David Ansell, an MD writes about the important role that inequality plays in health and life expectancy. His book analyzes Chicago as a case study. From U of Chicago press,
We hear plenty about the widening income gap between the rich and the poor in America and about the expanding distance separating the haves and the have-nots. But when detailing the many things that the poor have not, we often overlook the most critical—their health. The poor die sooner. Blacks die sooner. And poor urban blacks die sooner than almost all other Americans. In nearly four decades as a doctor at hospitals serving some of the poorest communities in Chicago, David A. Ansell, MD, has witnessed firsthand the lives behind these devastating statistics. In The Death Gap, he gives a grim survey of these realities, drawn from observations and stories of his patients.
While the contrasts and disparities among Chicago’s communities are particularly stark, the death gap is truly a nationwide epidemic—as Ansell shows, there is a thirty-five-year difference in life expectancy between the healthiest and wealthiest and the poorest and sickest American neighborhoods. If you are poor, where you live in America can dictate when you die. It doesn’t need to be this way; such divisions are not inevitable. Ansell calls out the social and cultural arguments that have been raised as ways of explaining or excusing these gaps, and he lays bare the structural violence—the racism, economic exploitation, and discrimination—that is really to blame. Inequality is a disease, Ansell argues, and we need to treat and eradicate it as we would any major illness. To do so, he outlines a vision that will provide the foundation for a healthier nation—for all.
As the COVID-19 mortality rates in underserved communities proved, inequality is all around us, and often the distance between high and low life expectancy can be a matter of just a few blocks. Updated with a new foreword by Chicago mayor Lori Lightfoot and an afterword by Ansell, The Death Gap speaks to the urgency to face this national health crisis head-on.
The difference between living downtown compared to some neighborhoods on the South and West Sides can be up to 30 years, according to recent analysis done at New York University School of Medicine. That's the largest gap in the country.
TheCity Health Dashboardand theCIA World Factbookreveal Streeterville's life expectancy of 90 is slightly higher than Monaco, the highest for any country in the world. Nine miles south, Englewood's 60-year life expectancy matches the Republic of the Congo, a third world country.
How did we get to this point?
Dr. David Ansell is the Senior Vice President of Community Health Equality at Rush University Medical Center and part of West Side United. He has spent decades taking care of patients at three different hospitals along Ogden Avenue and studying the life expectancy gap in Chicago.
As students enter, please try to create a model of the median American based on what we have been learning:
1. What does the median American look like in terms of:
A) Income
B) Wealth
C) Location
D) Education
2. Can you explain how a few of these components connect to one another? In other words, for example, how does ones income lead to education to prestige to wealth?
Putting the Dimensions of Class Together
All of the elements that we have been exploring combine to form a rough picture of social class. There is not a universally accepted model for social class but income, wealth, education, location, prestige/power all can arguably play a part in determining class.
Using your knowledge of what the median American looks like, let's evaluate social class in America. Think about these guiding questions as we go along today:
What are the different classes in the US?
Is there a middle class, and if so, what is it?
Gilbert's Model Sociologists have used different models of social class to explain how social class disaggregates in the United States. The table below is based on Hamilton College professor Dennis Gilbert's 1992 model of social class.
Which class do you think your family is, based on Gilbert's model?
Extra: If you want to explore more about where someone fits on the class ladder, you can explore an interactive graphic that shows where a person places on various aspects of class. This interactive graphic is based on a series that the NY Times did about social class called Class Matters.
What do you think about Gilbert's model? Any questions?
Dr. Williams' book came out of an article she wrote about the 2016 electionposted here in Harvard Business Review. (Extra) For more about her work, see these:
6. How does Williams' model differ from Gilberts'?
7. What do you think of Dr. Williams's model of social class? Do you think she does a good job of explaining why enough of middle American voters went from supporting Obama to supporting Trump?
