Welcome to Our Blog!

Hello all! 

Welcome to our blog Inequality, Poverty and Illness. In this blog we have a series of posts dedicated to discussing the intermingling of inequality, poverty and illness, with an emphasis on malnutrition, in urban areas of the United States of America. More specifically, we aim to answer this question:

How is malnutrition and poverty in urban America a manifestation of inequality?

First and foremost, our blog defines the word poverty, separating it into three sub facets: relative, absolute, and chronic poverty.


Relative poverty: Those categorized as poor in relation to the others around them, whom fall seriously behind normal nationwide standards (Dunn, 2017).

Absolute Poverty: Statistically, those making less than a dollar a day ($1/day) (Eitzen and Zinn, 81).

Chronic Poverty: Experienced poverty for 5 years or more (Mitlin, 2005).


The blog then delves into the concept of malnutrition, including other illnesses rooted in it, including over-nutrition (obesity) and undernutrition (wasting, stunting, underweight). The prevalence of these illnesses are heavily affected by the concept of food security, or the universal availability of "sufficient, safe and nutritious food that meets their dietary needs and food preferences of an active and healthy life" for all people at all times (World Food Summit 1996). Without food security, vulnerable populations can be gravely disadvantaged for making health a priority.


Additionally, we analyze our research question through the scope of three different inequality theories: Marx's Conflict Theory/Capitalism, Charles Tilly's Durable Inequality Theory, and Herbert Spencer's Social Darwinism Theory. Each theory explains the cause of inequality, and are further fleshed out in the blog posts. For now, a summation:

Marx's Conflict Theory/Capitalism looks at the power dichotomy between the bourgeoisie class and the proletariat class, arguing that the proletariat are exploited and in some cases can slip into poverty as a consequence.

Durable Inequality Theory asserts that inequality is the result of institutions that use categories to maintain control of valuable resources for the dominant group.

Herbert Spencer's Social Darwinism Theory views inequality as a natural consequence of a person's "evolutionary fitness" or lack thereof, thus blaming the individual for their own societal status, including if they are poverty stricken.


Our hope is that you walk away from this blog understanding the intricate relations between inequality, poverty and illness. While it has been explained by many before, inequality in society continues to prevail and further morph into more complicated versions of itself. Malnutrition and its related diseases will never resolve without the achievement of food security in all corners of the world, and with food security comes difficult political complications that go beyond the scope of this blog. In any case, we hope to give our audience, at the very least, perspective on how issues of inequality, poverty and illness have been viewed before, and potentially spur further conversation on how we can tackle these issues today.

Happy reading!

Contributors: Hannah Argumedo, Julia Arsan, Eboni Morgan, & Trevor Harding

What is Poverty?

Relative Poverty:

According to Dunn (2017)

--> Poor in relation to the masses or the average lifestyle within the population 

 --> If everyone within a given population has a smartphone, and some individuals are unable to afford it- this would place them in the category of "relative poverty". They are poor in relation to the rest of the population.

- "Keeping up with the Joneses"

are you up to par with your neighbors?

If you can't remember the definition of relative poverty-- try thinking about it this way!  Are certain people able to keep up with the average lifestyle within the population? Are they "Keeping up with the Joneses?"

Absolute Poverty:

According to Eitzen and Zinn (2012)

   

- Those making less than $1/day

- How many things can you think of that you can buy with  <$1 daily?

- A life degraded by disease, illiteracy, malnutrition and squalor

- Those who are living in absolute poverty are highly susceptible to these things. 

- Denial of basic necessities

--> No clean water, food, shelter etc.

Bradshaw (2006) defines poverty in a general sense as “lack of necessities- basic food, shelter, medical care and safety are generally thought necessary based on shared values of human dignity”.

Official Poverty:

- The government settles on who is poor
- This creates a uniform means for counting the poor & measuring poverty.
- This is where the "official poverty line" is established

According to the UC Davis Center for Poverty Research, "Since its initial rapid decline after 1964 with the launch of major War on Poverty programs, the poverty rate has fluctuated between around 11 and 15 percent [in the United States].

*supplemental poverty- "The supplemental measure includes basic costs of living that can vary across states. It also includes transfers from safety net programs and in-kind benefits" (UCDavis Center for Poverty Research, 2016).

