The Wire and Urban Health Education

Abstract

As urban health has emerged as a distinct field, experts have collaborated to develop models for interdisciplinary education to train health professionals. Interdisciplinary learning is an important yet challenging imperative for urban health education. This paper explores lessons learned from a 2010 speaker series at the Johns Hopkins Bloomberg School of Public Health. The television show, The Wire, was used as a teaching tool to illustrate the context of health disparities in American cities and to explore the complex factors perpetuating urban health outcomes. We suggest that individuals interested in developing interdisciplinary teaching models can learn from both the form and the content of The Wire. As a popular televised serial narrative, The Wire prompts an investigation into the forms and circulation of academic research in a fractured and specialized media landscape. The formal narrative structure of the show provides mental scaffolding from which epidemiological, historical, geographical, anthropological, and other relevant disciplinary learning can build. The Wire encourages critical reflection among public health professionals about the forces that shape public health training, research, and practice and offers creative expansions to existing urban health educational efforts.

“How do you get from here to the rest of the world?”

-Duquan “Dukie” Weems, The Wire, Season 5¹

Introduction

As public health professionals strive to make sense of the complexities of health within cities, we face the challenge of researching the interplay of political, social, and economic factors at the global, national, and local levels in shaping health outcomes. Many concerned with eliminating health disparities have called for research that not only focuses on the social determinants of health but also addresses the context in which multiple determinants shape health outcomes.^2,3 Urban health education has emerged as a distinct field, incorporating interdisciplinary strategies to train public health professionals.⁴ Experts have suggested a number of disciplines that, in total, provide the necessary portrait of the complexities of the causes and consequences of urban health.⁴ Urban health education should not only build bridges between multiple disciplines concerned with the urban environment but also should cultivate theories, models, and concepts integrated from these multiple orientations to promote health. Training should incorporate epidemiological, historical, geographical, anthropological, and other relevant disciplinary perspectives and move towards integrating and synthesizing these perspectives. Understanding these complexities is only part of the proposed training; practitioners also need communication, organizational, and political skills to facilitate interventions in and across communities. Interdisciplinary learning is an ideal much easier to describe than to attain. Not only do we often lack sufficient resources to use in such interdisciplinary training, but we also occupy different locations, maintain divergent perspectives, speak with unique jargon, and exchange ideas through specialized networks.⁴

In Spring of 2010, we initiated a seminar series at the Johns Hopkins Bloomberg School of Public Health (JHBSPH) that used The Wire as a teaching tool to illustrate the context of health disparities in American cities and to explore the complex factors perpetuating urban health outcomes. Members of the JHBSPH and Baltimore community examined the show’s depiction of public health issues in Baltimore, described related epidemiological, ethnographic, and intervention research, and facilitated discussions about strategies for meaningful change. As we reflected upon this series, we realized that The Wire can function as a powerful tool for teaching and learning about public health issues in American cities. Given the scope and depth of its portrayal of urban issues and its enduring legacy, we believe that individuals interested in developing interdisciplinary teaching models can learn from both the form and the content of The Wire.

The Legacy of The Wire

The Wire ended its run on HBO in 2008, but its stories maintain a presence in contemporary popular culture. The series, set in Baltimore, garnered significant praise from critics and fans for its complex portrayal of life in American cities. It also brought about mixed reactions from some in the very institutions it depicted. In January of 2011, Baltimore city Police Commissioner Frederick Bealefeld derided the show’s negative portrayal of Baltimore’s institutions as “a smear on this city that will take decades to overcome.”⁵ Former Mayor Sheila Dixon saw negativity in The Wire but also said, “It gives you a perspective to work on how to resolve some of the struggles and the systemic issues that [the drama] shows.”⁶ Competing assessments of the show haven’t been limited to Baltimore officials. President Obama has called it one of the best shows of all time, cautiously describing Omar as his favorite character.⁷ Its continued cultural currency survives as actors who portrayed main characters in the show, such as Michael K. Williams (who played Omar Little) and Sonja Sohn (who played Kima Greggs), appear as spokespeople for various social causes. The show’s co-creator, David Simon, received a 2010 MacArthur fellowship (the “genius” grant) that supports individuals demonstrating exceptional talent and creative promise.

The show’s continued presence is nowhere more apparent than in colleges and universities where academic interest has grown since the show’s end. The Wire has inspired dozens of books and innumerable journal articles, academic conferences,⁸ and courses in disciplines ranging from sociology to film studies—all devoted to articulating its significance.