Her article and her model of social class focus on these groups: The "poor" class
the bottom 30%
making less than 40K
median income of $22K
The "working" class
the middle 55%
approx. $41K - $131K
median of $75K
jobs may involve physical work, taking orders or implementing the work from managers
thrives on morals and telling the truth even if the truth is offensive
sees role as parent as a provider of essentials like safety, morals and wellness
work as a means to an identity; I work so that I can...watch baseball, go fishing, etc...
values self-employment/owning own business
See college as expensive and risky
See professional/managerial jobs as distant and leaving family behind
The "professional-managerial elite" or "PME"
the top 14% on earners and at least one college degree in household
earns more than $131K per year
median of $173,000
jobs involve advanced degrees such as MBA, JD, MD, and other doctorates
work is making decisions and overseeing them for the company or business, but less about implementing the decisions
values outward appearance and fitting their role
sees role as parent to provide opportunity to their kids
identity is often based on work or title
Princeton University sociologist, Robert Wuthnow explains the dynamic that Joan Williams describes in his book The Left Behind; Decline and Rage in Rural America that location has strongly affected how rural Americans feel and how they vote.
What is fueling rural America’s outrage toward the federal government? Why did rural Americans vote overwhelmingly for Donald Trump? And, beyond economic and demographic decline, is there a more nuanced explanation for the growing rural-urban divide? Drawing on more than a decade of research and hundreds of interviews, Robert Wuthnow brings us into America’s small towns, farms, and rural communities to paint a rich portrait of the moral order — the interactions, loyalties, obligations, and identities—underpinning this critical segment of the nation. Wuthnow demonstrates that to truly understand rural Americans’ anger, their culture must be explored more fully.Wuthnow argues that rural America’s fury stems less from specific economic concerns than from the perception that Washington is distant from and yet threatening to the social fabric of small towns. Rural dwellers are especially troubled by Washington’s seeming lack of empathy for such small-town norms as personal responsibility, frugality, cooperation, and common sense. Wuthnow also shows that while these communities may not be as discriminatory as critics claim, racism and misogyny remain embedded in rural patterns of life.
In our last lesson, we examined the difficulty with defining "middle class" in the United States. Today we will examine the bottom of the social class ladder, the Americans with the lowest incomes. Remember that this unit is focused on the inequalities (both obstacles and opportunities) that come from different social class positions. As the lesson goes on, please keep in mind these guiding questions:
What are the difficulties in defining "poverty"?
What are the obstacles associated with the lowest social classes?
Obviously, we saw that the U.S. has a wide range of income and a substantial number of citizens who are low income. But how many of these low-income earners should be considered "poor"? Experts talk about poverty in various ways. This 2019 analysis from the Annie E. Casey Foundation explains some of the most common terms used to describe poverty in the United States today: official poverty measure and the supplemental poverty measure, extreme poverty, low income, concentrated poverty.
The simplest way to define poverty is a threshold of income based on family size and the cost of food. Most experts believe that this number is too low and the actual number of Americans living in poverty should be much higher. In any case, the official poverty measure threshold for a family of 4 in 2018 was $25,465. About 12% of Americans fall into this threshold! That's 39 million Americans! Thirty. Nine. Million.
Besides the official number, there are other ways of calculating the actual number of people in poverty and these measure report higher numbers of poverty. And then there is a substantial number of Americans who do not qualify as impoverished but they are so low income that they are considered at-risk. They are working and getting by, but barely. One accident or unfortunate event can thrust them into poverty.
1. After clicking on the link above, what are the differences between the official poverty measure and the supplemental poverty measure?
Online Simulation
Living in poverty means many Americans have to make hard choices about their lives. Try the playspent website which guides readers through the difficult choices that those in poverty must make. When finished, please reflect on the simulation.
2. What happened in the simulation that made it difficult for you to be economically stable? Was there something that came up during the simulation that you had not thought about before?
Poverty and location
Poverty, like the other social classes, is segregated within the U.S. so we do not always notice it. Click on the map here.
3. What is the poverty rate in Lake County?
Now on the poverty map, click on the US as a whole.
4. How high is poverty in Lake County compared to the U.S. ? What areas of the U.S. have the largest numbers of poverty?
Effects of Poverty
Hypothesize about the ways that poverty might affect people in termsof:
Health
Location/environment
Criminal Justice System
Health
Americans with low income have a higher chance of dying at any age than a wealthy person!
