Poverty amongst riches is the most grievous form of want.
— Lucius Seneca (~4 BCE – 65 CE), Epistulae morales ad Lucilium, LXXIV, 4, adapted.
No society can be flourishing and happy, of which the greater part of members are poor and miserable.
— Adam Smith (1723 – 90)
We got to keep these here people down or they'll take the country. …
Outlanders.
Foreigners.
Sure, they talk the same language, but they ain't the same.
Look how they live. …
Why, Jesus, they're as dangerous as niggers in the South!
If they ever get together there ain't nothin' that'll stop 'em.
— John Steinbeck (1902 – 68), The Grapes of Wrath, 1939, p 250.
John Kennedy (1917 – 63):
If a free society cannot help the many who are poor, it cannot save the few who are rich.
(Chris Matthews, Jack Kennedy: Elusive Hero, Simon & Schuster, 2011, Reader's Digest, 2013,
p 129)
Abraham Lincoln (1809 – 65):
Fellow citizens, we cannot escape history. …
The fiery trial through which we pass, will light us down, in honor or dishonor, to the latest generation. …
The dogmas of the quiet past, are inadequate to the stormy present. …
In giving freedom to the slave we assure freedom to the free. …
We must disenthrall ourselves, and then we shall save our country.
(Message to Congress, 1 December 1892)
Clement Vallandigham ( 1820 – 71) [Leader, Peace Democrats, 14 January 1863]:
I see more of barbarism and sin, a thousand times, in the continuance of this war … and the enslavement of the white race by debt and taxes and arbitrary power [than in Negro slavery.]
In considering terms of settlement [with the South, we should] look only to welfare, peace, and safety of the white race, without reference to the effect that settlement may have on the African.
(James McPherson, Battle Cry of Freedom, 2nd Edition, Oxford University Press, 2003, p 513)
George Gilder (1939):
In order to succeed … the poor need, most of all, the spur of their poverty.
(Wealth and Poverty, 1981)
Robert Putnam (1941):
Over the four decades between 1974 and 2014, inflation-adjusted annual market incomeIf today’s income were distributed in the same way that 1970 income was distributed, it is estimated,
- fell $320 for households at the 10th percentile (the bottom tenth),
- rose $388 for those at the 20th percentile (the bottom fifth),
- rose $5,232 for those at the national median,
- rose $75,053 for households in the top 5 percent,
- rose $929,108 for those in the top 1 percent, and
- rose $4,846,718 for those in the top 0.1 percent. …
(The Upswing, 2020)
- the bottom 99 percent would get roughly $1 trillion more annually, and
- the top 1 percent would get roughly $1 trillion less.
Would you like to know more?
Mark Blyth (1967):
72% of the working population [in the US live from] paycheck to paycheck, have few if any savings, and would have trouble raising $2000 on short notice.
(Austerity, Oxford University Press, 2013, p 48)
Thomas Jefferson (1743 – 1826):
All eyes are opened, or opening, to the rights of man.
The general spread of the light of science has already laid open to every view the palpable truth that the mass of mankind has not been born with saddles on their backs; nor a favored few booted and spurred, ready to ride them legitimately, by the grace of God.
(Letter to Roger C Weightman, 24 June 1826)
Kim Robinson (1952):
There were of course very powerful forces on Earth adamantly opposed to … creating full employment …
Full employment, if enacted, would remove “wage pressure” — which phrase had always meant fear struck into the hearts of the poor, also into the hearts of anyone who feared becoming poor, which meant almost everyone on Earth.
This fear was a major tool of social control, indeed the prop that held up the current order despite its obvious failures.
Even though it was a system so bad that everyone in it lived in fear, either of starvation or the guillotine, still they clutched to it harder than ever.
(2312, Orbit, 2012, p 373-4)
Ridley Scott (1937):
Quite an experience to live in fear, isn't it?
That's what it is to be a slave.
(Blade Runner, 1982)
American Political Science Association Task Force on Inequality and American Democracy:
Today, the voices of American citizens are raised and heard unequally.