Some of the debates among academics have centered on the show’s depiction of, and effects on, reality.^9,10 In one such exchange, published in Dissent Magazine, academics spiritedly debated both the tone and the content of the show.^11,12 Peter Dreier and John Atlas characterized the show’s depiction of Baltimore as cynical and potentially damaging to efforts promoting social change.¹¹ Expressing concern that viewers would walk away from the series without a sense of seeing the “whole picture,” they suggested that, by excluding stories of positive social change and successful organizing, the show “won’t encourage America to care about change.”¹¹ Countering their argument, Anmol Chaddha, William Julius Wilson, and Sudhir Venkatesh advanced the position that The Wire “has done more to enhance both the popular and the scholarly understanding of the challenges of urban life and the problems of urban inequality than any other program in the media or academic publication.”¹² To expand on this, they describe how the stories of The Wire provide education on systemic urban inequities complementary to the reform efforts of community organizers and activists.¹²

Controversies such as these among academics and city officials generally focus on the show’s content and evaluate whether it accurately represents problems in our cities. In addition to its content, the form of the show (a drama series aired on HBO) as well as the show’s formal structure (a fictional braided narrative serial) provide important insights into interdisciplinary engagement. We believe that an exploration of these elements can also provide important opportunities to reflect critically on the state of urban health education and strengthen our interdisciplinary endeavors.

The Wire as a Popular Form

Televised around the world, The Wire is a form of popular entertainment that has imprinted a collection of scenes, characters, and stories to a collective memory bank, easily accessible to those who have viewed it as well as those who read about it or heard about it second-hand.¹³ Mass media is not simply a means of conveying information from those who have it to those who don’t, but it creates opportunities for future exchange, which are reliant on common references.¹³ The perspectives referenced above demonstrate how the show’s popularity allows its multiple story lines and characters to operate as a form of common currency through which varying interpretations of its meaning may be exchanged. Common forms are often hard to come by for those concerned with interdisciplinary work, especially in an increasingly specialized and fractured media landscape. Specialized journals, academic departments, and programs proliferate. These academic forms (journals, lectures, conferences, etc.) are among the networks of media from which academics are able to draw, though The Wire has enjoyed a far broader circulation than most academic works. Interdisciplinary efforts seeking to integrate material from multiple fields of study face challenges posed by the physical and cultural geography within which we work.

Take JHSPH’s Wire Series as an example: Located in the middle of east Baltimore, many students and faculty at Johns Hopkins occupy social and professional worlds completely isolated not only from other academics and professionals but also from the neighborhoods of East Baltimore that surround the campus. More broadly, research has documented dramatic growth in residential segregation of families by income in the United States over the past four decades.¹⁴ This segregation leads to the concentration of resources in wealthier neighborhoods and also raises concerns about the lack of awareness among the affluent of conditions facing a growing number of Americans, who are increasingly invisible to those in positions of power. The Wire, in this context, may serve as the lens through which many individuals gain access to what creator David Simon labels, “the America that got left behind.”¹⁵ With too few popular forms seriously addressing issues of social inequality, the broad educational promise of The Wire remains largely unfulfilled. Academic interest in the show, while substantive, circulates through small and specialized networks unavailable to those without the time or resources to seek them out. The show’s realism has also raised concerns about the impressions it may convey to those unfamiliar with the institutions or localities depicted, making engagement with its content all the more critical.^11,12 The forms of academic work and the circulation of research deserve attention as we strategize about the translation of research into broader networks to support meaningful engagement and interventions.

The Narrative World of The Wire

Of course, not all pieces of popular culture provide such a unique opportunity for interdisciplinary engagement as does The Wire. Many have compared The Wire to great works of literary fiction, placing co-creator David Simon alongside Charles Dickens, while others have suggested that its power exceeds literary fiction and that it is important to take into account its unique visual form as a televised serial.¹⁶ In contemplating the power of The Wire, Simon and others have proposed that fiction enjoys an artistic license allowing it to go places that research and fact struggles to go.¹⁵ Both the format of journalism and the professional norms of newspaper reporting, according to Simon, limited one's ability to tackle complex problems. “One of the problems with journalism …even the highest ambition of the people at my newspaper, was to bite off a small morsel of the actual problem.”¹⁵ However, the lines between fact and fiction aren’t always so clear.