Some of the evidence that supports and explains this claim:
Unnatural causes is a website and documentary about the connection between social class and health;
UNNATURAL CAUSES is the acclaimed documentary series broadcast by PBS and now used by thousands of organizations around the country to tackle the root causes of our alarming socio-economic and racial inequities in health. The four-hour series crisscrosses the nation uncovering startling new findings that suggest there is much more to our health than bad habits, health care, or unlucky genes. The social circumstances in which we are born, live, and work can actually get under our skin and disrupt our physiology as much as germs and viruses. Among the clues:
• It's not CEOs dropping dead from heart attacks, but their subordinates.
• Poor smokers are at higher risk of disease than rich smokers.
• Recent Latino immigrants, though typically poorer, enjoy better health than the average American. But the longer they're here, the worse their health becomes.
Furthermore, research has revealed a gradient to health. At each step down the class pyramid, people tend to be sicker and die sooner. Poor Americans die on average almost six years sooner than the rich. No surprise. But even middle class Americans die two years sooner than the rich. And at each step on that pyramid, African Americans, on average, fare worse than their white counterparts. In many cases, so do other peoples of color.
But why? How can class and racism disrupt our physiology? Through what channels might inequities in housing, wealthy, jobs, and education, along with a lack of power and control over one's life, translate into bad health? What is it about our poor neighborhoods, especially neglected neighborhoods of color, that is so deadly? How are the behavioral choices we make (such as diet and exercise) constrained by the choices we have?
From Voices For Illinois Children, we see that the number of children in poverty has been increasing and the effects can be very damaging;
Growing up in poverty can have serious and long-lasting effects on children’s health, development, and overall well-being. The effects of poverty have a well-documented impact on young children’s developing brains. And children who grow up in poverty are more likely to experience harmful levels of stress, more likely to struggle in school, and more likely to have behavioral, social, and emotional problems than their peers.
Impoverished black children, for example, are twice as likely as poor Hispanic or white children to have levels of lead in their blood that is at least 2.5 micrograms per deciliter. Some researchers have found that even that small amount of lead is enough to cause cognitive impairment in children — especially the kind that impacts their reading ability.
Food insecurity was associated with self-reported hypertension and hyperlipidemia. Food insecurity was associated with laboratory or examination evidence of hypertension and diabetes. The association with laboratory evidence of diabetes did not reach significance in the fully adjusted model unless we used a stricter definition of food insecurity. These data show that food insecurity is associated with cardiovascular risk factors. Health policy discussions should focus increased attention on ability to afford high-quality foods for adults with or at risk for chronic disease.
Once homeless, equitable access to both preventative and remedial health care is lacking and is associated with a higher than average burden of cardiovascular disease [CVD] risk factors, morbidity and mortality and is accompanied by disproportionately high health care costs.
Less access to healthcare, from the NIH, Journal of Community Health (2018);
Having a low-income presents a variety of problems for families and children, with access to health care being the most complex and prevalent. Although there are many challenges for low-income families to access adequate health care in the United States, the key barriers identified in this review of literature are a lack of education, complications with health insurance, and a distrust of health care providers. Each obstacle is influenced by a myriad of factors that affect vulnerable sub-groups of low-income families. Acknowledging the barriers that prevent access to health care for low-income families is the first step towards determining future sustainable solutions.
Ongoing research, however, is moving beyond correlation to test a causal relationship between growing up in poverty and development in key parts of the brain that govern learning and behavior. Findings suggest that aspects of poverty that affect brain development go beyond limited financial resources to include neighborhood violence, low-quality schools, environmental toxins, and unstable family life.
Low levels of household income are associated with several lifetime mental disorders and suicide attempts, and a decrease in income is associated with a higher risk for anxiety, substance use, and mood disorders, according to a new study.
One reason may be that violence tracks with poverty, thereby preventing people from being active out-of-doors. Similarly, parks and sports facilities are less available to people living in poor counties (5), and people who live in poverty-dense regions may be less able to afford gym membership, sports clothing, and/or exercise equipment. There are multiple individual and environmental reasons to explain why poverty-dense counties may be more sedentary and bear greater obesity burdens.
