Deindustrialization, Inner-City Decay, and the Hierarchical Diffusion of AIDS in the USA: How Neoliberal and Cold War Policies Magnified the Ecological Niche for Emerging Infections and Created a National Security Crisis

AIDS is well known to have diffused hierarchically among US metropolitan regions, from the larger to the smaller, along national travel routes. Here we relate that diffusion to economic and social policy, by using approaches from population and community ecology and quantitative geography. We find that patterns of deindustrialization driven by cold war policies have interacted synergistically with the ‘planned shrinkage’ hollowing-out of poor minority inner-city communities, and with the canonical national travel pattern dominated by the largest cities, to create conditions for the rapid spread of emerging infections. Application of this model to AIDS explains over 92% of the variance in observed case numbers through June 1995 for the 25 largest US metropolitan regions containing 113 million people. ‘Resilience’ analysis of the empirical AIDS model reveals that emerging infections, social disintegration, and national travel patterns constitute a sensitive ‘resonant eigensystem’ which greatly amplifies the impact of such perturbations as recent draconian welfare ‘reforms’. We conclude that ‘neoliberal’ and cold war policies have eroded the foundations of public health in the USA to the extent that emerging infections, including multiple-drug-resistant tuberculosis, now constitute a serious security threat. Remedies must include significant progressive reforms, which we discuss at some length, to correct a long-term policy imbalance whose consequences have placed at increasing risk a large and growing fraction of the country's population.