Worst Off Than New Delhi

When a teenager from East Baltimore was asked to describe his neighborhood, he spoke of “big rats going around in people’s trash, vacant houses full of squatters and needles on the ground.” 

A young woman in New Delhi, asked the same question, described the dirt and the “dirty water found lying on the roads,” while a young man in Ibadan, a large city in Nigeria, spoke of the smell of urine and streets “littered with paper and other refuse.”

All three teenagers live in the poorest neighborhoods in their communities and were surveyed as part of the “WAVE” study, a global research project that examines the well-being of adolescents in vulnerable environments around the world. 

Led by Dr. Kristen Mmari, an assistant professor at Johns Hopkins Department of Population, Family and Reproductive Health, the survey assessed health challenges faced by 2,400 15- to 19-year-olds from impoverished areas in Baltimore, Shanghai, Johannesburg, Ibadan and New Delhi, as well as their perceptions of their environments.

The researchers found many similarities—in all five cities, adolescents were exposed to unsanitary conditions, substance abuse and violence—but the differences between each area were especially compelling. 

Overall, teenagers in Baltimore and Johannesburg, despite being located in comparably wealthy countries, had far worse health outcomes and tended to perceive their communities more negatively.

In Baltimore, which is located in the world’s richest nation per capita and just 40 miles from the White House, adolescents exhibited considerably high rates of mental health issues, substance abuse, sexual risk-taking, sexual violence and teen pregnancy. 

In comparison, adolescents in New Delhi exhibited far fewer of those behaviors and outcomes, despite residing in a much less prosperous nation.

The reason for this, Mmari discovered, is rooted in the way teenagers interpret their surroundings. “How kids perceive their environments is really important,” she says. “That’s what’s driving many of these behaviors.” 

For example, a young man in New Delhi and a young man in Baltimore may both live in neighborhoods with poor living conditions and little opportunity, but because the teenager in New Delhi is able to see his environment in a more positive light, he is less likely to experience to adverse health problems. “He paints a different picture.”

But why do teenagers in Baltimore and Johannesburg have such a dark outlook?

According to Mmari, one could point to a combination of environmental and social factors, including the exposure to violence and a lack of social support, which were found to be less prevalent in the three other cities.

“When you look at how they perceive their environments, kids in both Baltimore and Johannesburg are fearful. They don’t feel safe from violence,” says Mmari. “This is something we didn’t really see in other cities. In Shanghai, for example, there wasn’t a great deal of violence. You’d ask kids about their safety concerns, and they would say something like, ‘I’m afraid of crossing a busy street.’”