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The observed diffusion of tuberculosis and AIDS from marginalized, inner-city populations to surrounding suburban counties, and of AIDS from larger to smaller metropolitan regions, constitutes an empirical 'failure of containment' at odds with the culturally defined ideology of the US system of de facto apartheid. Such spread, occurring along the commuting field defined by the daily journey to work, and along national travel routes connecting metropolitan regions, is characterized, respectively, as 'spatially contagious' and as 'hierarchical' by geographers. Here we explore the nested ecology of these and similar infections by using the martingale theorem of probability theory to study the endemic limit and apply Ito's stochastic calculus to analyze the approach to endemicity. We find that increasing segregation and marginalization of subpopulations creates, in terms of incurable infectious disease, the paradox of a highly integrated apartheid system, entraining the rich into the diseases of the poor across vast scales of space and population, in effect poisoning the public health well for all. We suggest that, on the global scale, analogous processes can entrain the affluent North into the suffering of the South, particularly through the importation and redistribution of emerging infections.

We adapt recent perspectives on the resilience of ecosystems in a stochastic environment to analysis of the effects of public policies of 'planned shrinkage' on stressed US urban minority neighborhoods. The 'synergism of plagues'—a self-reinforcing, interactive mix of contagious urban decay and deterioration in both public health and public order—emerges in the course of a sudden 'phase transition' from community-spanning geographically focused social networks within ghetto neighborhoods to a condition of fragmented and isolated subnets. This transition occurs because instabilities inherent in the marginalization of ethnic ghetto neighborhoods synergistically amplify externally imposed stressors, most notably public policies of disinvestment. The amplification, a short-time version of stochastic resonance, may be quite large. Our work implies that continued subjection of marginalized US urban minority neighborhoods to public policies of 'planned shrinkage' can trigger similar but larger scale—regional and national—transitions in patterns of public health and public order, ultimately placing much of the three quarters of the country's population living in or near central cities at significantly increased risk.

The political abandonment of impoverished inner-city minority populations has caused the virtual physical implosion of many US urban neighborhoods, ranging from the New York City's South Bronx to Los Angeles' South Central. Resulting extreme levels of social disintegration and community disruption, in turn, have greatly intensified a nexus of interrelated pathological behaviors and conditions leading to more rapid spread of human immunodeficiency virus (HIV), production of multiple-drug-resistant strains of tuberculosis, and rising rates of many other contagious diseases which recent evolutionary theory suggests may become increasingly virulent. The standard model of the geographic spread of disease, when coupled with long-standing observations on the patterns of contact between central cities and their suburbs, suggests that the economically segregated outlying suburban townships, local suburban minority enclaves, and the collapsing inner-city neighborhoods in fact constitute a single, linked, geographically extended disease ecosystem. We find that even at the earliest stages of a contagious epidemic originating from an inner city epicenter, the rate of suburban infection will be directly proportional to the number of those already infected within the city, as modulated by the spatial 'commuting field' between city and suburb. Extension of this view to the patchwork system of suburban minority enclaves embedded within more affluent townships suggests that the political abandonment of minority populations in any context will significantly increase rates of serious disease within affluent suburban communities.

Fire service cuts recommended by the Rand Corporation, and largely implemented before New York City's 'fiscal crisis', are known to have initiated a geographically spreading, temporally recurrent fire epidemic. Examination of a resulting fire outbreak in Brooklyn's Bushwick section shows the epidemic to have temporal and spatial 'patchiness' characteristics of a parasite infestation, as well as an apparent composite 'life cycle', but without the stabilizing mechanisms which assure the survival both of host and of parasite populations. The composite fire 'life cycle' implies the need for a multiple factor eradication program, in which improvements in fire service play a key role, both for extinguishment and for prevention purposes.

In further exploration of structural fire as an urban parasite, the influence of areal population density and housing overcrowding on incidence and average size of structural fires is analyzed. Because the more people per square mile and per room the greater the incidence and size of the structural fires, the destruction of housing by fire and fire-related building abandonment creates fertile ground for even greater fire damage due to the crowding of the refugees into the remaining housing stock. The vicious circle of housing overcrowding and fire holds serious implications with respect to other density dependent factors, such as public health, the public transportation system, and sanitation. Parasitology continues to provide insight into the mechanisms of the behavior of structural fire and its impacts.

In previous papers of this series we have shown how public policies of 'planned shrinkage' triggered contagious urban decay and massive destruction of low-income housing within poor minority communities of New York City. The resulting social disintegration exacerbated epidemics of infectious disease, including AIDS (acquired immunodeficiency syndrome) and TB (tuberculosis), and such behavioral pathologies as substance abuse and violence. We extend this work on the neighborhood-level 'synergism of plagues' to the metropolitan regional scale for eight US urban areas containing more than 54 million people. Several have central cities, which, like New York, suffer from what Skogan characterized as a relentless 'hollowing out' of poor communities. We find AIDS, TB, violent crime, and low birthweight near the worst affected cities to be markers of an accelerating regional synergism of plagues, a diffusing system of interacting and self-reinforcing pathology fueled by, but spreading far beyond, the worst affected inner-city areas. We uncover an apparent threshold condition for regional spread of this synergism, triggered through a stochastic resonance with public policies affecting the distribution of catastrophic events within central-city minority neighborhoods. Control of AIDS, violence, multiple-drug-resistant TB, and other pathologies in the United States will require regional reform and the sharing both of resources and of authority across presently ungovernable systems of fragmented administrative units: the urban centers of the late 19th-century USA, by the late 20th, are vast, tightly coupled urban and/or suburban complexes producing a regional 'linear chain' condition for both public health and public order in which the welfare of the whole is increasingly determined by the sickness of the least strong.

Empirical and theoretical analyses based on observed patterns of incidence of AIDS and tuberculosis, on rates of poverty, and on statistics describing a 'Markov infection' driven by the 'commuting field' around Manhattan, strongly suggest that urban and suburban epicenters within a twenty-four-county metropolitan region, covering eighteen million people and more than 7600 square miles, may be significantly and increasingly linked to outlying affluent areas through a process driven by fundamental social, geographic, and economic structures. AIDS and TB rates outside the epicenter of New York City are found to display similar patterns of spread in space and time, and have been strongly coupled to rates of infection within it for some time, a circumstance which will continue and may intensify as 'heterosexual AIDS' becomes more predominant and as multiple drug-resistant forms of TB evolve within disintegrating inner city minority communities. The work reported here, involving a relatively large area and a high population, strongly contradicts the findings of a recent National Research Council report on the social impact of AIDS, which, based on a severely constrained scale of analysis, concluded that the concentration of disease within marginalized urban communities implies many geographical areas and strata of the population are and will remain untouched by the AIDS epidemic. The hyperconcentration of infection in urban epicenters is not containment, but rather a principal force behind further spread. This work, in part a technology transfer from community ecology of ideas on refugia and reservoirs, adds significantly to a growing body of evidence which strongly implies that wide-spread urban reform is an essential, but largely unrecognized, component for any realistic national programs to control AIDS, multiple-drug-resistant TB, and other infectious diseases.

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