San Francisco Chronicle - Wednesday, August 7, 2002
Christopher Heredia, Chronicle Staff Writer

For the country as a whole, the study documented a mixed picture of U.S. urban health trends in the 1990s, including what experts described as ominous signs of declining public health on a few key measures.

The 1990s brought evidence of declining AIDS cases, fewer homicides and lower incidence of sexually transmitted diseases and tuberculosis in many big cities.

But study authors noted that rates of low birth weight rose overall in the nation's 100 largest cities and suburbs, a problem that grew particularly in bedroom communities. Low birth weight is considered a key indicator of future health problems and costly medical care, and so prompted the most concern.

"The rising rates of low birth weight in the cities and especially suburban America serve as a not-so-early warning sign about the health of our next generation," said Dennis Andrulis, a research professor at the SUNY Downstate Medical Center in Brooklyn, N.Y., and lead author of "Healthy People, Healthy Suburbs."

Researchers based the report on census data and information from the FBI and Centers for Disease Control and Prevention. The numbers were compiled to gauge progress toward achieving the government's health goals known as "Healthy People 2000."

The U.S. Department of Health and Human Services set a goal of 5 percent of live births under 5.5 pounds as an acceptable goal for low birth weights.

Experts noted that none of the nation's 100 largest cities and just two of their suburbs -- Stockton's suburban rate of 4.5 percent and Portland's suburban rate of 5 percent -- had met that goal for 2000.

The good news, experts said, included the fact that infant mortality rates dropped by more than one-fifth in cities and suburbs across all regions during the 1990s, inching closer to the goal of 7 deaths per 1,000 live births.

San Francisco, at the low end of the spectrum, had an infant mortality rate in 1999 of just 3.8 percent, compared with 7.2 percent in 1990. St. Louis and Birmingham, Ala., shared the dubious distinction of having the highest infant mortality rate -- 15.8 per 1,000 in 1999.

Dr. Mitchell Katz, San Francisco's public health director, said the city's long-standing policy of sending public health nurses to do home visits for new mothers and babies was part of the reason for the low infant mortality rate.

The study's authors also noted San Francisco's sharp decline in the rate of new AIDS cases, which dropped 67 percent from 132.5 cases per 100,000 population in 1990 to 44.2 cases per 100,000 in 2000, just above the Healthy People 2000 goal of 43 cases per 100,000.

But Katz said he took little solace in that.

"These numbers don't reflect the rise in unsafe behavior we've been seeing in the past five years," Katz said, noting that it takes on average 10 years to develop full-blown AIDS after infection with HIV. "I fear that when we're looking at the statistics in 2010, we're going to be seeing more and more new AIDS cases."

Andrulis and other experts cited advances in technology -- which have enabled premature babies to flourish -- and a rise in the number of multiple births as factors leading to the increase in the rates of low birth weight. Among the report's other findings:

The average increase in suburban rates of low birth weight from 1990 and 1999 was 14 percent -- almost three times the 5 percent increase in cities. Although 14 suburban areas met the Healthy People 2000 low birth weight goal in 1990, only two met the goal in 1999.

San Francisco had a low birth weight rate of 6.8 percent in 1999, little changed from 6.7 percent in 1990. Its suburbs fared only slightly better, with a low birth weight rate of 5.7 percent in 1999, up from 5.1 percent in 1990.

Oakland and Fremont, which were listed together in one category, had a low birth weight rate of 7.2 percent in 1999, below the 7.7 percent the area received in 1990. San Jose's low birth weight rate was 6.1 percent, up from 5.7 percent in 1990, while its suburbs rose from 4.7 percent to 6.3 percent for the same period.

E-mail Christopher Heredia at cheredia@sfchronicle.com.
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