BOOK REVIEW: Tapping into The Wire: The real urban crisis by Peter L. Beilenson and Patrick A. McGuire

Abstract

Illicit drug use continues to be a major threat to public health. Moreover, the illicit drug economy coupled with the US War on Drugs impacts both public health and security. It is in this context that Peter Beilenson, a former Baltimore Health Commissioner and candidate for Congress, and his co-author Patrick McGuire, a writer, tell the true stories behind the HBO drama The Wire. Beilenson and McGuire use vignettes from The Wire to draw attention to a wide variety of public health problems in American cities. One of the key aspects of this book is a focus on the social determinants of health and the strategies a city might employ to address them. The term “social determinants” is rarely used, and the terms “governance” or “intersectoral action” do not make it onto the page. However, these three themes are woven through each chapter, drawing upon Beilenson’s tenure as health commissioner under Mayors Kurt Schmoke and Martin O’Malley. Most of the book focuses on drug-related topics including addiction, infectious consequences of drug use (i.e., HIV and hepatitis C), intergenerational drug use, harm reduction strategies, treatment-on-demand, drug economy-related violence, and the failure of the US War on Drugs. For example, chapter 1 uses the violent lives of the adolescents in The Wire, most of whom are engaged in various aspects of Baltimore’s drug economy, to frame the problem of youth violence and its determinants while also providing a case study of an intervention for the most vulnerable violent youth. Chapter 3 essentially argues that the War on Drugs prioritizes quantity (i.e., numbers of arrests and media-friendly tables of seized drugs) over quality (i.e., incarceration of violent drug users and sellers as opposed to non-violent drug users). Chapters 4 and 6 describe how some Baltimore political leaders worked to reframe drug addiction as a public health problem rather than a criminal justice problem and within that frame tried to redirect resources from incarceration to treatment-on-demand. The book does not strictly focus on drug-related outcomes. Chapter 11 explores the political and social determinants of childhood lead exposure and describes the intersectoral approach Baltimore employed to address this issue. Chapters 8 and 12 discuss teenage pregnancy and sexually transmitted diseases, and obesity, respectively. Of particular interest to those interested in urban health, chapter 10 describes why place matters. Through the story of The Wire’s Bodie, an adolescent involved in Baltimore’s drug trade, Beilenson and McGuire explore neighborhood context and its connection to health outcomes. Tapping into The Wire (Johns Hopkins University Press, 2012) is an engaging, fast-paced read that translates the fiction of a cable one-hour drama to the reality of an American City. Using the themes of the social determinants of health, governance, and intersectoral action, the book seeks to reframe the discourse about drug policy and the health of US cities. It is an important read for students and for those seeking to communicate the importance of social determinants of health and understand the politics of drugs and health in cities.