A comparison with a recent work of non-fiction might illuminate one of the most valuable aspects of The Wire: its ability to create a memorable world, compelling to audiences across and beyond academic walls. In The Immortal Life of Henrietta Lacks, Rebecca Skloot tells the story of Henrietta Lacks, a poor African-American woman who died from cancer at the age of 30.¹⁷ Before her death in 1951, doctors at Johns Hopkins Hospital had taken cell samples from Lacks. HeLa cells, as they are now commonly known, have provided the basis for countless scientific breakthroughs. Throughout the book, the text moves between multiple time periods and narratives to draw a complex and nuanced picture of how race, class, and politics intersect in medical care, research, and ethics. Drawing a humane and sympathetic view of a diverse cast of actors, Skloot transcends the world of science writing and moves beyond “facts” about HeLa cells, research ethics, and health disparities to something much more powerful.¹⁸ About the narrative structure, Skloot said, “If you learn the story of the HeLa cells by itself, it’s a very different story than if you learn it alongside the story of what happened to Henrietta and her family as a result of those cells. Each story takes on a different weight when you learn them at the same time…Plus, if I had just told the story from the beginning—Henrietta Lacks was born …blah, blah, blah—nobody would have known why they should care who Henrietta was.”¹⁹ Skloot drew from fiction, concluding that a braided narrative would allow her to both to keep the reader engaged and help raise important questions about the relationships between race, poverty, and scientific discovery, bridging the stories and circumstances of individual stories across time and space.¹⁹

Just as Skloot employed a creative structure to the ends described above, Wire co-creators David Simon and Ed Burns created a complex of multi-layered narratives that guide the viewer on an addicting journey through various structural institutions in Baltimore. It is precisely this braided narrative structure that builds a world of memorable stories, characters, and institutions from which learning can build. Though the stories of The Wire were fictionalized, Burns and Simon drew heavily from their many years of experience in Baltimore: Simon spent 13 years as a newspaper reporter for the Baltimore Sun; Burns worked as a Baltimore city police detective for two decades and then as a teacher in the Baltimore schools. There may be things that fiction can do that are harder to accomplish with data and facts (or perhaps impossible), but a more careful engagement with fiction might introduce opportunities for academics to create more effective forms for developing and communicating research.

Ecological models have been cited as useful tools to give a big picture representation of people within their environments as well as to help understand the ways in which cities affect health.²⁰ As a learning tool, ecological models are intended to facilitate a process of cognitive mapping, a type of mental processing that allow individuals to accumulate, organize, and retain information. Considering an ecological model of health as an example, we might see individual health at the end of a chain of influencing spheres that span out to one’s immediate physical and social living environment, then to larger local, regional, national, and global forces. Generally, causal arrows flow from larger forces down to the individual level, though many models incorporate movement in more than one direction. Ecological models might be compared with a cartographer’s map of the social world, though we understand that what ecological maps don’t capture well is real-world spatial relationships and elements of time. The Wire represents these layers but adds something that is missing in ecological models. It approaches what cultural critic Fredric Jameson referred to as a cognitive mapping of the individual’s place among global social, economic, and political conditions.²¹ Jameson adapted the term from an earlier project concerned with an individual’s ability to visually map the geographical layout of city they inhabit from memory. This concept has become easier to grasp with the advent of geographical positioning systems (GPS). We can easily distinguish between a cartographer’s map of the world and a GPS device that an individual might use to navigate an unfamiliar city. Jameson was concerned not simply with geographical information but with class relations on a multi-national scale: “that mental map of the social and global totality we all carry around in our heads in variously garbled forms.”²¹ He suggests that our inability to mentally plot these social, political, and economic relations onto our daily experience has consequences mirroring the navigational issues an individual might have trying to navigate an urban setting for which they had no cognitive map (no metaphorical smart phone with GPS, for example).

In contrast to other forms used in urban health education (ecological models as one example), The Wire, as a representation, offers a powerful tool for the process of cognitively mapping the interactions between political, cultural, structural, and individual factors of health.²² While it doesn’t teach audiences everything about conditions in American cities, it provides rich mental scaffolding from which learning can build. Importantly, it does so outside of the disciplinary references and jargon that often renders interdisciplinary work so challenging and inaccessible. Historian Earl Lewis asserted that academic concepts rarely reflect the ways people remember their experiences in the urban setting. “Rather,” he argued, “such framing concepts reflect the intervention of the historian and highlight the interface of our imagination, understanding, and memory with that of the subjects of our study.”²³ This suggests a fruitful starting point for interdisciplinary engagement, as we all struggle to reconcile our various interpretive experiences of the world with competing facts, data, and alternative interpretations. Stories are models for learning.

Interdisciplinary engagement, in part, requires some common forms around which exchanges can explore points of overlap and disagreement. Drawing on different bodies of theory and methodologies, academics continue to reflect upon The Wire’s success in stimulating exchange in multiple traditions: urban sociology, ethnography, social network analysis, literary, and critical theory.^22,24–26 Drawing from diverse media landscapes, these varying interpretations involve struggles among a variety of social, cultural, and political interests to make sense of the show. As urban health practitioners and researchers drawing from many disciplines, we too see potential to expand our own work. By bringing our knowledge of urban health problems to our viewing of The Wire, we argue that the stories of The Wire are fundamentally stories about health. In our series, each seminar presenter drew from epidemiological, social science, and ethnographic research to expand on the representations of The Wire. Presenters provided empirical context to a given issue and discussed the current and emerging state of related public health research and intervention strategies.

