themselves, he says.

Alderman Charles Q. Troupe, D-1st Ward, another critic of Slay, says the administration isn't as aggressive as it should in calling attention to health issues more common among the poor.

“Some sexually transmitted diseases in this city involve children as young as 12,” he says, “but how many times do you recall anybody going to jail for statutory rape? I realize that’s the prosecutor’s job, but it’s also a public health issue, and it shows how indifferent we are to the plight of some young girls, especially on the north side.”

Troupe also called attention to a study, pushed by black aldermen, which concluded that St. Louis was falling way short in addressing health disparities on the north side. Troupe says Slay's administration had failed to carry out any of the recommendations in that report.

Some health experts have said the report was questionable because it equated some north side health conditions to those in Third World countries.  Among those who say the conclusion overstated the problem was Dr. Will Ross, an expert on health disparities, who is associate dean for diversity and an assistant professor at Washington University’s medical school.

Walker was also extremely upset by the Third World reference, saying it wasn’t worth commenting on. She added that some of Troupe’s comments had less to do with concerns about disparities than about the administration’s rejection of his request to place an urgent care center on the north side although Troupe insisted that his real beef was with the administration’s refusal to provide money to carry out some of the study's recommendations.

“There is just no indication (a center) is needed there,” Walker says. “We are not moving in that direction with funding.”

Slay’s camp says that his actions on health issues speak to his commitment to reducing disparities.