Pride of place.

Photographer: Ron Haviv / VII for Bloomberg

The Baltimore Solutions

Mark Whitehouse writes editorials on global economics and finance for Bloomberg View. He covered economics for the Wall Street Journal and served as deputy bureau chief in London. He was previously the founding managing editor of Vedomosti, a Russian-language business daily.
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The death of Freddie Gray shocked a nation in a way that his life did not. Nonetheless, it's important to know how Gray lived as much as how he died -- because his story illustrates how hard it is for the residents of Sandtown-Winchester, his neighborhood in West Baltimore, to succeed.

Gray was born prematurely to a mother who said she couldn’t read and had been a frequent heroin user. Court documents suggest he suffered severe lead poisoning from the crumbling paint in his childhood home. When he was old enough to have finished high school, a psychologist assessed his academic ability at the third- or fourth-grade level. His criminal record began less than two months after his 18th birthday, narrowing whatever job prospects he might have had. Not long after that, he did a two-year stint in state prison.

The upcoming trials of six Baltimore police officers will focus attention once again on how Gray's life ended so abruptly in their custody (he died on April 19, at the age of 25, after suffering a spinal-cord injury and falling into a coma). Rightly so: Anger over police conduct helped to spark the city's first riots in almost five decades. Any examination of Sandtown must include a careful review of police training and tactics.

That said, it's also crucial to understand why lives like Gray's remain so common in poor, predominantly black neighborhoods throughout the U.S. Tens of millions of dollars -- public and private -- have been devoted over the years to alleviating poverty in Sandtown. Yet it remains among the worst places in America to live and grow up. Why?

A big part of the problem is a long history of economic decline, neglect and outright discrimination. Local and federal policies crowded blacks into neighborhoods with poor services and denied them credit. Manufacturing and waterfront jobs disappeared. Drugs fueled crime and violence. All this created an environment that made escaping poverty increasingly difficult.

Turning things around requires the kind of sustained and comprehensive attention that neither the political system nor the market is well equipped to provide. Newly elected officials want to start new programs, often without assessing the old ones. People in poor neighborhoods tend not to vote. Even the most civic-minded business has to make a profit. Philanthropies can never completely bridge the gap.

Moving families to better neighborhoods can help, but it can’t be the only answer. The many derelict homes in and around Sandtown attest to the effect on those left behind.

There is no simple solution, no giant anti-poverty machine that someone forgot to plug in. Rather, there are dozens of smaller ones that require constant care and maintenance. Though it may not be apparent amid the din surrounding the riots and police trials, some exist in Sandtown. It's worth taking a look at those that might have had an effect on Freddie Gray -- grassroots initiatives that have the potential to improve people's health, education, security and standard of living.

*****

Let's start with education.

As of 2013, less than half of eighth-graders in the Sandtown area qualified as proficient in state reading tests, and about a quarter in math. Fully 43 percent of high-school students were chronically absent. Almost a quarter of 12th-graders didn't graduate. Those who did were often woefully underprepared for college.

Asked what he would do if he could start from scratch, Federico Adams, principal of Sandtown's William Pinderhughes Elementary-Middle School, has a ready answer: Hire the most talented teachers, extend the school day, offer intensive tutoring for kids falling behind and set high expectations with individual study plans. As it happens, his intuition coincides almost precisely with what economists Roland Fryer and Will Dobbie have identified as the attributes of successful charter schools -- institutions that receive public funding but are free from many public-school constraints.

Photographer: Ron Haviv / VII for Bloomberg

Federico Adams: "What keeps kids from learning is generally not a kids' issue. They are already behind when they get to school."

Unfortunately, Maryland is not friendly to charter schools. Thanks in large part to union lobbying, state rules leave them very little room to innovate. They can’t hire and fire teachers at will, they have to follow union pay scales, and they suffer a funding disadvantage compared with public schools -- drawbacks that a recent reform effort by Governor Larry Hogan, a Republican, has done little to alleviate.

Until state policy changes, the challenge will be to help kids succeed in the existing system, in part by addressing what happens outside school. Among the crises Adams has faced: convincing a pregnant sixth-grader -- and her parents -- not to give up on her education, and finding clothes for a boy who showed up barefoot for his first day of classes. 

