Do We Have Real Poverty in the United States of America?

Consider the images of starving children in Africa, Asia, or Latin America accompanying appeals for humanitarian aid. It is not difficult to understand why people deprived of the most basic material necessities for subsistence — adequate food, clean water, shelter from extreme heat or cold — would suffer high rates of preventable disease, disability, and premature death. Poverty in developing countries is often defined as living on less than $2.00 per person per day (1). By those terms, very few people in the United States would be poor. But poverty criteria for poor countries are not applicable in affluent countries with far higher living costs. The official U.S. poverty guideline in 2005 was an annual income of $19,350 for a family of four (2), which would represent wealth in many poor countries (3). Why, then, are Preventing Chronic Disease and other U.S. journals participating in this multi-journal issue, to be released October 22, 2007, on poverty and human development? Is it simply a magnanimous gesture to support fighting poverty and its adverse health consequences in poor countries, or is poverty an issue we must address at home? In the days after Hurricane Katrina, televisions around the world revealed many desperate New Orleans residents, too poor to leave before the storm, who were without food, shelter, or clean water days later. The post-Katrina revelations were even more shocking because they exposed not only an inadequate disaster relief response but also poverty and long-standing neglect of public services affecting poor African Americans that predated the hurricane. The depth of deprivation reached levels that many Americans had thought existed only in poor countries, not here. By official U.S. criteria, widely considered too low, more than one in eight individuals overall and one in five children younger than 5 years in the United States were poor in 2005 (2). We have the highest rates of poverty and child poverty among affluent nations (4). New Orleans' poverty was not an anomaly, but a reflection of widespread conditions in our country. Still, one might question: is U.S. poverty real, in the sense that it is associated with worse health? How could poverty affect one's health in a rich country? In the now-famous Whitehall studies (5-7), British civil servants were categorized into several socioeconomic groups according to their occupational standing, ranging from unskilled manual workers at the bottom to the highest executives at the top. A stepwise …