Conditions in the places where people live, learn, work, and play affect a wide range of health risks and outcomes.1 These conditions are known as social determinants of health (SDOH).We know that poverty limits access to healthy foods and safe neighborhoods and that more education is a predictor of better health.2,3,4 We also know that differences in health are striking in communities with poor SDOH such as unstable housing, low income, unsafe neighborhoods, or substandard education.
...early-life exposures to nitrogen dioxide (NO2), a marker of traffic-related pollution, and fine particulate matter (PM2.5), a mixture of industrial and other pollutants, are positively associated with subsequent childhood asthma diagnosis...
From Yale’s School of Forestry and Environmental Studies, Scientific American documents numerous particulates of air pollution containing more hazardous ingredients in non-white and low-income communities than in affluent white ones, a new study shows.
From the Huffington Post, the poor are more likely to experience asthma and other health issues.
...poor black children are more likely than poor white or Hispanic children to be diagnosed with asthma — another ailment that plagues poor children in Jacksonville and one that is linked to living in older, more industrialized areas. Poor white children, though, are more likely to be exposed to secondhand smoke, or to be born to mothers who smoked during pregnancy than poor black or Hispanic children. And poor Hispanic children, it found, are twice as likely to have no place to go for health care, as compared to poor white or black children.
And Clint Smith, a Washington DC teacher explains in his slam poem the ways that location affects his students. As you watch, make a list of the ways that location affects them:
Criminal Justice Poor people are more likely to enter the criminal justice system and remain there.
Loyola's 2022 New Student Convocation featured keynote speaker Reuben Jonathon Miller, Loyola alum, and professor at University of Chicago. Miller highlighted the many ways that the criminal justice system creates obstacles for those who enter it. You can read more about Miller's work from NPR here.
This is one revelation in William Chambliss's study called "The Saints and the Roughnecks" Chambliss argues that money was a key factor in preventing kids from getting into trouble. If you have enough money it helps you cover up the deviance. Do you think this applies to kids at our school (no names please). Who is deviant? How do they hide it? Does money play a role? Is everyone at school a "saint"? Another important revelation in Chambliss's research is that the kids who accept the label of "deviant" then act upon that label. In other words, if I think that everyone expects me to be deviant, I may accept that as the truth and then I act deviant. Once you are labeled as "deviant", that becomes a stigma or a badge of disgrace that you carry with you. Sociologists who study this perspective call it the labeling theory.
In one of the richest countries on Earth it has effectively become a crime to be poor. For example, in Ferguson, Missouri, the U.S. Department of Justice didn’t just expose racially biased policing; it also exposed exorbitant fines and fees for minor crimes that mainly hit the city’s poor, African American population, resulting in jail by the thousands. As Peter Edelman explains in Not a Crime to Be Poor, in fact Ferguson is everywhere: the debtors’ prisons of the twenty-first century. The anti-tax revolution that began with the Reagan era led state and local governments, starved for revenues, to squeeze ordinary people, collect fines and fees to the tune of 10 million people who now owe $50 billion.
Nor is the criminalization of poverty confined to money. Schoolchildren are sent to court for playground skirmishes that previously sent them to the principal’s office. Women are evicted from their homes for calling the police too often to ask for protection from domestic violence. The homeless are arrested for sleeping in the park or urinating in public.
The chart below from the Bureau of Justice Statistics shows the different stages of the criminal justice system. In each stage, a person of lower social class is more likely to progress through the system than a person of upper social class.
Far from offering people a "second chance," our criminal justice system frequently punishes those who never had a first chance: people in poverty. By focusing law enforcement on low-level offenses and subjecting criminal defendants to money bail and other fees, our country effectively punishes people for being poor.
Poverty is not only a predictor of involvement with the justice system: Too often, it is also the outcome. Criminal punishment subjects people to countless fines, fees, and other costs (often enriching private companies in the process). A criminal record, meanwhile, does lasting collateral damage.
POVERTY IN OUR JUSTICE SYSTEM IS TOO OFTEN TREATED AS A CRIMINAL OFFENSE.