At Pinderhughes, some programs appear to be making progress. Home Instruction for Parents of Preschool Youngsters employs home visitors and a 30-week curriculum to get parents involved in building their children's cognitive and literacy skills -- an approach that research has shown, and Adams agrees, can improve performance well into elementary school. Meanwhile, the Enterprise Women's Network offers mentoring for about 40 Pinderhughes girls, introducing them to women in various careers, teaching them about college and taking them on field trips aimed at expanding their horizons.

Photographer: Ron Haviv / VII for Bloomberg

Tina Hike-Hubbard, creator of the Enterprise Women's Network mentoring program in Baltimore, with mentee Raahmia Davis, now 22 and an aide to a special education student. "She always wanted me to have plans," says Davis.

 *****

Getting support at home, though, can be difficult. Children in Sandtown typically lack one of the most valuable assets a kid can have: two involved parents. As of 2013, less than 10 percent were living in married-couple families, according to the American Community Survey. That compares with 38 percent in Baltimore and 69 percent across the U.S.

Time and again, research has shown that family structure plays a crucial role in the success of children and entire communities. But keeping low-income parents together isn’t easy.

Consider the experience of Otis Buckson, a program manager at the Center for Urban Families, just a few blocks north of Sandtown. One recent evening, his counseling group included an unemployed couple, parents of a 1-year-old boy, who had failed to show up at a job fair that afternoon. One had thrown away the flyer, the other had forgotten the time. A heated discussion ensued, leaving Buckson struggling to keep the session together. Many of the couples he deals with, he says, have never seen what a functional family looks like.

Photographer: Ron Haviv / VII for Bloomberg

Otis Buckson, manager of the Couples Advancing Together program at the Center for Urban Families: "Most of them have never seen what a nuclear family looks like."

Discrete shifts in policy could make the job easier. The government, for example, demands reimbursement from absentee fathers of children who receive public assistance, on the grounds that taxpayers shouldn't step in for deadbeat dads. This makes sense, but the child-support debt accrues even if the father has no income or is in prison, and is then garnished from any wages earned -- discouraging employment and making it hard to provide for a family. Fathers who want to start supporting their kids should be able to get the arrears written off, something the Center for Urban Families has been working to help them do.

A more radical approach is to redefine the family. That's what Sarah Hemminger, then a graduate student in biomedical engineering at Johns Hopkins University, set out to do in 2004. Unable to ignore the contrast between the affluent university and nearby Paul Lawrence Dunbar High School, she persuaded the principal to let her work with his worst-performing ninth-graders, kids who typically had little support at home and were most at risk of dropping out. The effort grew into Thread, a program that provides each participant with several volunteers who help with homework, transportation, lunches -- anything a parent might do. The broader aim is to build a community that transcends borders of race and class.

Photographer: Ron Haviv / VII for Bloomberg

Sarah Hemminger: "We're not trying to fix kids. We're building a diverse and equitable community."

Recruiting so many volunteers for each student is less daunting than it might seem, Hemminger says: People feel more comfortable joining a larger group whose members can cover for one another. So far, the results have been impressive. Of the 47 kids who joined the program at least five years ago, all have completed high school, and 37 have gone on to college. Thread now has more than 750 volunteers, with 207 students and alumni. It operates in three high schools, including Frederick Douglass just north of Sandtown.

*****

When it comes to health, Sandtown is a dangerous place to be.

In 2013, life expectancy at birth was 69.7 years, almost a decade less than the national average. The infant mortality rate was somewhere between that of Sri Lanka and Uruguay. In West Baltimore, people are hospitalized for diabetes and cardiovascular disease at about double the statewide rate.

Some unconventional programs are trying to help by targeting problems where they start, outside the hospital. Helen Owhonda, for example, is one of several community health workers employed by a local clinic called Total Health Care. She remembers finding a 65-year-old woman with diabetes, hypertension and heart issues living in a house without heat or electricity in the middle of winter. She managed to get the power and heat turned on, and the patient later moved into a more manageable home.

Photographer: Ron Haviv / VII for Bloomberg

Helen Owhonda: "Some people need other people to encourage them, to know that somebody out there really does care for them."