Beyond various disciplinary uses of the series, The Wire prompts a consideration of the common narrative features of our daily experiences and actions. As public health professionals work to create pathways to interdisciplinary engagement, it’s worth considering narratives as a form common to us all, powerful “because they are woven into life, not simply imposed upon a chaotic existence after the fact.”²⁷ Our hope was that, as students and presenters supplemented the stories of The Wire with details from academic research and community initiatives, participants would retain the mental infrastructure and memory from the show’s narrative, thinking relationally and critically about the many pieces at play.

The Stories of The Wire

In five seasons, The Wire takes viewers on a journey through Baltimore’s drug trade and explores its relationship to law enforcement, deindustrialization, politics, the educational system, and journalism. As each season brings an expanded cast of characters and plot lines, it not only explores various institutions in depth but also maps the dynamics at play between institutions through the characters navigating its world. These organizations include the Police Department, local drug trafficking operations, the Baltimore Sun newspaper, a local stevedores’ union, and the public school system. While many characters have vividly developed and complex personalities, they also allow us insights into the institutions, networks, and environments that they inhabit.²² In this way, The Wire offers an excellent tool for conceptualizing the layered nature of urban life and, more importantly, urban health. It is through this lens that we finally approach a brief treatment of the show’s content.

Within our seminar series, individual seminar topics explored the impacts of the illegal drug and sex industries, guns and violence, HIV, employment, family and social networks, educational, and political institutions on health outcomes (Table 1). Many more topics were brainstormed than time or faculty expertise allowed us to include. While some topics reflected major themes from the show, others received only cursory treatment in The Wire, and several were not central to its storylines. Though guns were ubiquitous, the role of the gun market in shaping urban violence received little direct attention. The sex trade, for example, served as background to major narratives. Depictions of women and gender dynamics in the show were heavily critiqued in the media. Even so, The Wire provides powerful imagery to which urban health professionals can attach historical, social, and epidemiological research and intervention strategies, expanding beyond the storylines to build a more detailed picture of multi-level factors shaping health in our city and beyond.

Table 1.

Seminar topics

Title	Content
ReWIRED for Change	Sonja Sohn, the actor who played The Wire character ‘Kima,’ describes her work to empower at-risk youth in Baltimore using a curriculum based on seasons from The Wire to develop critical thinking and personal transformation
Bubs’ Life: Networks, Neighborhoods, and IDUs	Historical and social research describing the relationships between drug policy, social networks, neighborhoods, and injection drug users in Baltimore
What About Mom?: Women and Families in the Inner City	A discussion of the role of women and families in disadvantaged urban neighborhoods, highlighting the effects of poverty over the life-course drawing on research from a longitudinal cohort study following young people in a disadvantaged neighborhood in Chicago
Shardene’s Dance: Stripping/Working on the Block	Ethnographic data from research among dancers in a set of Baltimore exotic dance clubs to examine the engendered risk environment. Needle exchange staff discussed their work with exotic dancers
Education	Wire co-creator Ed Burns discusses the failing educational system, Harlem Children’s Zone, and alternative models to promote pathways out of poverty for children.
The Only Game in Town: Employment Options in the Inner-City	Ethnographic data exploring challenges ex-convicts face during transitions to employment in the formal sector; strategies of a Baltimore non-profit working to advocate policies and programs to support low-skill, low-income workers
Omar Puts a Face to African American MSM	Observational and evaluation research data describing context of life for African-American men who have sex with men in urban settings, including discussion of HIV risk and prevalence, social stigma, and extent of social support
Is There a Choice? Violence and Guns on the Streets of Baltimore	Demographic and epidemiological description of factors contributing to urban violence, including de-industrialization, changes in policing policy and practice, illegal drug market, neighborhood, and social influence. Description of Cease-Fire and Safe Streets as promising models to reduce urban violence
Where Do We Go from Here?	A panel discussion exploring promising routes for research and interventions to reduce health disparities and improve health in urban settings, with focus on Baltimore