The privileged participate more than others and are increasingly well organized to press their demands on government.
Public officials, in turn, are much more responsive to the privileged than to average citizens and the least affluent.
Citizens with lower or moderate incomes speak with a whisper that is lost on the ears of inattentive government officials, while the advantaged roar with a clarity and consistency that policy-makers readily hear and routinely follow.
(American Democracy in an Age of Rising Inequality, Perspectives on Politics, December 2004, p 651)
Don Watson (1949):
[The US minimum wage has fallen by a third since 1968.]
More than 20% of children in the United States live in poverty, more than twice the rate of any European country.
[The Australian child poverty rate is 17.4%.]
With a quarter of totalitarian China's population, democratic America has about the same number of people in jail.
(Enemy Within: American Politics in the Time of Trump, Issue 63, 2016, p 34)
Sean Reardon [Sociologist, Stanford University]:
The achievement gap [in education] between children from high- and low-income families is roughly 30–40% larger among children born in 2001 than among those born 25 years earlier.
(The Widening Academic Achievement Gap Between the Rich and the Poor: New Evidence and Possible Explanations, in Whither Opportunity? Rising Inequality, Schools, and Children’s Life Chances, Greg Duncan & Richard Murnane, Editors, Russell Sage Foundation, 2011)
Andrew Cherlin:
The wages of men without college degrees have fallen since the early 1970s, and the wages of women without college degrees have failed to grow.
(Demographic Trends in the United States: A Review of Research in the 2000s, Journal of Marriage and Family, 72, June 2010, p 404)
Milton Friedman (1912 – 2006):
[In] a free choice [educational] system, you would have more heterogeneous schools [and] far less segregation by social and economic class than you now have. …
I went to a state school, Rutger's university.
I went on a state scholarship.
The poor suckers in the state of New Jersey paid for my going to college.
I personally think that was a good thing. ….
[And] I don't see any reason whatsoever, why I shouldn't have been required to pay back that money.
(What's Wrong With Our Schools, Free to Choose, Episode 6, PBS, 1980)
Robert Putnam (1941)
A World Without Trust
I've told you about my granddaughter, Miriam …
Mary Sue and Miriam are exactly the same age.
They are both granddaughters of Port Clinton [Ohio] in the 1950s. …
I'm just going to read to you, the field notes from [our meeting with Mary Sue:]
Mary Sue tells a harrowing tale of loneliness, distrust and isolation.
Her parents split up when she was 5.
And her mother turned to stripping and left her alone and hungry for days.
Her dad hooked up with another woman who hit her, refused to feed her, and confined her to room with baby-gates.
Caught trafficking marihuana at 16, Mary Sue … spent several months in a juvenile detention center, failed out of high school and got a "diploma" online.
[Mary Sue's] experiences have left her with a deep seated mistrust of anyone and everyone embodied in the scars on her arms (which we saw) where her boyfriend had burned her in the middle of the night, just a few days earlier.
Mary Sue wistfully recalls her stillborn baby, born when she was 13.
Since breaking up with the baby's dad, who left her for someone else, and with a second fiance who cheated on her after his release from prison, Mary Sue is currently dating an older man with two infants born two months apart to two other women.
And to Mary Sue this feels like the best that she can hope for. …
Mary Sue posted on facebook, not long ago, that she'd figured out her problems.
Her problem, she said, is that no one in the world loves her — which is probably true …
And, she's figured out how to solve that problem.
Mary Sue's going to have baby, because the baby will love her.
And if you think Mary Sue is in a pickle, imagine Mary Sue's baby …
[The] most important feature of the life of a poor kid in America today, bar none, is that poor kids are isolated and alone.
And they don't trust anyone.
They don't trust their parents …
They don't trust schools.
They don't trust anybody.
Mary Sue recently posted on facebook:
Love hurts.Think what it means to grow up in a society in which you cannot trust anyone.
Trust kills.