People like Owhonda can save health-care systems money by cutting down on expensive drug treatments and emergency-room visits. Still, Total Health has struggled to find funding for the community workers, who must depend on a patchwork of charities to address issues such as unpaid energy bills. A more sustainable approach -- and one that can match the magnitude of the need -- would be to tap federal spending under Medicaid, the program for the poor. A series of pilot programs, begun under Obamacare, are already doing so by, for example, paying for transitional housing in the Bronx. The aim is to improve health without increasing spending.

Doctors -- or the lack thereof -- are another problem. West Baltimore has just 25 primary care physicians per 100,000 people, compared with 114 per 100,000 people statewide (as of 2014). One challenge is to get more minorities into the profession: They are more likely to practice in underserved communities and in some cases produce better outcomes for patients.

Enter Tyler Mains, a student at Johns Hopkins School of Medicine. He has set up a program called Merit that takes underrepresented 10th-graders and gives them three years of intensive training for careers in health care. The magnitude of the need hit him when he was teaching biology at Carver Vocational-Technical High School, the institution Freddie Gray attended: One of his students chose to limp in pain rather than take his swollen knee to a doctor, explaining that the nearest clinic was two bus rides away.

Of the 58 students Merit has accepted since it started in 2010, almost all have stayed in the program. Of the 21 who have completed the three-year high-school component, 18 are attending four-year universities.

Photographer: Ron Haviv / VII for Bloomberg

Since joining Merit in January, Branecia Bull, a 16-year-old from Sandtown, has boosted her grades at school to A's and B's from D's and F's. She says she wants to become a trauma surgeon, a choice driven in part by personal tragedy: By her count, at least 10 men in her extended family have been shot. "The sense that you can really help somebody live, there's nothing better than that," she says.

 *****

For all this to work as well as it can, people must feel safe. And living in Sandtown can be like running a gantlet. Thanks in large part to gun violence, people from the ages of 25 to 44 are more than twice as likely to die as those in the rest of the U.S. Those who survive commonly end up in the criminal justice system: As of 2010, the neighborhood had more people in state prisons than any other in Baltimore -- at a cost to taxpayers of $17 million a year.

Baltimore's handling of the April 27 riots reinforced the perception that authorities are focused on containing the community, rather than serving and protecting its residents. Bus routes that could have taken people out of the area were canceled, causing a crowd to build. Officers stood by as businesses were burned and looted. Afterward, foot patrols that residents had fought to establish disappeared amid concerns about officers' safety. This year, for the first time this century, the number of homicides in Baltimore exceeded 300.

A strategy built too emphatically around anti-drug efforts not only fails to reduce violence, but also has unintended consequences. Of almost 800 arrests recorded in 2014, more than half involved possession of drugs, including marijuana. Although such arrests can snare serious offenders, they start a booking process that can also trap the innocent. Those too poor to make bail sometimes spend months in detention awaiting trial. Unable to attend to responsibilities such as work, rent, car payments and child support, they can end up jobless and deep in debt. Some accept plea deals just to get out, creating criminal records that complicate future employment.

Photographer: Ron Haviv / VII for Bloomberg

An arrest in progress on the southwestern edge of Sandtown. Such arrests lead to a booking process that can have dire consequences even for the innocent. 

Baltimore's recent history suggests a way forward. In the late 2000s, the city de-emphasized drugs and focused intensely on gun violence. The police registered known offenders, put them on notice that shooters would be pursued relentlessly, created elite units to conduct investigations, and -- in collaboration with state and federal prosecutors -- followed through by extracting the most violent criminals from the community.

Meanwhile, officers received a kind of training that remains too rare. Entire squads spent a month learning skills such as how to handle suspects without resorting to lethal force, and getting to know people in the neighborhoods they patrolled. 

The effort faded after the resignation of Mayor Sheila Dixon in 2010, but not before producing some encouraging results. One study found that the focused gun deterrence (which has been successful elsewhere) significantly reduced homicides and nonfatal shootings in the areas where it was deployed. Touchy-feely as the training may seem, police praised it, saying it sharply improved community relations.

Incidents of police brutality still occurred. Reducing them will require more vigilant supervision, more emphasis on training, and giving residents greater power to hold police accountable.

