Section 7.3 Cui Bono - Who Benefits?
The previous section 7.2 described the connection between poverty and health outcomes. But why do we have such a problem with poverty in the United States in the first place, and who benefits from the status quo being the way that it is?
If we want to understand this, we need to take a slight digression and explore the connection between geography and race. The unfortunate truth is a history of systemic racism.
Subsection 7.3.1 Redlining, disinvestment, and race and geography as social determinants of health
We gave some examples of social determinants of health in the previous section. Yet another pair of social determinants of health is your address and your race. Let’s dig a bit deeper into why this is.
Not all neighborhoods are created equally. In the 1930s, the U.S. government established standards for providing home loans to Americans after commissioning maps categorizing neighborhoods by desirability for lending. In a racist process known as redlining, the most "undesirable" neighborhoods, outlined in red, tended to be older urban neighborhoods, collectively including a majority of the African American households in the country [7.12.1.124].
In the following decades, historians theorize that these maps were used to deny loans to African Americans, effectively trapping them in these same neighborhoods [7.12.1.121]. African Americans received less than 2 percent of all federally-insured home loans from 1945 to 1959 [7.12.1.127]. Meanwhile, many whites moved out of these neighborhoods in the 1950s and 60s in a process known as white flight. They were incentivized in part by their ability to actually obtain home loans in newer affluent suburbs, as well as other racist practices such as blockbusting, where developers convinced white homeowners to sell their homes at a discount in part through fearmongering about racial minorities in their communities [7.12.1.144].
Thus began a cycle of disinvestment in Black communities, for the benefit of a powerful few, which continues today. These cycles of poverty exist elsewhere, too, and might follow this formula:
A neighborhood of racially minoritized Americans, usually Black or Latinx, is perceived to be undesirable by those with influence.
Those who can afford it distance themselves from that community and move to newer, affluent communities.
There is little incentive to invest in the original community. Rather, those in power often lobby for infrastructure improvements in the affluent communities where their constituents live. This might be attributed in part to gerrymandering (Chapter 4), suppression of voting rights, misinformation (Chapter 3), and/or prioritization of corporate interests.
Disinvestment in the disenfranchised community causes quality of life to decrease. The quality of housing, education, public transportation, infrastructure, social services, access to healthcare, etc., declines due to lack of investment. Crime may increase, opportunities diminish, and health outcomes worsen. Perception of the community may worsen as well, creating a feedback loop.
Repeat.
Subsection 7.3.2 Whataboutism
Depending on your background, you may have a kneejerk negative reaction to the narrative above that is worth acknowledging and briefly addressing. In particular, a white person who grew up poor might read the section above and ask "What about my story?"
It is true that such individuals' stories should be told, and that their perspectives are valuable. There are of course other issues causing suffering besides systemic racism; it just so happens that the phenomenon is a particularly well-documented and widespread manifestation of the brokenness of many deeply ingrained systems. Shedding light on and fixing this brokenness is in fact likely to improve the system for all of us.
The tendency to get stuck comparing our struggles and degrees of suffering with one another is a form of whataboutism. Rather than leading to productive change, this way of thinking only leads to gridlock. In fact, those in power who benefit when the status quo is maintained use whataboutism in their rhetoric to pit us against one another while keeping us from uniting against the root causes of our unhappiness [7.12.1.133]. This idea is closeWindow()ly related to the concept of false consciousness [7.12.1.145].
In any case, both your address and your race can negatively affect your health, and those in power have so far not been willing and able to adequately address the root of the inequality. It appears that a true solution to the problem of poor health outcomes in the United States would involve a confrontation of systemic racism. This is a monumental task, but a worthy one if we believe that everyone deserves to have their basic medical needs met.
Let’s now explore how free health clinics can function better within the current state of affairs.