(Closing the Opportunity Gap, RSA, 6 October 2015)
Freedom and Justice for All
From 2009 to 2012, the real incomes of the top 1% of American families rose 31%, while the real incomes of the bottom 99% barely budged (up less than half a percentage point).
(p 36)
In terms of average wages, a college degree was worth 50% more than a regular high school degree in 1980, but by 2008 the college degree was worth 95% more.
(p 184)
[The] net worth of college-educated American households with children rose by 47% between 1989 and 2013, whereas among high school-educated households net worth actually fell by 17% during that quarter century.
(p 36, emphasis added)
[The] growing access by poor kids to college does not mean growing access to selective colleges and universities.
Increasingly, poor kids who go on to college are concentrated in community colleges …
Community colleges can play a valuable role as a ladder out of poverty …
[However, in] terms of entry into more selective institutions, which … offer the best prospects for success in America, the class gap has actually widened in recent years. …
By 2004, in the nation’s “most competitive” colleges and universities … kids from the top quartile of the socioeconomic scale outnumbered kids from the bottom quartile by about 14 to one.
(p 185)
Parental income and university access, United States, 2014
In 2014, the rate of access to higher education (percentage of individuals age 19–21 enrolled in a college, university, or other institution of higher education) was barely 30 percent for children of the poorest 10 percent in the United States and 90 percent for the richest 10 percent.
(Thomas Piketty, Figure I.8, Capital and Ideology, 2020)
[Furthermore, much] of the recent growth in enrollment in postsecondary institutions by low-income students has been concentrated in the rapidly expanding for-profit sector …
In 2013 this sector attracted 13% of all full-time undergraduates, compared to 2% in 1991.
These students are disproportionately from low-income backgrounds (as well as older and ethnic minorities).
Giving a leg up to such students could narrow the opportunity gap …
[However,] for-profit institutions are twice as expensive for students as public universities — and have much worse records in terms of
- graduation rates,
- employment rates, and
- earnings.
- much higher debt burdens (especially government-backed loans) and
- much higher default rates.
David J Deming, Claudia Goldin, and Lawrence F Katz, “The For-Profit Postsecondary School Sector: Nimble Critters or Agile Predators?,” Journal of Economic Perspectives 26 (Winter 2012): 139–64, show that the outcomes from for-profit institutions are worse, even holding constant the students’ background characteristics.
(Note 78, p 338)
The class gap in college completion, which was already substantial 30 to 40 years ago, has steadily expanded.
This matters hugely, because completing college is much more important than entering college on all sorts of levels:
- socioeconomic success,
- physical and mental health,
- longevity,
- life satisfaction, and more. …
Kids from low-income backgrounds … are working more or less diligently to improve their prospects in life, but no matter how talented and hardworking they are, at best they are improving their play at checkers, while upper-class kids are widening their lead at three-dimensional chess. …
[Changes in family] structure, parenting, childhood development, peer groups, [and] extracurricular opportunities [have all] contributed to the widening gap in college graduation rates in recent decades, along with the neighborhood and community influences …
(p 188)
The burdens on the poor kids have been gathering weight since they were very young.
Rising tuition costs and student debt are the final straw, not the main load. …
As the twenty-first century opened, a family’s socioeconomic status had become even more important than test scores in predicting which eighth graders would graduate from college. …
[Academically] high-scoring poor kids are now slightly less likely (29%) to get a college degree than low-scoring rich kids (30%).
(p 190, emphasis added)
[Social] capital can protect privileged kids from the ordinary risks of adolescence.
Studies during the past 40 years have consistently shown that, if anything, drug usage and binge drinking are more common among privileged teenagers than among their less affluent peers.
What is different, however, are the family and community “air bags” that deploy to minimize the negative consequences of drugs and other misadventures among rich kids. …
To be sure, social capital is not the only advantage that privileged kids have in confronting unexpected risks; … financial capital [also provides significant protection from the potentially catastrophic consequences of wayward behavior.]
(p 210)
[Class] segregation across America has been growing for decades, so fewer affluent kids live in poor neighborhoods, and fewer poor kids live in rich neighborhoods.
