‘It’s poverty, stupid!…’

By Dennis Archambault
In our attention to the social determinants of health, it’s important to reconsider the root cause – poverty. By fighting for scarce funds allocated to help low income populations — housing, food security, education, transportation, health promotion and disease prevention — we lose sight of the cause. American poor are getting poorer; in fact, our poor are now being compared with other developing countries. Those who say that the poor in the United States are not really poor, as compared with the poor in developing countries, need to read an analysis by Angus Deaton in the New York Times https://www.nytimes.com/2018/01/24/opinion/poverty-united-states.html.

According to the World Bank, 769 million people lived on less than $1.90 a day in 2013 – of these, 3.2 million live in the United States. It’s even worse if you factor in the advantages, Deaton argues, of poor villagers who don’t have to deal with housing, transportation, heat and other infrastructure costs. In that case 5.3 million Americans are “absolutely poor.” And this number is growing, as it is throughout the world, as the disparity between the rich and the poor grow.

For population health, in a society where there is little commitment to improving the social infrastructure, that’s a deadly sign.

Just as political consultant James Carville once advised presidential candidate Bill Clinton, “it’s the economy, stupid!” Indeed, it’s poverty. As long as poverty prevails, and the income disparity between the rich and the poor widens, and there is a social climate adverse to equity, then we’re going to have hustle that much harder. And hustle we will.

Dennis Archambault is vice president, Public Affairs, at Authority Health.