Mounds of trash on the sidewalk. Used hypodermic needles strewn around parks. Memorials to kids who died from gun violence posted on streets.

That’s what Latino high school students in North Philadelphia walk past in their neighborhoods every day. So when researchers asked them to take pictures of what prevents them from being healthy, the answers seemed obvious to many.

“I don’t feel safe when my community is dirty,” one student wrote in a caption for a photo of trash strewn across the street.

The project was part of an initiative by the Philadelphia Collaborative for Health Equity and Thomas Jefferson University to assess health disparities affecting Latinos living in North Philadelphia east of Broad Street.

Along with the high school students’ photos, researchers conducted focus groups with more than 70 residents and local community organizations, and collected data from the Public Health Management Corporation’s 2018 Household Health Survey. (The student photographers’ names were withheld to protect their privacy.)

The researchers focused on five zip codes, which include the neighborhoods of Frankford, Fairhill, Harrowgate, Hunting Park, Juniata Park, Kensington, and Port Richmond — areas where the life expectancy of a child at birth is 20 years lower than it is for children born in Center City.

“This area represents some of the worst health outcomes in the city,” said Jack Ludmir, executive director of the Philadelphia Collaborative for Health Equity (P-CHE). “We’re trying to address that by going in and listening to find what are the true needs.”

P-CHE's health assessment report focused on the five zip codes in North Philadelphia, which include the neighborhoods of Frankford, Fair Hill, Harrowgate, Hunting Park, Juniata Park, Kensington, and Port Richmond.
Courtesy Philadelphia Collaborative for Health Equity
P-CHE's health assessment report focused on the five zip codes in North Philadelphia, which include the neighborhoods of Frankford, Fair Hill, Harrowgate, Hunting Park, Juniata Park, Kensington, and Port Richmond.

While the report pointed to a number of issues affecting the community, from poverty to low-quality education and little access to healthy food, the one issue that rose to the top was mental health.

Nearly two in five Latinos in North Philly had a mental-health condition, the report found — double the national rate of mental illness.

“Mental health is still fairly stigmatized in Latino communities,” Ludmir said. So he’s glad the community is drawing more attention to it, especially for children and adolescents. “It can really carry a significant burden for the rest of your life,” he said.

The report found North Philly residents are more likely to experience four or more adverse childhood experiences (ACEs), which include events such as parental divorce, having an incarcerated family member, and suffering emotional or physical abuse.

Dozens of large-scale studies have shown that the more ACEs children experience, the more likely they are to have poorer health outcomes as adults, including premature death.

“We are effectively creating a generation of people with mental-health issues,” said one of the residents interviewed by researchers.

A number of factors are driving the mental-health concerns, Ludmir said. Here’s a look at some of the biggest ones — through the eyes of residents, as well as researchers:

The opioid crisis

More than 1,200 people in Philadelphia died of an overdose in 2017, according to the city’s health department. But they’re not the only ones affected by the opioid crisis.

One high school student involved in the photography project wrote that he no longer visits the basketball court he loved while growing up because it’s become a hub for drug sales. Another student photographed a man pulling his pants up on the street after injecting himself in the thigh with heroin.

Dealing with the opioid crisis at their doorstep creates cumulative trauma for these children, the report found, especially in the Kensington neighborhood, which is often considered the heart of the epidemic.

A previous study on college students found knowing people in addiction can affect students’ mental and emotional well-being too.

The neighborhood environment

In a photo titled “Community Destruction,” a high school student captured an old toilet, toppled on its side in front of a pool of wet, decaying trash.

“Leaving trash around the community makes us look like we don’t love our community,” the caption read.

This photo, titled "Community Destruction," is one of several taken by North Philadelphia Latino teens in response to the prompt: What prevents you from being healthy? Trash and a dirty neighborhood environment were common themes.
Courtesy Philadelphia Collaborative for Health Equity
This photo, titled "Community Destruction," is one of several taken by North Philadelphia Latino teens in response to the prompt: What prevents you from being healthy? Trash and a dirty neighborhood environment were common themes.

Several other photographs featured abandoned lots filled with trash and community gardens overgrown with weeds.

The report found that residents felt less safe in areas with trash and graffiti, and the physical deterioration of their spaces made them feel undervalued relative to residents in cleaner neighborhoods.

Previous research has found that renovating vacant lots into green spaces can make nearby residents feel significantly less depressed, and the effect is most pronounced in neighborhoods that fall below the poverty line.

Violence

Exposure to community violence can lead people to develop post-traumatic stress disorder, depression, anxiety, and other mental illnesses.

In Philadelphia, where gun violence is a public health crisis, residents in the study area are exposed to a particularly high volume of death. The rate of fatal shootings there is more than double that of the rest of the city, the report found.

Sexual crimes were 144 percent more common in North Philadelphia than in all other neighborhoods in the city.

Immigration policy

Nearly three-quarters of Latinos in Philadelphia identify as Puerto Rican, and are citizens whether they were born on the island or on the mainland. Yet the report found they are still feeling the effects of national immigration policy and anti-immigrant sentiment.

Many community members recalled seeing their friends or neighbors scooped up by Immigration and Customs Enforcement (ICE) officials. One told researchers, “People are afraid ICE will come after them, regardless of whether they are a citizen or not.”

One student captured the other daily hardships faced by immigrants in a photo titled “Immigrants fighting for survival.”

“I met this guy from Uruguay,” the student wrote in the caption. “His wife is working two jobs and he’s doing what he can to make money without papers: selling metal to the junkyard. How is he and his family going to survive?”

This photo, titled "Immigrants fighting for survival," was one of several taken by Latino high school students in North Philadelphia. As a caption, the student (whose name was withheld for privacy) wrote, "I met this guy from Uruguay. His wife is working two jobs and he's doing what he can to make money without papers: selling metal to the junkyard. How is he and his family going to survive?"
Courtesy Philadelphia Collaborative for Health Equity
This photo, titled "Immigrants fighting for survival," was one of several taken by Latino high school students in North Philadelphia. As a caption, the student (whose name was withheld for privacy) wrote, "I met this guy from Uruguay. His wife is working two jobs and he's doing what he can to make money without papers: selling metal to the junkyard. How is he and his family going to survive?"

Poverty

More than 45 percent of Latinos in the study area live below the poverty line.

The burden of living in poverty, finding housing, food, and employment, all create chronic stress, medical experts say. That stress harms physical health too, leading to higher rates of hypertension, diabetes, and heart disease.

Accessing mental-health care

Latinos in Philadelphia are less likely to receive mental-health services than other demographic groups, the report found.

While there are many organizations that provide mental-health services in the neighborhood, residents said some were of poor quality, and high-quality services often had long waiting lists.

Others pointed to a stigma around therapy that prevents people from seeking care, as well as a lack of understanding that mental illness is treatable and not something you have to learn to live with.

Next steps

Now that the P-CHE report has quantified the problem, Ludmir said the next step is to address it.

Jack Ludmir is executive director of the Philadelphia Collaborative for Health Equity.
Courtesy Thomas Jefferson Hospital
Jack Ludmir is executive director of the Philadelphia Collaborative for Health Equity.

But “it’s naive to think we’re going to solve this issue with one specific intervention,” he said.

The answer has to be greater than bringing more psychiatrists to the neighborhoods. It has to also address violence, green spaces, poverty, and more, he said.

The collaborative has put out a request for proposals for community organizations in the study area to come up with innovative approaches to the issue. Grants totaling $500,000 will be awarded later this year.

The collaborative also hopes to replicate the health assessment and grant process for other Philadelphia communities.