Poverty as a Public Health Issue : Poverty since the Kerner Commission Report of 1968

This paper reviews trends in poverty since the late 1960s. Poverty is as prevalent now as it was then. A good deal about the nature of poverty and our efforts to deal with it, however, has changed. The paper has three major themes. First, we note that urban poverty is no longer a predominantly black issue; the composition of the urban poor has changed considerably since the late 1960s. Second, poverty outside the central city continues to be a problem and should not be ignored. Third, we argue that the current approach to poverty that emphasizes personal responsibility is clearly ineffective and should be replaced with a focus on poverty as a public health issue. Viewing poverty as a public health issue points to the crucial role of both government and individuals in efforts to overcome it. Poverty as a Public Health Issue: Poverty since the Kerner Commission Report of 1968 American society has changed in many ways since the Kerner Commission issued its report on March 1, 1968. Our understanding of poverty, its dimensions, and possible ways of dealing with it is much different from the perceptions that underlay that report. In this chapter, we review trends in poverty and antipoverty policy since 1968. In part, the paper is an update of a similar report prepared by one of us—Sandefur (1988)—on the occasion of the 20th anniversary of the report of the Kerner Commission. One startling feature of poverty in the United States is that it is as prevalent now as it was in the late 1960s. This is in spite of the War on Poverty launched in the 1960s and subsequent efforts to make poverty policy more effective. Many have become disillusioned with government efforts to help the poor, given the failure of these efforts to reduce the level of poverty. Such a pessimistic view of government efforts ignores two essential aspects of poverty and government policy. First, as Danziger and Weinberg (1994), Sandefur (1988), and others have pointed out, government efforts to help the poor do in fact raise substantial numbers of people above the poverty line, and these efforts also do a good deal to ameliorate the effects of the poverty. Food Stamps feed those among the poor who would not otherwise eat, and Medicaid provides medical care to poor children who would not otherwise receive it. To criticize government programs that help the poor because they do not eliminate the problem is like criticizing aspirin because it does not eliminate headaches. A medical analogy, more specifically a public health analogy, can also help illustrate the second aspect of poverty ignored by the critics of government programs. A certain level of poverty in our society is generated by the nature of the American economy. In an economy in which 5 percent or so of the population is unemployed in the best of times, and in which millions of Americans have full-time jobs that do not pay enough to lift them and their families above the poverty line, a substantial group of people will be poor. The existence of poverty in our society is, in effect, similar to the existence of the common cold. Although people may engage in behavior that increases or decreases their risk of catching a cold, it 2 is naive to believe that no one will catch a cold even if they do the right things. The same is true of poverty. People may behave in ways that increase or decrease their risks of being poor or the length of time that they remain poor, but it is foolish to believe that poverty is solely the fault of the poor. If we accept the analogy of poverty as a public health problem, our understanding of why poverty has not disappeared becomes dramatically different. It will never disappear as long as our economy is characterized by an unemployment rate of at least 5 percent and by millions of jobs that do not pay enough to lift people above the poverty line. Given that these negative features of the economy are associated with positive features, such as low inflation, we are not in a position to eliminate unemployment or pay everyone a wage that raises them above the poverty line. What we need is a set of government programs that reduce the length of time that people are poor and ameliorate the effects of poverty. As we argue below, recent policy changes do not move in this direction. In fact, our current efforts are likely to generate more poverty rather than to reduce it. As we revisit the original report of the Kerner Commission, it is also important to note that poverty is not just a central city phenomenon, nor does it involve only blacks. In fact, the levels of poverty in some nonmetropolitan areas exceed those in central cities. What is most distinctive about poverty in the central cities is the geographical concentration of large numbers of black and Hispanic poor people. Many of the factors associated with poverty seem to be similar whether we are talking about rural or urban poverty, or black, white, Hispanic, Asian, or American Indian poverty. Poverty was only one concern of the Kerner Commission (1968). It set out to understand the circumstances leading to the urban race riots of the mid-1960s. In its investigation, the Commission appropriately identified the plight of poor, urban blacks as one major factor in the riots. In 1992, a largescale race riot again raged in Los Angeles, yet this time the media, social scientists, and politicians discussed more than just blacks and whites. The predominantly black rioting that characterized the 1960s was replaced by rioting involving Hispanics as well as blacks, with Korean-owned businesses targeted 3 for vandalism and looting. The change in the nature of the riots illustrates a fundamental change in America’s urban poverty that has taken place and continues to take place. Urban poverty can no longer be thought of as primarily a black issue. The urban poor population has become increasingly diverse as Asians and Hispanics have joined the population of urban areas. Further, racial issues in the United States can no longer be seen solely, or even predominantly, in black/white terms. The Hispanic population of the United States will soon surpass the black population in size, and the Asian population continues to grow at a much faster rate than either the black or white populations. Our paper proceeds as follows. We first discuss the recent debate over defining and measuring poverty and briefly point out the implications of using the definition of poverty proposed by the National Research Council (NRC) for understanding minority poverty. Second, we review trends in poverty since the 1960s, looking not only at central cities but also at poverty trends in other geographical areas. We also follow trends for different racial and ethnic groups and different demographic groups. Third, we review trends in public policies for dealing with poverty, including the 1996 Personal Responsibility and Work Opportunity Reconciliation Act. We conclude with a call for viewing poverty as a public health issue rather than predominantly as a moral failure of those who are poor. I. THE MEASUREMENT OF POVERTY In 1965, the U.S. government adopted an official poverty definition for use in national statistics. Under the definition, the poverty threshold equals the cost of a minimum diet multiplied by three and adjusted for the age of the household head and the number of persons in the family. Except for changes in the number of different poverty thresholds for different types of families and a change in the price index used to adjust the thresholds for inflation, the official poverty definition has not been altered since its inception (National Research Council, 1995). Many have begun to wonder, however, whether a definition of poverty developed in the mid-1960s is applicable today. 4 Many observers have criticized the official poverty definition over the years. One issue has been how to measure household income. The official poverty definition compares a family’s pretax income to the appropriate threshold. Some have argued that government in-kind benefits (such as Food Stamps and Medicaid) should be included in the measure of income, while others have argued that income should be measured after taxes. Still others have suggested that work-related expenses and child care costs should be deducted from income to better indicate the amount of resources a family has available. Another criticism is that the current poverty line does not take into account the different costs of living in various parts of the country. Responding to these concerns, the Joint Economic Committee of Congress authorized an independent review of the official U.S. poverty measure. The NRC appointed a committee to conduct the review. After much deliberation, the NRC committee proposed several changes in the current measure of poverty in the United States. Its first recommendation was that the poverty threshold should represent a budget for food, clothing, shelter, utilities, and a small amount for other needs, instead of simply being a multiple of basic food costs. A second recommendation was that the thresholds should reflect the needs of different family types and geographical differences in housing costs. Third, the NRC committee recommended that family resources be measured as the sum of all money income and near-money benefits (e.g., Food Stamps, free school lunches) from all sources minus the expenses that are not included in the family budget of goods and services. These later expenses include taxes, child care, workrelated expenses, and out-of-pocket medical costs. This proposed definition of poverty is dramatically different from the official definition and using it leads to a different estimated poverty rate for a given year. In 1992, for example, the official poverty rate was 14.5 percent, but under the NRC’s proposed poverty measure the overall poverty rate