What’s Your Poverty IQ?

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As growing income inequality continues to divide the nation into the have’s and have not’s, more and more families are finding themselves having not. For too many, the tight rope of financial stability has frayed and as we are realizing, more is dangling in the balance than dollars and cents. America’s future is on the line.

With many struggling to survive without basic necessities, like quality education, meaningful employment, affordable housing, nutritious food, or accessible healthcare, poverty is the contemporary atrocity that challenges our most fundamental American values; that everyone is created equal and endowed with rights to life, liberty, and the pursuit of happiness.*

Today, liberties are constrained by access to resources, the plight of the poor is hardly a pursuit of happiness, and for many, their very lives are at risk. Just look at this graph that illustrates the association between income and life expectancy. I guess rapper 50 Cent had it right. In America, if you don’t get rich, you will certainly die sooner, trying or not.

The implication here is that poverty not only threatens the health and well-being of a growing population of Americans, but its persistence also threatens the foundation of our democracy. So, at a certain level, understanding the impact of poverty is central to understanding what it means to be an American today.

So let’s talk about it. What do you know about poverty?

Take this 10 question quiz from Marketplace public radio and see how you stack up!

How’d you do? Post your score or thoughts on this exercise in the comments below!

Now that you’ve seen the facts and figures, let’s look at what those numbers mean.

To understand the impact of poverty, we have to engage the context and ask the right questions. For example, take the statistic that says, “of all working age people living in poverty, about half (7.2%) had full or part-time employment in 2010.” I took this fact directly from our handy quiz link above. You can translate that figure into a number of questions. One question might be, “Why don’t poor people work harder to lift themselves out of poverty?” Or if you are Paul Ryan** you might ask, “Why don’t poor people value work?” These questions create value-laden assumptions about individuals and communities and ignore the local systems that contribute to poverty.

Better questions might be, “What is the relationship between employment and poverty in the United States?” “If half of the poor are already working, what role do for-profit corporations play in the perpetuation of poverty?” “Should conditions of employment include provisions for basic needs, like a minimum wage that approximates local housing costs or health insurance coverage for part-time employees?” “How does race, gender, or educational status influence opportunities for upward mobility?” These questions interrogate the economic, political, and social systems that disseminate resources, structure local opportunities, and define the face of poverty in the US. Asking questions in this way allows us to formulate an actionable agenda to address poverty.

It is time to transform the national conversation around a topic that is literally redefining what it means to be an American. Today, the long reach of poverty extends throughout every state and city in this country, influencing lives from cradle to grave, and intimately shaping the ways we live, work, and play.  If all meaningful action starts with knowledge, what’s your poverty IQ?

* Here, I should clarify that the Declaration of Independence specifically declared “all men” created equal. This of course purposefully excludes women and people of color. Slaves were not considered people until 11 years later, when it was decided they would be 3/5 of a person. This was known as the three-fifths compromise.

** Paul Ryan was quoted on the Bill Bennett Morning Show in March 2014 indicting “a culture, in our inner cities in particular, of men not working and just generations of men not even thinking about working or learning the value and the culture of work.” Here, he conflated institutional failures with cultural pathology. Given his influence over the federal budget, it is concerning to hear him voice this deep misunderstanding of the forces of poverty in the US. Charles Blow, an op-ed columnist at The New York Times addressed this point here. For a bit of a longer read on the nuances between culture and poverty, check out this beautifully written piece by Ta-Nehisi Coates, an op-ed columnist from The Atlantic.

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Equal Pay, Now

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Today is Equal Pay Day, or the day that marks how many extra days the average US woman must work into 2014, to earn as much as her average male counterpart in 2013. Given this momentous occasion to spotlight gender wage inequality in America, let’s take a brief look at the wage gap, why it matters, and what our President is doing about it today!

Did you know there is a gap inside the gap?

