The Tipping Point

The Tipping Point
by Malcolm Gladwell
CHAPTER ONE
The Three Rules of Epidemics
In the mid-1990s, the city of Baltimore was attacked by an epidemic of syphilis. In the space of a year, from 1995 to
1996, the number of children born with the disease increased by 500 percent. If you look at Baltimore's syphilis rates
on a graph, the line runs straight for years and then, when it hits 1995, rises almost at a right angle.
What caused Baltimore's syphilis problem to tip?

In poor Roy areas this can be an Oy-R problem and hence hidden and deceptive, people would tend to lie about how they got diseases. Also much of their lifestyle would be hidden because of criminalized behavior. Sex can be an Oy predator to R prey relationship or disease can grow in an R contagious situation. Much of this doesn't show up in statistics because it can be insignificant in there. This fringe of society can form where statistics doesn't find signficant enough data to take action leading to chaotic and random influences poorly understood unless it spills over into significance. 

According to the Centers for Disease Control, the problem was crack
cocaine. Crack is known to cause a dramatic increase in the kind of risky sexual behavior that leads to the spread of
things like HIV and syphilis. It brings far more people into poor areas to buy drugs, which then increases the
likelihood that they will take an infection home with them to their own neighborhood. It changes the patterns of social
connections between neighborhoods. Crack, the CDC said, was the little push that the syphilis problem needed to turn
into a raging epidemic.

This is an R infection into more wealthy V-Bi areas, they might also go out to steal or for prostitution. Often they are contained by Oy parts of the O police to push them out of these areas as pests. This kind of policing can be unstable leading to booms and busts of crime from R as well as their contagion into other neighborhoods.

John Zenilman of Johns Hopkins University in Baltimore, an expert on sexually transmitted diseases, has another
explanation: the breakdown of medical services in the city's poorest neighborhoods. "In 1990-91, we had thirty-six
thousand patient visits at the city's sexually transmitted disease clinics," Zenilman says. "Then the city decided to
gradually cut back because of budgetary problems. The number of clinicians [medical personnel] went from seventeen
to ten. The number of physicians went from three to essentially nobody. Patient visits dropped to twenty-one
thousand. There also was a similar drop in the amount of field outreach staff. There was a lot of politics — things that
used to happen, like computer upgrades, didn't happen. It was a worst-case scenario of city bureaucracy not
functioning. They would run out of drugs."
When there were 36,000 patient visits a year in the STD clinics of Baltimore's inner city, in other words, the disease
was kept in equilibrium. At some point between 36,000 and 21,000 patient visits a year, according to Zenilman, the
disease erupted. It began spilling out of the inner city, up the streets and highways that connect those neighborhoods
to the rest of the city. Suddenly, people who might have been infectious for a week before getting treated were now
going around infecting others for two or three or four weeks before they got cured. The breakdown in treatment made
syphilis a much bigger issue than it had been before.

The doctors here can be acting as Iv keeping a lid on these diseases in B people, they often work anonymously as well. It can also be a Bi-Ro community effort to quench the chaos of this disease with cooperatives, they build up enough healthy people in these team communities to isolate the disease enough so it cannot easily spread. So there can be a balance between the Oy police cracking down on these people deterring bad behavior and Ro clinics quenching the R contagion. This is then a balance where the O police watch over both Oy and Ro. When Ro experiences cutbacks the situation becomes more chaotic and can escalate into an epidemic.

There is a third theory, which belongs to John Potterat, one of the country's leading epidemiologists. His culprits are
the physical changes in those years affecting East and West Baltimore, the heavily depressed neighborhoods on either
side of Baltimore's downtown, where the syphilis problem was centered. In the mid-1990s, he points out, the city of
Baltimore embarked on a highly publicized policy of dynamiting the old 1960s-style public housing high-rises in East
and West Baltimore. Two of the most publicized demolitions — Lexington Terrace in West Baltimore and Lafayette
Courts in East Baltimore — were huge projects, housing hundreds of families, that served as centers for crime and
infectious disease. At the same time, people began to move out of the old row houses in East and West Baltimore, as
those began to deteriorate as well.
"It was absolutely striking," Potterat says, of the first time he toured East and West Baltimore. "Fifty percent of the
row houses were boarded up, and there was also a process where they destroyed the projects. What happened was a
kind of hollowing out. This fueled the diaspora. For years syphilis had been confined to a specific region of Baltimore,
within highly confined sociosexual networks. The housing dislocation process served to move these people to other
parts of Baltimore, and they took their syphilis and other behaviors with them."

This is an R neighborhood where much is G public or abandoned property, when this is cleaned out like a hiding place for R insects then they spread out elsewhere to find other hiding places and can take disease with them. So trying to close down R ghettoes and projects can just cause R people to move elsewhere rather than making them change.