The Indignity of Poverty

When I look back at our household when I was young, I can’t but help admire my parents’ tenacity and resilience.  When I was a child I had no perception that we were poor, and compared to some around us, we weren’t. My mother was frugal and as early as March would start putting a few cans and bottles of special treats aside for Christmas. She made many of our clothes. Dad was handy around the house and grew vegetables for our consumption. We also kept a few hens for eggs. But we lived pretty well for a one income family (as was the norm in those days) and Dad’s income was modest. When I was very young, there was no hot water system and no refrigerator (not that that was so unusual either). Dad never owned a car until he was in his fifties. As each of us got old enough to ride a bicycle to school, dad would cadge bits and pieces and manufacture a bike for each of us. (I vividly remember an older brother on getting his first job investing in a brand new Malvern Star bicycle with gears. Now that was something to be envied!) But despite all this my parents raised five children and finally paid off their mortgage on our modest cottage when they were in their sixties. My parents felt quite comfortably off later in their lives on the aged pension once the children had grown up and the mortgage was paid off.

(Poverty, like many other things is relative. The family of one of my schoolfriends lived in a house with unlined, corrugated iron walls! I felt we were pretty well off in comparison.)

So I am not pretending to know what it is like to be dirt poor, but my childhood days were one of financial struggle and pay day was always welcomed.

But it seems to me that poor people are disadvantaged and humiliated in many ways in our modern society, beyond anything with which I and my family had to contend.

Health is a particularly heinous example. The burden of deaths from so-called “preventable diseases” falls disproportionately on the poor.

I remember reading, probably fifty years ago, about the incidence of gout. Gout as you probably know is due to the deposit of uric acid crystals in your joints. It is usually the outcome of the consumption of rich foods. Once upon a time it was an affliction of rich people. But in recent times as the more well off have been more discerning in the selection of their food, gout has become more prevalent in poorer people who either don’t know about its causations or don’t have the wherewithal to make the appropriate substitutes in their diets. So what is the lesson here? It is merely that more well off people know more about what causes ill-health and have a greater capacity to do something about it.

Husband and wife economists at Princeton University, Angus Deaton and Anne Case, published a paper titled Morbidity and Mortality in the 21st Century. It showed among white Americans there was a growing gap between the mortality rates of wealthy white men and poor white men. There was a similar but less dramatic trend for women. (Angus Deaton won the Nobel Prize in Economic Sciences for his analysis of consumption, poverty, and welfare.)

I am unaware of any similar studies conducted in Australia but I am sure we would find similar trends.

[However the National Rural Health Alliance has researched data from the Australian Bureau of Statistics on mean income and wealth in Australia and healthcare cost barriers particularly as it impacts rural Australia. Their research shows that the risk of poverty is higher in rural and remote areas. The research also highlights the fact that:

 …. poverty has a clear and substantial impact on the social and economic determinants of health experienced by people who live in rural and remote areas. These determinants (including housing, food security, education) are estimated to be responsible for around 40 per cent of the expression of burden of disease – with risk factors (which are often influenced by social determinants) responsible for another estimated 30 per cent.]

There are also some prevalent myths that don’t help the cause of poor people. In the 1960’s medicine discovered “stress”. For many years stress was universally related to the life styles of executives. It was correlated with high blood pressure and heart disease. Having been an executive I can attest to the fact that such work can often be stressful. But it is difficult to imagine that such stress would be more than that endured by a poor person continually living from hand to mouth, with no certainty about how he might feed his family or provide a roof over their heads. And this is reflected by more modern studies that show that stress, as measured by levels of cortisol in the blood stream, increases as you move down the socioeconomic scale.

Add to this the added indignity that if you are poor, without medical insurance, you are last on the long waiting lists for such procedures as cataract removal or hip or knee replacements.

But I suppose what I find most offensive is that poor people are often blamed for their poor health by those who are better off. It is easy for those in more privileged situations to proclaim that the poor should eat more responsibly, take more exercise and so on. But maintaining a health regime that includes a selective diet and the necessity to go to the gym is beyond the financial capacity of such people.