Much more can and should be tried. Seattle, for example, has circumvented the detention process by authorizing officers to send low-level drug offenders directly to rehabilitation instead of booking them -- with the threat of charges providing an incentive to make progress. Also, Maryland's recruitment strategies could use some updating: The state rejects candidates who can't convince a lie detector that they haven't used marijuana anytime in the past three years or more than five times since turning 21 -- a requirement that rules out a large portion of college graduates and military veterans.

With all the federal attention being paid to Baltimore, the new police chief, Kevin Davis, may be able to marshal the resources needed to get started. He faces a monumental task: In poor, black neighborhoods across the U.S. -- and particularly in Sandtown -- it will take years to restore trust between the police and the people for whom they are, for better or worse, the most visible face of government.

*****

The foundations of a rewarding life are the same in Sandtown as anywhere else: safe neighborhoods, supportive families, good health, decent education, gainful employment. Some programs are demonstrating that they can help. What they lack are scale, evidence and staying power.

Taken together, Thread and Merit -- the programs aimed at providing high-school kids with support networks and preparing them for careers in health care -- are serving fewer than 300 people in a city of more than 600,000. Many initiatives, such as the Enterprise mentoring program, haven't done the kind of controlled assessment required to demonstrate that their participants are better off than they would be otherwise. All face the challenge of operating with uncertain or politically vulnerable funding.

What's needed is a radically better system to identify what works, stop wasting money on what doesn't and help entire neighborhoods reclaim themselves. That will require rethinking the way governments -- federal, state and local -- allocate taxpayer money. Together, they spend almost $1 trillion a year on programs aimed largely at benefiting the poor. An additional $80 billion or so goes to incarcerating more than 2 million people.

What if governments made some of that money available to anyone who could do a better job? In other words, what if any program that demonstrably saved taxpayer dollars -- by, say, keeping people out of prison or off welfare -- could get a portion back? There needn't be any downside risk. Such social entrepreneurs would have to find their own seed funding, most likely from philanthropies, until they had built a track record. They could then qualify for government support, on the condition that they regularly produced reputable third-party research confirming their value.

Such a system would have multiple benefits. It would, by definition, reduce government spending. It would attract more minds to the task of addressing entrenched poverty, creating a market for ideas. Philanthropies would be more willing to invest in initiatives that were more likely to receive longer-term funding. The research would create a body of knowledge that could be applied across the country. Programs that constantly had to prove their value would be much harder for politicians to kill (and those that couldn't would be easier to kill). With the right incentives, places like Sandtown could become magnets for social entrepreneurship.

Photographer: Ron Haviv / VII for Bloomberg

Hathaway Ferebee: "A young black man is guaranteed a prison bed at a moment's notice, and not much else. We need to change our priorities."

Maryland is experimenting with the idea. A Baltimore group called the Safe and Sound Campaign has set up three "opportunity compacts" that, according to founder Hathaway Ferebee, have saved the state more than $75 million since 2005 and received back more than $28 million to fund and expand their operations. One provides substance-abuse treatment and other services for parents, allowing their kids to come home from costly foster care. Another provides therapy to help keep at-risk children out of juvenile detention. A third -- which, unfortunately, is struggling to renew its contract with the state -- helps keep former convicts from returning to prison.

Photographer: Ron Haviv / VII for Bloomberg

Dana Harris says he used to make $25,000 a month dealing heroin and cocaine in Sandtown. After doing time in prison, he joined the Public Safety Compact, where he makes $15 an hour counseling jail inmates and creating play spaces for children. "As soon as I got this opportunity, I went after it with everything I had," he says.

What distinguishes the compact model is how it empowers its participants. They know that by sticking with the program -- by doing the difficult work of changing the behaviors that took away their freedom or their families -- they are helping to reorder society's priorities, diverting taxpayer money from more expensive and often damaging systems such as prisons and foster care. It's a great job, and one that more people should have the opportunity to do.

Christopher Flavelle contributed to this article.

This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.

To contact the author of this story:
Mark Whitehouse at mwhitehouse1@bloomberg.net

To contact the editor responsible for this story:
Michael Newman at mnewman43@bloomberg.net