(p 217)
The pervasive growth of neighborhood economic segregation [first became evident shortly] after the rise in nationwide economic inequality in the 1970s.
The onset and aftermath of the Great Recession in 2008 only accelerated these disparities.
Given the manifold ways in which neighborhood economic differences affect the lives and opportunities open to young people, it is hardly surprising that neighborhood inequality across metropolitan areas is associated with less equality of opportunity.
[Unlike in the mixed neighborhoods of the past:]
- the benefits of neighborhood affluence are [now] concentrated on rich kids [while]
- the costs of neighborhood poverty are concentrated on poor kids.
- the lower the rate of upward social mobility and
- the greater the opportunity gap.
(p 223, emphasis added)
{This is not the first time in our national history that widening socioeconomic gaps have threatened our economy, our democracy, and our values.}
It took many decades for public high schools to become nearly universal in America, but the High School movement that made America a world leader in economic productivity and social mobility began in earnest in local communities across the nation a century ago.
The essence of that reform was a willingness of better-off Americans to pay for schools that would mainly benefit other people’s kids. …
The specific responses we have pursued to successfully overcome these challenges and restore opportunity have varied in detail, but underlying them all was a commitment to invest in other people’s children.
And underlying that commitment was a deeper sense that those kids, too, were our kids.
(pp 260-1)
Throughout [US] history, a pendulum has slowly swung between the poles of individualism and community, both
- in our public philosophy and
- in our daily lives.
At the same time, researchers have steadily piled up evidence of how important social context, social institutions, and social networks — in short, our communities — remain for our well-being, and [for] our kids’ opportunities.
(p 206)
(Our Kids: The American Dream in Crisis, 2015)
A half century [of] increased competition in the global marketplace, improved information technology, greater focus on short-term financial returns, and new management techniques have combined to make virtually all jobs more "contingent". …
One consequence of these changes has been increased employee anxiety, but there have been winners as well as losers.
More independence from the firm, flatter hierarchies, less paternalism, and more reward for merit and creativity rather than seniority and loyalty have been good for many firms and their employees.
Even when corporate morale and employee commitment have been badly damaged, as they typically are, research often finds that corporate productivity has improved.
[Nevertheless, in terms of] their impact on trust and social connectedness in the workplace … the balance sheet is negative.
(Bowling Alone, Touchstone, 2001, p 88)
Contents
The Upswing: How America Came Together a Century Ago and How We Can Do It Again
Living the American Nightmare
Our Kids: The American Dream in Crisis
Robert Putnam (1941)
Malkin Professor of Public Policy, John F Kennedy School of Government, Harvard University.
- Our Kids: The American Dream in Crisis, Simon & Schuster, 2015.
[Because of our sampling method the most] alienated and detached young people in [our] communities {escaped our net:}
- those who don’t work, don’t go to school, and don’t participate in communal leisure activities,
- those who are homeless, on the run, or in prison …
Far from being cherry-picked to exaggerate the plight of poor kids in America, the heartbreaking stories of poor kids in this book actually understate the tragic life experiences of those on the very bottom of our society, the most deprived of American kids.
(p 274)
Because of growing class segregation in America, fewer and fewer successful people (and even fewer of our children) have much idea how the other half lives.
So we are less empathetic than we should be to the plight of less privileged kids.
Before I began this research, I was like that.
I’ve worked hard, I thought, to rise from a modest background in Port Clinton — much of the time heedless of how much my good fortune depended on family and community and public institutions in that more communitarian and egalitarian age.
If I and my classmates could climb the ladder, I assumed, so could kids from modest backgrounds today.
Having finished this research, I know better.
(p 230)
Some of us learn from numbers, but more of us learn from stories.
Since one central purpose of this book is to enlarge the number of educated Americans who appreciate “how the other half lives,” we have given pride of place to the life stories of rich kids and poor kids.
(p 264)
[It was for this reason that we] spent two years and hundreds of hours talking with families [and] interviewing 107 young adults and their parents.
(p 265)
We offered all recruits fifty dollars in exchange for their time.
