Doctor’s Corner… Understanding Poverty

by Allen Weiss, MD, MBA, FACP, FACR
President and CEO, NCH Healthcare System

Understanding poverty, unemployment, homelessness, drug-addiction, or any other socio-economic stress and unfortunate situation is a challenge for those of us who are so fortunate not have such an affliction. Equally arduous is being close to fellow citizens living with these circumstances.

What does it feel like to be homeless or impoverished? What happens when your car breaks down and you are broke—living from paycheck to paycheck? Or you have an acute medical need and no insurance or a high deductible? Sadly, one of these unexpected, disabling events begins a cascade of other troublesome stresses that can ultimately end in joblessness, bankruptcy, homelessness, malnourishment, and illness. The vicious cycle can become
multigenerational, overwhelming, and pervasive, extending over entire geographic regions.

Interestingly, even in beautiful and balmy Southwest Florida we have an economic divide between coastal and inland Collier County. Huge differences in economic abilities are easy to ignore if you are fortunate to have resources, but hard to take if you are at or below the poverty line. Poverty is relative—if everyone around you has similar circumstances, the differences are not so stark. Ruby Payne, in her Framework for Understanding Poverty, shares some key points to remember. Poverty becomes more apparent when others better off than you are present for comparison.

Poverty is ubiquitous across America and all nations, particularly as the middle class shrinks and wealth concentrates. The eighty-five richest people in the world have as much wealth as the 3.5 billion poorest according to the World Economic Forum’s paper entitled, Working For the Few. Economic class is continuous without clear-cut lines of distinction. The poverty thresholds were originally developed in 1963-1964 by Mollie Orshansky of the Social Security Administration. Orshansky based her poverty thresholds on the economy food plan—namely,
the cheapest of four food plans developed by the Department of Agriculture that would feed a family of two. Larger families would have proportionally larger thresholds. At that time, other family costs were not as great as they are today, e.g. for healthcare, residences, fuel, etc. Thus, now poor families have even greater stress.

A very important point about poverty is the distinction between generational poverty and situational poverty. Generational poverty occurs in two or more consecutive generations whereas situational poverty can be the result of illness, death in a family, divorce, unemployment, etc. Situational poverty can and should be addressed as quickly as possible to avoid a further deterioration into generational poverty.

Classical family diagrams in the middle class are easy to trace with husband and wife having children and the next generation producing grandchildren. Even with the current divorce rate greater than 50%, middle class family trees are orderly. However, family patterns in generational poverty typically center around the mother or maternal grandmother who are the primary care-givers. Family diagrams are difficult to construct because generational poverty families lack many legal documents—marriages sometimes don’t occur, little or no property needs splitting, children usually stay with mom, and legal documents serve limited purpose.

Anthropologist Oscar Lewis, in his study of cultural poverty (one of four horsemen, the other three being pollution, famine, and violence), wrote:

The economic traits which are most characteristic of the culture of poverty include the constant struggle for survival, unemployment and underemployment, low wages, a miscellany of unskilled occupations, child labor, the absence of savings, a chronic shortage of cash, the absence of food reserves in the home, the pattern of frequent buying of small
quantities of food many times a day as the need arises, the pawning of personal goods, borrowing from local money lenders at usurious rates of interest, spontaneous informal credit devices organized by neighbors, and the use of second-hand clothing and furniture.

I know which churches and sections in town have the best rummage sales.

I know which rummage sales have “bag sales” and when.

I know which grocery stores’ garbage bins can be accessed for thrown-away food.

I can get someone out of jail.

I know how to physically fight and defend myself.

I know how to get a gun, even if I have a police record.

I know how to keep my clothes from being stolen at the laundromat.

I know what problems to look for in a used car.

I know how to live without a checking account.

I know how to live without electricity or a phone.

I know how to use a knife as scissors.

I can entertain a group of friends with my personality and my stories.

I know what to do when I don’t have money to pay the bills.

I know how to move in half a day.

I know how to get and use food stamps.

I know where the free medical clinics are located.

I am very good at trading and bartering.

I can get by without a car.

I know how to get my children into Little League, piano lessons, soccer, etc.

I know how to properly set a table.

I know which stores are most likely to carry the clothing brands my family wears.

My children know the best name brands in clothing.

I know how to order in a nice restaurant.

I know how to use a credit card, checking account, and savings account—and I understand annuities, term life, disability, medical, homeowners, flood, and replacement insurance.

I talk to my children about going to college.

I know how to get one of the best interest rates on my new-car loan.

I understand the difference among the principal, interest, and escrow statements on my house payment.

I know how to help my children with their homework and do not hesitate to call school if I need additional information.

I know how to decorate the house for the different holidays.

I know how to get a library card.

I know how to use the different tools in the garage.

I repair items in my house almost immediately when they break—or know a repair service to call.

I can read a menu in French, English, and another language.

I have several favorite restaurants in different countries of the world.

During the holidays, I know how to hire a decorator to identify the appropriate themes and items with which to decorate the house.

I have a preferred financial advisor, legal service, designer, domestic-employment service, and hairdresser.

I have at least two residences that are staffed and maintained.

I know how to ensure confidentiality and loyalty from my domestic staff.

I have at least two or three “screens” that keep people whom I do not wish to see away from me.

I fly my own plane or company plane.

I know how to enroll my children in the preferred private schools.

I know how to host the parties that “key” people attend.

I am on the boards of at least two charities.

I know the hidden rules of the Junior League.

I support or buy the work of a particular artist.

I know how to read a corporate financial statement and analyze my own financial statements.

Inspiring movement on a large scale first involves empathy—placing yourself in someone else’s situation to find his/her perspective. Empathy is not pity. Rather, empathy should empower us to understand and help. Many of our current economic stresses could be remedied as impoverished citizens become more productive and simultaneously move into the middle class. Southwest Florida is special in many ways. We can continue to differentiate ourselves as we recognize and address poverty.

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