It is the site of a conflict between residents and the city's plans for creating a biotech park to serve nearby Johns Hopkins Hospital.

The swath of land between Johns Hopkins Hospital and Frank C. Bocek Park, which includes much of Middle East, is often referred to as the "Down the Hill" neighborhood by local residents.

By 1969, the Czech-American immigrant community in what is now the Middle East neighborhood was predominantly composed of ageing homeowners who lived alongside more recently arrived African-American residents.

The neighborhood has suffered from extensive urban decay and housing abandonment due to poverty and crime, as well as the after-effects of the Baltimore riot of 1968, and now has a largely poverty-class and working-class African-American majority.

The neighborhood was one of the hardest hit in Baltimore, as the white-working class and middle-class African-American tax base left and the area was effected by epidemics of heroin, crack cocaine, and HIV, along with an intensification of gang activity fueled by the drug trade.

Crime and domestic violence rates were double those of the city as a whole, and the incidence of lead poisoning and child abuse were among the highest in Baltimore.

[5] Middle East is the site of ongoing and extensive gentrification and many buildings have been leveled to make way for the expansion of the Johns Hopkins School of Medicine.

There have been many delays and controversies over the past 17 years, as Johns Hopkins has attempted to transform the neighborhood into a biotech hub amid accusations of gentrification.