You go to their funerals and people among the mourners murmur, “they drank too much”, “didn’t do much to control their obesity”, “smoked all their lives”, and so on reinforcing that their reduced longevity was due to lifestyle choices that they could just as easily modified. And yet, a good friend of mine, an executive died of a heart attack in his early fifties and people said, “It was the stress, you know. He was in charge of a huge project with a demanding timeline.” There was no mention of his lifestyle.

John H Knowles was the president of the Rockefeller Foundation and an international medical leader. Knowles was famous for insisting that individuals take responsibility for their personal health. Despite his own personal fitness, Knowles died of pancreatic cancer at age 52!  To be fair, according to some medical experts, pancreatic cancer is a disease that is not preventable.  But that is true of other diseases and also diminishes the substantial effect on longevity of our genetics. We need to be careful about blaming the individual for his state of health.

Knowles well-meaning approach to health easily led to a variant of “victim blaming” and as it is often the poor whose lives are unduly cut short, the lifestyles of the poor are unduly criticised.

Susan Sontag, the American author and film maker published a book titled Illness as Metaphor. In this book she argued against the oppressive moralising of disease which was increasingly portrayed (as per Knowles above) as having causative factors that were an individual’s problem. She bemoaned the fact that we were being admonished to, “Watch your appetites; take care of yourself; don’t let yourself go.”

There has also been a school of thought in the pseudo-scientific press that some people had personalities that predisposed them to cancer. Such “cancer personalities” were characterised by repressed anger and which presumably might be cured by psychotherapy. So again suffering cancer was the individual’s fault and they could have chosen otherwise.

American author and political activist, Barbara Ehrenreich writes:

(My friends) understand the task of ageing to be one of self-denial, especially in the realm of diet, where one medical fad or another, condemned fat and meat, carbs, gluten dairy or all animal-derived products. In the health-conscious mindset that has prevailed among the world’s affluent people for about four decades now, health is indistinguishable from virtue, tasty foods are ‘sinfully delicious’, while healthful foods might taste good enough to be advertised as ‘guilt-free’. Those seeking to compensate for a lapse undertake punitive measures such as hours-long cardio sessions, fasts, purges or diets composed of different juices carefully sequenced throughout the day.

And more than that, when the Nanny State intervenes to prohibit junk food, enact a sugar tax, increase the excise on tobacco or whatever, those that bear the brunt of such interventions are generally the poor. It is largely the poor who rely on the gratification of these “sinful” pursuits to get through their lives.

It is astounding that those on the left in politics, who profess to act for the lower classes are also the evangelists for such Nanny State interventions where the poor have to endure the predominant burden of such actions!  Their virtue signalling inevitably hurts those who can least afford it.

The World Bank offered this statement:

Poverty is a major cause of ill health and a barrier to accessing health care when needed. This relationship is financial: the poor cannot afford to purchase those things that are needed for good health, including sufficient quantities of quality food and health care. But, the relationship is also related to other factors related to poverty, such as lack of information on appropriate health-promoting practices or lack of voice needed to make social services work for them.

Ill health, in turn, is a major cause of poverty. This is partly due to the costs of seeking health care, which include not only out-of-pocket spending on care (such as consultations, tests and medicine), but also transportation costs and any informal payments to providers. It is also due to the considerable loss of income associated with illness in developing countries, both of the breadwinner, but also of family members who may be obliged to stop working or attending school to take care of an ill relative. In addition, poor families coping with illness might be forced to sell assets to cover medical expenses, borrow at high interest rates or become indebted to the community.

It is tough being poor. For most people in poverty day to day sustenance dominates their thinking. Longer term health objectives are put aside because of the immediacy of their other survival concerns.

And it is certainly tough enough being poor without moralising virtue signallers excoriating you for bringing about your own poor health because of your poor choices when they have infinitely more choices than you do!