The Tipping Point: How Little Things Can Make a Big Difference

by Malcolm Gladwell

John Zenilman of Johns Hopkins University in Baltimore, an expert on sexually transmitted diseases, has another explanation: the breakdown of medical services in the city’s poorest neighborhoods. “In 1990–91, we had thirty-six thousand patient visits at the city’s sexually transmitted disease clinics,” Zenilman says. “Then the city decided to gradually cut back because of budgetary problems. The number of clinicians [medical personnel] went from seventeen to ten. The number of physicians went from three to essentially nobody. Patient visits dropped to twenty-one thousand. There also was a similar drop in the amount of field outreach staff. There was a lot of politics—things that used to happen, like computer upgrades, didn’t happen. It was a worst-case scenario of city bureaucracy not functioning. They would run out of drugs.”