The Reality of Redistribution: Poverty and Health in the District of Columbia

Abstrak

Poverty restricts a person’s ability to achieve and maintain health. As one response to the poverty-health link, redistributive institutions provide subsidized goods. To understand how redistribution affects the poverty-health link in reality, I explore poverty and poor health on a general level, and on a specific level in the District of Columbia. I then present the experience of fifty low-income individuals as they work with Family Help Desk—a small D.C. NGO—to obtain subsidized goods in the nation’s capital. To document the experience of these fifty individuals, I worked as a participant observer with Family Help Desk during summer 2006. This thesis argues for acknowledgement and response to institutional deviance—deviance that can, in practice, maintain and even intensify the link between poverty and poor health. The experience of Help Desk clients supports that redistribution must be accompanied by helping individuals work with institutions and structural reform of specific organizations. Without such measures, institutional redistribution will not reach its potential to counter socioeconomic health disparities.

CHAPTER I

THE HEALTH CONSTRAINTS OF POVERTY

Within any society, certain groups have greater access to “desirable resources and rewards” (Williams, 1990:81).  Health is one such social “reward.”  Disease and premature death are not equitably distributed across socioeconomic strata.  Individuals with the least income and least education—individuals living in poverty—are more likely to suffer from illness those farther up the socioeconomic ladder.  It is certainly possible for the poorest to achieve and maintain health.  But the literature, time and time again, confirms that while poverty does not necessarily cause disease, it restricts a person’s ability to stay healthy. 

John Bowker, a professor of religious studies, argues that pathology is effectively understood using a model of constraints versus causality (1997).  To justify his approach, he recalls Hume’s caution (Ibid, 372).

We never observe ‘cause,’ but only a constancy of conjunction from which we infer “cause.”

Whether or not a person falls ill, in short, is more complicated than matters of cause and effect.  Even the “simplest” of relationships, such as the expression of a mutated gene that results in cystic fibrosis, is mediated by a larger context.  A person’s access to knowledge, to medication, and even the development of an embryo’s genome are influenced by matters beyond the gene-phenotype “causal” chain.  Overall, Bowker urges his reader to consider the following (Ibid, 374)

When we are trying to explain any complex phenomenon, we will always be wise to think of sets of constraints, even if we wish to isolate some among them as being proximate causes of particular outcomes.  An explanation will then be an adequate specification of those constraints that have brought about the eventuality (or outcome) in question.   

The poverty-disease link is one such “complex phenomenon” that operates through a related set of constraints.  There is not one, or even a set, of neatly defined causal mechanisms.  There is, rather, a network of related and interacting restrictions that constrain physical and mental well-being.  Though not a sociologist by trade, Bowker’s framework effectively organizes countless sociological studies that explore the stratification of health. 

Applying Bowker’s approach, it is quickly clear that economic marginalization is about more than federal thresholds.  Life at the bottom of the economic hierarchy subjects a person to health-hazardous constraints—constraints that are both internal and external to the individual.  I first consider how poverty can degrade a person’s sense of self-efficacy.  I then consider how even if a person is absolutely determined to achieve and maintain health, economic and social marginalization constrain their ability to avoid illness.  Overall, I consider how poverty restricts health through perceived control, stress, purchasing power, education, employment, residence, diet and exercise, race, and generational experience. 

These issues are central to the experience of my Family Help Desk (FHD) clients.  FHD clients regularly expressed feelings of powerlessness and stress as they recalled the reality of redistributive institutions.  My clients and I, moreover, worked together to obtain subsidized GED programs, housing, food and other goods and services.  Overall, the experience of FHD clients and the reality of redistributive institutions do not occur in isolation.  Such experiences enter into a broader picture of poverty and health.

As I will discuss, Bowker’s approach counters trends in both academic and popular literature.  He ultimately shares the same end goal as many of his fellow theorists—that goal being to understand and alleviate socially-stratified suffering.  But the path that Bowker advocates is a necessary intervention.  He brings debate and discussion away from simple causal relationships and toward a broader picture of human experience (Ibid, 376):

The point of reformulating the boundaries should be to shake loose the narrow concentration on single causes (important and successful though it may often be) in order to realize how profoundly the wider circumstances of existence constrain human lives into distress, some of which presents itself in what we now define as medical symptoms.

Bowker’s approach, in short, treats poverty as a “wider circumstance of existence that constraints human lives into distress.”  This approach yields insight into the myriad connections between economic marginalization and disease.  And his approach is a necessary intervention in the current debate on poverty and health.