According to US census statistics, the average, full-time, female worker in America makes 77 cents to the dollar of what the average, full-time, male worker earns. But this statistic only refers to White women. The wage gap is far wider and deeper for women of color in the US, who face both a larger disparity in pay deferential and also fewer opportunities to rectify this great imbalance. The average African-American female worker makes 64 cents to the dollar and the average Latino female worker only makes 53! Part of that deferential is related to lower educational attainment among African-American and Latino women. And yet, “you can’t educate your way out of the gap!” Even as higher education raises everyone’s wage, African-American and Latino women continue to earn less than their White peers with the same educational background. This reveals a racial gap, inside the gender gap that may reflect discriminatory hiring practices, disparate access to meaningful employment by neighborhood or region, and disparate opportunities for upward mobility for professional women of color.

There is also geographic variation in the wage gap. Check out this chart to see how your state compares to Washington, DC or Wyoming, the areas with the smallest and largest gender wage gap in the US!

Why does the gender wage gap matter?

Since 1960, the number of women who are the primary wage-earners for their household has almost quadrupled, such that women now comprise nearly two-thirds of the breadwinners or co-breadwinners in their family. And as it turns out, more than 6 and 10 of the women who are the primary breadwinners in their home, are single mothers.

That means, average American families are increasingly depending on the earning power of women to make ends meet.

So when Mom brings home 23% percent less than her male counterparts (remember, that percentage can be as high as 44% less for Latino women), that is less income for everyday needs including healthcare, less investment in our children’s futures and education, and when added over a lifetime of work, significantly less for retirement.

AND, as a pediatrician, I know that children who live in poverty are more likely to have poor health as adults, including increased risk for cardiovascular disease, high blood pressure, diabetes, arthritis, and depression. What is more, there is evidence to suggest that these risks persist, despite changing social class in adulthood. So in many ways, investing in women is also vital to our country’s health and wellness!

So what is today’s big news?

Today, President Obama continued his commitment to the economic empowerment of women by signing one executive order and one presidential memorandum that take the legislative steps necessary to level the pay-ing field for women, well at least, female federal employees. This week the US Senate is also considering the Paycheck Fairness Act, which would extend the standards put forward by the President’s executive order to all employers covered by the Fair Labor Standards Act. To see President Obama’s complete legislative agenda to address gender income inequality click here!

And finally, any quality discussion of income inequality would be remiss to leave out the debate on minimum wage. Suffice it to say, raise the wage! Doing so, would especially benefit women who are more likely to occupy low-wage sectors of the labor force or to participate in part-time work (given many women’s commitment to their education or their growing family). It is also estimated that increasing the national minimum wage may be essential to lifting more than half of our working poor families out of poverty.

As Martin Luther King Jr said in his 1965 commencement address at Oberlin College, “The time is always right to do right.” And for income inequality in America, that time is now.

 

 

Structural Inequality and the Future of Medicine

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4 weeks ago, I published an article on Kevin.MD that garnered a lot of attention. It was titled The Myth of the Entitled Single Mother Remains as Relevant as Ever.* In it, I reversed the popularized notion that single mothers are a societal liability and suggested that instead, they are powerful forces in our local economies and influential leaders of future generations. I presented the idea that how society thinks about single mothers affects how we fiscally prioritize their needs. The point was, stigmatizing public rhetoric informs pubic policy in ways that perpetuate inequality and contribute to poor health. In response, however, I received a number of comments, many from other physicians, suggesting that such a topic was not “medical” enough to warrant physician concern.

That sentiment sits at the crux of one of the most contentious debates in medicine and frames one of the most important questions facing clinicians today. If inequality drives poor health, what is the physician’s role in addressing the structural forces in society that perpetuate inequality?

To answer this question, we must first unpack the ways enduring public narratives inform our institutions and shape opportunities in America. We must talk about how structural forces in society can align to create predictable patterns of disenfranchisement, including inter-generational poverty and poor health. Let’s get started!