How they used this money was telling: upper-middle-class parents often refused the payment and upper-middle-class kids joked about beer money, but working-class respondents used it to pay for immediate, dire needs.
A religious family in Orange County viewed us literally as “a gift from God,” because they hadn’t known how they were going to pay for both gas and lunch that day.
Lola, also in Orange County, put the money toward the funeral of a family member who had just been killed in a gang shooting.
Often the recruitment process taught us a great deal about their daily lives.
For example, when we approached Stephanie at her service job in Atlanta and told her we would offer her daughters $50 to participate in a study, she immediately called her daughter Michelle to insist that Michelle not leave the house without speaking to [us] — a sign of how desperately Michelle, out of work and out of school, needed money for gas and food.
And when [we met Bill, a firefighter,] at a local fried fish restaurant with his entire family in tow, [he explained:]We wanted both kids to see someone who had [actually] graduated from college and was doing something with her life,
we realized in a visceral way how bewildered some working-class families feel when they try to guide their children into a baffling future.
(p 267)
In some cases, [our] interview guide seemed laughably naive, such as when we began to ask Mary Sue — a young working-class woman abandoned by her mother at an early age and left with no company but a mouse — about piano lessons.
In such situations, we realized how removed working-class kids are from our notions of a “normal” childhood …
(p 268)
Parenting
[No] matter what measure of parental investment in child development we use, kids from more educated, affluent homes have a substantial and even widening lead. …
Stressed parents are both harsher and less attentive parents.
Economic stress, in particular,- disrupts family relations,
- fosters withdrawn and inconsistent parenting, and
- directly increases chronic stress among children. …
[Indeed, what] we usually understand as an impoverished parent’s lack of skills, care, patience, tolerance, attention, and dedication can actually be attributed to the fact that the parent’s mind is functioning under a heavy [allostatic] load.
(p 130)
The percentage of grandparents who serve as primary caregivers roughly doubled between 1970 and 1997, with virtually all of that increase concentrated in poor and minority families.
Such full-time grandparents are increasingly forced to replace parents because of the collapse of the lower-class family. …
[This] replacement grandparenting typically does little more than replace younger, poor, less educated (and now often missing) caregivers with older, poor, less educated caregivers …
Replacement grandparenting is more common among nonwhites, but it is rising more rapidly among poor whites. …
(p 132)
Could changes in public policy or political ideology have had the perverse effect of undermining the conventional two-parent family?
The most commonly discussed possibility, by far, is that welfare benefits gave poor single women an incentive to have kids.
Some careful studies have confirmed a modest, statistically significant effect of that sort.
But the steady, accelerating increase in single-parent families over the last half century does not correspond to the ebb and flow of mothers on welfare. …
Moreover, since many mothers who experienced the collapse of the traditional family were not on welfare, the welfare system cannot have been the major cause.
And the collapse continued apace even after welfare eligibility was tightened in 1996.
"Family values" conservatives have sometimes argued that liberalism and secularism cause family disintegration.
But unwed births and single-parent families are widely distributed across the country, and are concentrated neither in secular areas nor in "blue" states, which presumably have pursued more progressive policies.
If anything, the opposite seems to be true: divorce and single-parent families are especially common in the Southeastern, heavily Republican, socially conservative Bible Belt.
(p 75)
We can't make any inferences about causality from such simple correlations, but these patterns should caution us against assuming that the collapse of the working-class family (white or nonwhite) can be attributed to the decline of organized religion or to any political ideology.
Changing personal values are an important part of the story, but only in conjunction with adverse economic trends, and ideology seems to have very little to do with it.
(p 76)
Schooling
Stressful conditions from outside school are much more likely to intrude into the classroom in high-poverty schools.
Every one of ten such “stressors” is two or three times more common in high-poverty schools than in their low-poverty counterparts:- student hunger, unstable housing, and economic problems;
- lack of medical and dental care;
- caring for family members and other family and immigration issues;
- community violence and safety concerns.