In one seminar, for example, a researcher partnered with representatives from a community organizing and outreach program combatting gun related violence in Baltimore. They discussed the depiction of guns and gun-related violence in The Wire and offered a contextualized view of gun access and outcomes within the real neighborhoods depicted in The Wire’s fiction. Drawing from historical, social, and epidemiological research, they described the role that deindustrialization has played in cultivating conditions ripe for violence. They discussed changes in drug and gun policy and policing of the illegal drug trade along with other structural factors related to disproportionately high rates of gun violence and death among African-American youth in our city. They also presented evidence of promising policy, program, and community interventions to change policing, limit gun sale, prioritize violence reduction over drug arrests, and shape social norms, creating alternative paths for at-risk youth. This is a presentation that could have taken place without the storylines of The Wire, which focus on many of the same issues. However, in mapping out the factors contributing to the spread of violence, it can be difficult to explore its relationship to other problems. The Wire as a set of interrelated stories creates a mental world in which to place violence as one of many issues navigated daily by citizens.

Other seminars built on story lines of characters in the show to illustrate challenges facing drug users and ex-convicts. One seminar supplemented the plotline following Reginald “Bubbles” Cousins, a homeless chronic heroin user, with historical and social research describing the relationships between drug policy, social networks, neighborhoods, and injection drug users in Baltimore. Another lecture followed the story of Dennis “Cutty” Wise, a former ‘soldier’ from the Barksdale drug trade. Upon his release from prison, Cutty struggles to resist a return to crime and to gain legal employment. Departing from Cutty’s story, a researcher discussed ethnographic data exploring challenges ex-convicts face during transitions to employment in the formal sector. In addition, a representative from a Baltimore non-profit discussed challenges as well as promising strategies to develop policies and programs to support low-skill, low-income workers.

Some presentations drew out stories that were missing or marginally represented in The Wire, such as those of women working on “the Block”—a one-block section of downtown Baltimore known for its sex shops and exotic dance clubs. In one seminar, researchers and needle exchange workers presented ethnographic stories of women working as exotic dancers in Baltimore and discussed the health risks that an underground economy of sex trade cultivates.

Through The Wire, researchers and community workers were able to teach participants about the stories physically surrounding our campus that are far too often invisible, even to public health professionals. The stories of The Wire also encouraged reflection and inquiry into the roles that Johns Hopkins and other local public health institutions have played in the social and historical development of contemporary urban health issues in Baltimore. As much as The Wire speaks to American cities, it has unique salience for individuals witnessing the extent of social and health disparities in the blocks surrounding one of the leading public health universities in the nation. The university researcher appears only briefly in The Wire, as a character critiqued for being more concerned with published research than making any substantive changes in the city. The Wire created an important opening in the seminar series for public health professionals to reflect on our own institutions and discuss the challenges and opportunities to expand interdisciplinary engagement and promote practical applications. While professionalized training in public health emerged out of a vision directed at improved services, educational and training institutions have developed in such a way as to privilege the accumulation of academic research over its practical applications.²⁸ Like health in our environment, our work as public health professionals has been shaped by political, economic, social, and cultural factors. The ability to reflect on the formal structures of our institutions (research universities, departments of health, community organizations, etc.), the forms and structure of our communications, and our institutional struggles and successes are critical for finding pathways to more meaningful interdisciplinary collaboration.

Conclusion

In the fifth and final season of The Wire, a short exchange between two characters crystallizes the very dilemma that our series attempted to address. After enduring bullying and taking several beatings from boys on the block, a teen boy, Duquan “Dukie” Weems, approaches Dennis “Cutty” Wise who has started a boxing gym to steer youth in his neighborhood away from the drug trade. Cutty puts Dukie into a sparring match with another student, where Dukie receives a pummeling. After watching Dukie struggle in the ring and talking with him further about his struggles to try to fit in on the corner, Cutty says “Not everything comes down to how you carry it in the street. I mean, it do come down to that if you gonna be in the street. But that ain’t the only way to be …the world is bigger than that.”¹ Dukie’s response, “How do you get from here to the rest of the world?” encapsulates our challenge as academic health professionals: how to build bridges across disciplinary divisions, beyond the ivory tower divide, into meaningful health improvements in our cities. In some ways, the seminar series that we ran illustrates these challenges as much as it opened a path to explore alternative pedagogical models. The Wire suggests that we consider ways to improve the circulation and accessibility of local insights, whether they originate in research or tactical struggles. It offers a formal structure that encourages creative expansion of our theoretical and physical structures as we work to develop frameworks to understand complex processes. It helps us to place our work within a larger world shaped by a variety of forces. Beyond that, it offers a chance to reflect on the common struggle that we, as urban health professionals, share to understand and improve conditions in our cities. As we search for tools to build meaningful interdisciplinary engagement, it reminds us of the common role that narrative and interpretation plays in each of our lives: as academics, researchers, professionals, and citizens.