The archetypes society erects to distinguish populations, commonly by race, gender, socioeconomic, marital, or immigration status, are not simple social tropes that define broad categorizations of people. Over time, and historically in fact, these social constructs lay deep roots in the political processes that govern society, processes that in turn, inform many of the institutions on which society relies, including the justice system, the education system, and the public health system. This pattern of influence is problematic because it allows shared public stereotypes to drive major public policy. This institutionalizes bias and creates inequality. And as we know, inequality drives poor health.

Let’s take one example of this and flesh it out. Look at the effect of race and gender on incarceration rates in America and the associated health consequences.

African-Americans make up 13.1% of the US population and yet African-American males alone, make up 38% of those incarcerated in federal and state prisons today. That means Black males are 6 times more likely to be incarcerated than White males and if these trends continue, 1 in 3 Black males will be imprisoned at some point in their lifetime.

The origin of the stark racial disparities in the US criminal justice system is complex and multifactorial. It is, in part, related to the disproportionately high rates of poverty,** unemployment, and low educational attainment in African-American communities. But it is also driven by a public narrative that associates Black males with criminality. That is why, even when you control for the crime rate, Black males are more likely to be arrested, once arrested, more likely to be convicted, and once convicted, more likely to face longer prison sentences than their White peers. This criminalization of African-American males is far from benign and, in fact, may have adverse health consequences for Black children and Black families.

When 1 in 3 African-American males are projected to be removed from their communities, often at the age of greatest productivity, it has profound effects on the communities in which these men live.*** Without their earning potential, these families disproportionately rely on the income of single mothers, many of whom live on the brink of poverty.**** Children who live in poverty are more likely to have poor health as adults, including increased risk for cardiovascular disease, high blood pressure, diabetes, arthritis, and depression. What is more, there is evidence to suggest that these risks persist, despite changing social class in adulthood. That means, there are physiologic pathways whereby systems of inequality and social stress may act to create immutable changes to children’s bodies, affecting everything from their brain development to their DNA. These changes can potentially be passed down to future generations, allowing under-resourced social environments to create predictable patterns of disease.

When considered in this way, it is easy to see how shared public narratives can become entangled in policies that systematically disenfranchise families and communities, dismissing productive members of society, shaping local economic opportunities, and informing the health of our future generations. When the life expectancy of a child can be predicted by the zip code in which they live, it exposes important drivers of health and disease in America. As physicians, we must dissect the threads that connect sociopolitical environments to biological consequences. If that is not “medical” enough to warrant our concern, I don’t know what is.

This is the future of medicine and it requires physicians confront issues of stigma and inequality as a function of their clinical duty to promote health and wellness. Doing so will certainly be a challenge. Success will rely on our ability to understand the impact social, political, and economic environments have on the population’s health and, to systematically incorporate this framework into the canon of medical scholarship and medical education. From there, we will need to build interdisciplinary models that bridge political action with health impacts. Jonathan Metzl and Helena Hansen have mapped a way to do that in their article entitled, “Structural Competency: theorizing a new medical engagement with stigma and inequality.” There is much to do be done. Let’s get to work!

Footnotes:

* Kevin.MD. is an online medical publication. You can also find this article on my site here!

** Communities in poverty have higher rates of crime regardless of racial composition.

*** This lends a new urgency to addressing the national gender wage gap, a gap that is wider for women of color, as communities of color may disproportionately rely on the income of women. It also underscores the importance of creating pipelines to higher education for men and women of color, to both supplant the pipeline to prison and to position women of color to occupy leadership roles in the community.

**** Many states also legally revoke prior felon’s voting rights and increasingly, laws and policies are being enacted to limit prior felon’s ability to: obtain employment, receive government benefits like food stamps, access public housing, or qualify for student loans. This results in 1 in 13 African-Americans no longer being able to vote today and prevents countless others from making meaningful contributions to their families and communities.