Troy High [a low-poverty public school,] offers more than 100 different extracurricular clubs, each with its own advisor and at least ten active members …
(p 146)
Consistent involvement in extracurricular activities is strongly associated with a variety of positive outcomes during the school years and beyond …
These positive outcomes include- higher grade-point averages,
- lower dropout rates,
- lower truancy,
- better work habits,
- higher educational aspirations,
- lower delinquency rates,
- greater self-esteem,
- more psychological resilience,
- less risky behavior,
- more civic engagement (like voting and volunteering), and
- higher future wages and occupational attainment. …
One study found that during the past 15 years, activity levels in out-of-school clubs and organizations- rose among affluent youth, and
- fell among poor youth.
Admirable though it may be for other reasons, “school choice” has had at most a slight impact on the class gap. …
[Among] lower-income families, the choices parents make are often not well informed and are constrained by transportation and child care problems.
(p 164)
Most researchers have found … that school finances (including spending per pupil, and teacher salaries) are not significant predictors of school performance.
(p 165)
Private schools may give a modest edge to affluent students, but that edge has apparently not grown during the years in which the opportunity and achievement gaps have widened sharply.
(p 173, emphasis added)
Community
[A] controlled experiment called “Moving to Opportunity” found that randomly chosen poor families who were enabled to move to low-poverty neighborhoods experienced significant reductions in obesity and diabetes.
(p 223)
Controlling for many other characteristics of the child, her family, and her schooling, a child whose parents attend church regularly is 40 to 50% more likely to go on to college than a matched child of nonattenders.
Churchgoing kids- have better relations with their parents and other adults,
- have more friendships with high-performing peers,
- are more involved in sports and other extracurricular activities, [and]
- are less prone to
- substance abuse (drugs, alcohol, and smoking),
- risky behavior (like not wearing seat belts), and
- delinquency (shoplifting, misbehaving in school, and being suspended or expelled).
(p 224)
High-quality national surveys of high school seniors confirm that [compared to] {their counterparts from college-educated homes,} kids from less educated homes are- less knowledgeable about and interested in politics,
- less likely to trust the government,
- less likely to vote, and
- much less likely to be civically engaged in local affairs …
[A] nationwide study … found that (even with extensive controls for the sorts of kids who attend them) Catholic schools produced higher levels of achievement than public schools, especially for kids from poor backgrounds.
[This] strong performance [was attributed] to the social and moral community within which parochial schools are embedded.
(pp 254-5)
What Can Be Done?
[Several] high-quality experimental studies have shown that simply giving poor families money can improve the academic and social performance of their kids — money matters.
Even ideal parenting cannot compensate for all the ill effects of poverty on children, and even incompetent parenting cannot nullify all the advantages conferred by parental affluence and education. …
That said, the best scientific evidence confirms that the … disadvantages facing poor kids begin early and run deep, and are firmly established before the kids get to school …
(p 134)
Also relevant to this debate is the finding of Juho Harkonen and Jaap Dronkers, "Stability and Change in the Educational Gradient of Divorce: A Comparison of Seventeen Countries," European Sociological Review, 22 (December 2006): 501-17, that more extensive welfare state policies are associated with lower divorce rates, especially among less educated couples, suggesting that welfare state generosity reduces strain on lower-income couples.
(Note 54, p 305)
Jamie L Hanson, Nicole Hair, Dinggang G Shen, Feng Shi, John H Gilmore, Barbara L Wolfe, and Seth D Pollack, “Family Poverty Affects the Rate of Human Infant Brain Growth,” PLOS ONE 8 (December 2013), report that directly increasing the income of poor parents has measurable positive effects on children’s cognitive performance and social behavior, strongly suggesting that the link between social class and child development is causal, not spurious.
(Note 37, p 314)
An increase in family income by $3,000 during a child’s first five years of life seems to be associated with an improvement on academic achievement tests equivalent to 20 SAT points and nearly 20 percent higher income later in life. …
Getting such resources where they are most needed could be done in a variety of well-tested ways.- Expand the Earned Income Tax Credit, especially for families with young children.