Take driver’s licenses for instance: A driver with a busted tail light will be assessed a fine. For many living in poverty, they cannot afford to pay. If left unpaid, most states will eventually suspend the driver’s license.
Unless the person lives in a city with reliable public transportation, they will have to keep driving to stay employed – putting themselves at higher risk of punishment. Driving on a suspended license leads to additional suspension time and fines, a criminal record, and possible jail time. A simple lack of money can have devastating impacts on one’s livelihood.
The collateral consequences do not end there. Someone who can’t drive has a hard time staying employed or finding another job. A study in New Jersey showed that 42% of drivers who had suspended licenses lost their jobs and could not readily find another. Eligibility for public housing is restricted or denied if the applicant has a criminal record, including misdemeanors such as driving with a suspended license. Local public housing authorities can be even more restrictive and evict occupants if a member of their family or another person residing in commits a crime, such as a misdemeanor drug offense.
For someone with low income, having a busted tail light leads to criminal consequences, loss of employment, and even homelessness.
In the United States, wealth, not culpability, often shapes outcomes. From what is defined as criminal behavior to how penalties are decided, our legal system punishes people who are poor in America far more often and more harshly than the wealthy.
No person in America should be locked up because they are poor. Yet, every day we see homeless people arrested for sleeping outside; parents who can’t afford to purchase their release from jail; and people who cycle in and out of jail because they can’t afford to pay old fines as their debt grows from new ones. Meanwhile, cities and counties fill their coffers from the fines and fees that are imposed on people who are struggling just to survive. We need a criminal justice system that puts people over profit and helps to make vulnerable people more stable, not less stable.
Housing and Eviction
Housing and living expenses cost more if you are poor, from the ASA's Society Pages,
Social science research demonstrates that the poor pay more for necessities like housing and food, and debt can have serious consequences beyond just financial. The poor pay significantly more for housing than others — sometimes 70% or 80% of their income. In 2018, low-income households paid over half their income for rent or lived in substandard housing. Further, landlords overcharge tenants in high poverty neighborhoods and those with higher concentrations of African Americans relative to the market value of the property. When families cannot afford basic needs they will make calculated tradeoffs to keep their housing, paying for rent instead of utilities to avoid eviction. Such tradeoffs often lead to compounded costs from late fees, and families living without water, electricity, or heat....Poor families tend to pay more for food, too....When poor people face fines and fees, their inability to pay or keep up with payments means they go further into debt. When these fees are part of the criminal justice system, failure to pay can also result in jail time.
Evicted by Matthew Desmond
The award-winning book Evicted from Harvard sociologist Matthew Desmond shows how society profits off the poor and how lack of housing can lead families to spiral downward.
In this groundbreaking book, Harvard sociologist and 2015 MacArthur “Genius” Award winner Matthew Desmond takes readers into the poorest neighborhoods of Milwaukee, where families spend most of their income on housing and where eviction has become routine—a vicious cycle that deepens our country’s vast inequality. Based on years of embedded fieldwork and painstakingly gathered data, Evicted transforms our understanding of extreme poverty and economic exploitation while providing fresh ideas for solving a devastating, uniquely American problem.
Mercy Housing provides 6 ways that being poor costs more.
5. What is one of the factors above (from either health, environment, criminal justice or housing) that you had not realized before? Can you see how these factors make it difficult to rise out of poverty?
In the contemporary United States, thinness is associated with high social status and taken as evidence of moral virtue. In contrast, fatness is linked to low status and seen as a sign of sloth and gluttony....news media in our sample typically discuss how a host of complex factors beyond individual control contribute to anorexia and bulimia. In that anorexics and bulimics are typically portrayed as young white women or girls, this reinforces cultural images of young white female victims. In contrast, the media predominantly attribute overweight to bad individual choices and tend to treat binge eating disorder as ordinary and blameworthy overeating. In that the poor and minorities are more likely to be heavy, such reporting reinforces social stereotypes of fat people, ethnic minorities, and the poor as out of control and lazy.
After you have thought about your own personal example, classify the four people in this Esquire article and analyze what class they are and why? Try to use components other than income. How is each person shaped by their social class?
