The Thing About the USA

October 13, 2006 at 5:02 pm (Michael's Posts)

We all know that health disparities exist in the United States as well as abroad. We know it in our heads, that is. Of course there are poor people here and they must be at greater risk for threatened health than the non-poor (to borrow a Farmer-ism). This is something we can deduce from the knowledge that there are poor people in the US and that the poor are vulnerable.

But can you visualize poor Americans? I mean really hard-luck folks whose reality is so different from our own? Like Third World different? Often, it’s hard to see the sunken cheeks associated with poverty and hunger that haunt our own urban centers because (I assume) many of us don’t associate basic resource dearth with the idea of Home. But here I sit in the Public Library in downtown Chicago. And across from me is a man in his thirties coughing like a TB patient with eyes as big as the hungry I saw in Delhi. He’s got a coat on, but it’s dirty and worn and destitution is obviously his reality. If I hadn’t been sitting down to write a post for the blog on the health-threatened in America, would I have noticed him? I fear I might not have.

I’ve been thinking lately (spurred by some questions I was asked in my interview at UChicago med) about health disparities in our own country. Global must include our Home, too. We have to remember to always be open to what is going on here, where most of us have the greatest expertise and most number of connections to resources. I think the question is how to locate the inequalities. Obviously, there are more Absolutely Poor people in “developing” countries, but there are millions of Comparatively Poor in the United States who we must not neglect.

Discuss. 🙂


ps- sorry I’ve been AWOL. Moving is a crazy endeavor.



  1. misarita said,

    Oy. This is an issue that haunts me sometimes. I feel like a traitor sometimes by working away from home–and it makes me ask myself why the allure to be somewhere else and help. Part of the answer, for me, is that it “feels” like a bigger impact because everything is so much more visible and in-your-face here in India. But, I’ve thought about that, as well… because it obviously isn’t that poverty doesn’t exist in the US even though the overall standard of living is higher. But, I think that we also do a better job of hiding poverty. Of building housing developments for low-income individuals and families, out of the eyes and ears of those who don’t share their concerns. We can ignore it much more easily.

    There is so much work to do… and I think you’re right, Michael, that we can’t forget the work on the ground at home. I’m really happy to know some amazingly dedicated folks who are really interested in public health in the US. In my ideal world, everyone’s different interests would mean that all issues in the world get some coverage. But that’s just me being an idealist again.

  2. Michael Soule said,

    I think the big thing is getting to the bottom of this question:

    Is it better to help the worst-off bunch (the poor in impoverished countries) where you can SEE the improvement happening or is it better to help the comparatively better-off poor of the United States?

    And in considering that answer, it is necessary to know where you can marshal the most resources to have the most comparative good in your sphere of work. Also, where do you have the most cultural knowledge and capital so that you know how to get taken seriously and be relevant? In the future, all of us must find out the answers to these questions and use those answers to shape our work.

  3. Alexandra Coria said,

    First, let me say that the question about effective resource use is a very interesting one; cultural capital is enormously important. However, I respectfully disagree with a few fundamental assumptions in your response, Michael.

    First, the American poor are not necessarily “better off” than the poor in developing nations. Some kids that I work with are totally unaware of basic health services; sure, they don’t get malaria, but they also don’t get effective educations, and they are discriminated against within the health care system. And at the same time, they are bombarded with advertisements and images that give them totally inappropriate priorities when it comes to their health. Child mortality rates in parts of NY are just as high, and higher, than in some developing nations partly because the social structures that encourage good health and health care have broken down, despite the US’s status as a so-called “donor” country.

    Second, I disagree that you can’t see improvement happening in the US. When a fifteen-year-old mother who grew up in the projects goes to her prenatal care visits because there’s a supportive maternal-child health program at the local Planned Parenthood and a free clinic in the neighborhood, that’s seeing a difference. When teenagers come in to speak to their English teachers privately because they know they can get free condoms from them, that’s seeing improvement. We see the same kinds of progress here as we do in the developing world; we just don’t have the outsider’s perspective that we do when we’re in a foreign culture, so the differences may not be as stark. But the statistics all tell us the same things: Education is key, accessibility and infrastructure are key, cultural appropriateness is key.

  4. msoule said,

    Alex, thank you for your excellent and well-warrented reply. Bringing about positive change wherever you can be of the most use is really the bottom line and people with that strength of vision are needed like CRAZY here. And I agree completely with your assertions. Of my formative educational experiences in health awareness, I have let my teacher know of their full impact on my life, oh, one percent of the time. And their impact on me is largely invisible because it has kept me out of trouble. We just have to take on faith that our educational efforts, wherever they may be, will be impactful in the ways we hope.
    I like that you briefly touched on US foreign aid. It is somehow more important to our politicians to spend money extending our range of influence in the world than it is to spend it on creating a healthy populace. Foreign aid, as I understand it, started as a really expensive carrot to post-colonial states to not go over to the Dark Side (read: Cold War and Commies). And even though foreign aid is almost across the board proven not to have outcomes that are nearly equivalent to its cost, we keep dumping money in it. Go figure. Why not dump that money into Appalachia? Or South Central LA? I’m afraid the answer to that question would make me more bitter about American politics than I already am.

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