Originally conceived by conservative economist Milton Friedman … this program [succeeds in] increasing the disposal income of [the working poor — though not] the poorest of poor kids. - [Expanding] the modest existing child tax credit (as advocated by Tea Party favorite Senator Mike Lee [R, Utah]) [would, on the other hand, extend support to] the poorest kids.
- Protect long-standing antipoverty programs, like food stamps, housing vouchers, and child care support. …
Any serious effort to deal with the family and community facets of the opportunity gap should include efforts to reduce incarceration for nonviolent crime and enhance rehabilitation. …
Crime has fallen to near-record lows, while the massive increase in incarceration in recent decades has come at great expense both in terms of taxpayer dollars and in terms of impact on families and communities. …
Among policy changes that could eventually begin to narrow the opportunity gap are these:- Reduce sentencing for nonviolent crime and use greater discretion in parole administration.
- Rehabilitate ex-prisoners, keeping in mind that the prison population is comprised of young men with
- very little education,
- poor job records, and
- frequent histories of mental illness and substance abuse.
- Redirect current funding for prisons to funding for
- job training,
- drug and medical treatment, and
- other rehabilitation services.
Extracurricular activities provide a natural and effective way to provide mentoring and inculcate soft skills, and we already have a dense, nationwide network of coaches, instructors, advisors, and other adults who are trained to help kids.
In short, Americans have already invented and deployed a near-perfect tool to address this problem — as close to a magic bullet as we are ever likely to find in the real world of social, and educational, and economic policy.
Perversely, as the opportunity gap has widened, we have increasingly excluded poor students from participation in this time-tested system by instituting pay-to-play.
So if you are concerned about the issues discussed in this book, here is something you could do right now.
Close this book, visit your school superintendent [and insist] that pay-to-play be ended.
(p 258)
American Dream, American Nightmare
Melinda Moyer:
At the [windowless] Tumaini Center [in Detroit, homeless] people live in chairs because the center has no beds.
(p 50)
[A] major driver [of the rising tide of infectious disease in the US] is the country’s ever worsening income inequality.
The disparity between America’s highest and lowest earners exceeds that of virtually every other developed country, and it is still widening.
The number of households earning less than $15,000 a year grew by 37% between 2000 and 2016.
Households earning $150,000 or more increased by exactly the same amount.
In poor areas, where almost half the people live below federal poverty levels, populations doubled during this period.
(p 47)
[The] Trump administration’s budget request for the 2019 fiscal year for the CDC slashes:(American Epidemic, p 57)
- $43 million from current programs for STD and tuberculosis prevention …
- $704 million from public health preparedness and response,
- $44 million from immunization and respiratory diseases, and
- $60 million from emerging and zoonotic diseases.
Lois Parshley:
[Experts] at the Brookings Institution … have written that [funding cuts to the Global Health Security Agenda] could be “devastating for global health,” damaging economic growth as well as weakening international stability.
(Catching Fever, May 2018, p 65)
Amartya Sen (1933) [Swedish National Bank's Prize in Economic Sciences in Memory of Alfred Nobel, 1998]:
Black men between the ages of 35 and 54 are 1.8 times more likely to die than are white men of the same age.
And black women in this group are almost three times more likely to die than are white women of the same age. …
The survival chances of the average African-American are … unfavorable when compared with … those of the citizens of China and Kerala, who have much lower incomes.
(The Economics of Life and Death, May 1993, p 44-5)
Julie Willems Van Dijk [Population Health Institute, University of Wisconsin]:
Research is now showing that many health effects once attributed to racial differences are actually tied to educational and economic disparities.
(Deborah Franklin, Healing Kansas, January 2012, p 18)
Board of Editors:
In 2016 drug overdose deaths numbered 63,000, more than the US death toll from the entire Vietnam War.
(Safe Injection Facilities Save Lives, p 10)
Rob Jackson [Department Chair, Earth System Science, Stanford University]:
[The proposed] rollback in mileage standards [by the Trump Administration] would mean:Rarely in my career have I seen a proposal more shortsighted and counterproductive than this one.
- Thousands of Americans would die unnecessarily from cardiovascular and other diseases every year.
- Our elderly would face more bronchitis and emphysema.
- More children would develop asthma …
(Auto Mileage Rollback Is a Sick Idea, Scientific American, July 2018, p 10)
Rising mortality among white middle-aged Americans in the 21st century
Anne Case & Angus Deaton: Woodrow Wilson School of Public and International Affairs and Department of Economics, Princeton University
[There has been] a marked increase in the all-cause mortality of middle-aged white non-Hispanic men and women in the United States between 1999 and 2013.
This change reversed decades of progress in mortality and was unique to the United States; no other rich country saw a similar turnaround.
The midlife mortality reversal was confined to white non-Hispanics …
[In all other] racial and ethnic [groups and age cohorts] mortality rates [have continued to] fall.
This increase for whites was largely accounted for by increasing death rates from:
- drug and alcohol poisonings,
- suicide, and
- chronic liver diseases [including] cirrhosis.
Although all education groups saw increases in mortality from suicide and poisonings, and an overall increase in external cause mortality, those with less education saw the most marked increases.
Rising midlife mortality rates of white non-Hispanics were paralleled by increases in midlife morbidity.
- Self-reported
- declines in health, mental health, and ability to conduct activities of daily living, and
- increases in chronic pain and inability to work,
- clinically measured deteriorations in liver function,
From 1978 to 1998, the mortality rate for US whites aged 45–54 fell by 2% per year on average, which matched … the average over all other industrialized countries. …
After 1998, other rich countries’ mortality rates continued to decline by 2% a year.
[By] contrast, US white non-Hispanic mortality rose by half a percent a year. …
If it had continued to fall at its previous (1979‒1998) rate of decline of 1.8% per year, 488,500 deaths would have been avoided in the period 1999‒2013, [including] 54,000 in 2013 [alone.]
(p 15078)
[In fact, all white non-hispanic] 5-y age groups between [30–64] have witnessed marked and similar increases in mortality from the sum of drug and alcohol poisoning, suicide, and chronic liver disease and cirrhosis over the period 1999–2013; the midlife group [differed] only in that the sum of these deaths is large enough [to reverse the downward trend in] all-cause mortality.
(p 15080)
The fraction reporting being unable to work doubled for white non-Hispanics aged 45–54 [over the] 15-y period [— ie increasing from 4.7% to 9.2%. …]
Although the epidemic of pain, suicide, and drug overdoses preceded the financial crisis, ties to economic insecurity are possible.
After the productivity slowdown in the early 1970s, and with widening income inequality, many of the baby-boom generation are the first to find, in midlife, that they will not be better off than were their parents.
Growth in real median earnings has been slow for this group, especially those with only a high school education.
However, the productivity slowdown is common to many rich countries, some of which have seen even slower growth in median earnings than the United States, yet none have had the same mortality experience.
(Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century, PNAS, 112: 49, 8 December 2015, p 15081)
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Healing Kansas
Researchers rank US counties according to how they measure up along the following behavioral, clinical, socioeconomic and environmental lines known to contribute to overall health.
Health Checklist | |||
|---|---|---|---|
Socioeconomic Factors (40%) | Health Behaviors (30%) | Clinical Care (20%) | Physical Environment (10%) |
| Education (10%) | Smoking (10%) | Access to care (10%) | Environmental quality (5%) |
| Employment (10%) | Diet and exercise (10%) | Quality of care (10%) | Built environment (5%) |
| Income (10%) | Alcohol use (5%) | ||
| Family and social support (5%) | Unsafe sex (5%) | ||
| Community safety (5%) | |||
[The] evidence that socieoeconomic factors like education play a major role in health is solid and growing.
[High] school dropouts tend to die earlier than graduates [and] their children are more likely to be born prematurely, robbing another generation of a healthy start.
Every year of additional education improves … outcomes.
(Deborah Franklin, Scientific American, January 2012, p 18)