Food Security and Malnutrition

“Food security exists when all people, at all times, have physical and economic access to sufficient, safe and nutritious food that meets their dietary needs and food preferences for an active and healthy life”. (World Food Summit, 1996)

 The four pillars of food security from the Food and Agriculture Organization of the United Nations (FAO) (2006):

Food availability

• When there are sufficient quantities of food of appropriate quality, supplied through domestic production or imports (including food aid).

Food access

• Acess by individuals to adequate resources for acquiring appropriate foods for a nutritious diet. 

Utilization

• Utilization of food through adequate diet, clean water, sanitation and health care to reach a state of nutritional well-being where all physiological needs are met. This brings out the importance of non-food inputs in food security.

Stability

• To be food secure, a population, household or individual must have access to adequate food at all times. They should not risk losing access to food as a consequence of sudden shocks or cyclical events (seasonal food insecurity). 

These four pillars must present themselves simultaneously under food security. When people are unable to meet the above defintion of food security, or if any of the pillars are not present, they are dealing with food insecurity. Fourty-three percent of households with incomes below the poverty line are food insecure. In many poverty dense regions, people are unable to access affordable, healthy food, even when funds are available, as they reside in food deserts (Levine 2011, 2667).

Severals of the Millennium Development Goals (MDGs) pertain to food insecurity, including the goal to halve the number of people living in hunger, and the goal to reduce child mortality. Nutrition of infants is an important concern, since nutritional deprivation in the early stages of life can lead to irreversible damage to physical and mental health (Heltberg, 2009).

Food insecurity can lead to malnutrition. The World Health Organization (WHO) defines malnutrition as “deficiencies, excesses, or imbalances in a person’s intake of energy and/or nutrients” (WHO 2017). The term addresses three groups:

Undernutrition: this form of malnutrition includes

• wasting (low weight-for-height)
• stunting (low height-for-age) 
• underweight (low weight-for-age)

Micronutrient-related malnutrition: this form of malnutrition consists of micronutrient deficiencies, whereby a person has a lack of important vitamins and minerals. Micronutrients enable the body to produce the enzymes, and hormones necessary for proper development.

Micronutrient excess: this form of malnutrition includes obesity and diet-related noncommunicable diseases including cardiovascular diseases, certain cancers, and diabetes (WHO 2017).

According to the WHO (2017), poverty amplifies the risks associated with malnutrition. People living in poverty are more likely to be affected by different forms of malnutrition. Furthermore, as it increases healthcare costs and reduces productivity, malnutrition may aid to perpetuate a cycle of poverty and ill health.

(UNICEF 1990)

Obesity and Illness: The Impacts of Malnutrition

Minimum wage does not supply enough income for a nutritious diet, therefore those living in poverty tend to emphasize quantity over nutritional benefits. They are also less likely to have access to transportation, or the resources to travel to a supermarket outside of their immediate neighbourhood, forcing them to prioritize convenience over quality. This inadequate access to nutritionally sound food is why obesity disproportionately affects those living in poverty, as well as women, racialized groups, indigenous people, immigrants, and the working class (Koc 2016).

Early childhood poverty and later childhood obesity are strongly connected. This is critical, as it highlights how early life poverty contributes to obesity in later years, and suggests that US policies that affect childhood poverty might also impact obesity. Prevention of childhood obesity could have great implications for the US population at large, as early obesity is associated with the persistence of obesity into adulthood and the development of chronic diseases (Lee et al., 2014). The graph below shows the growth in obesity across the US over the past 50+ years.

(stateofobesity.org) 

According to the Centres for Disease Control and Prevention (CDC), consequences of obesity include:

• High blood pressure (Hypertension)
• Type 2 diabetes
• Coronary heart disease
• Stroke
• Gallbladder disease
• Some cancers (endometrial, breast, colon, kidney, gallbladder, and liver)
• Mental illness such as clinical depression, anxiety, and other mental disorders

The unequal distribution of wealth contributes to many inequalities that have a direct impact on health and risk for obesity, such as a lower level of education, less access to information, a lower capability to cope with risks, reduced access to health services, and a reduced possibility of engaging in healthy activities (Peña and Bacallao 2002, 242). The graphs below show the positive correlation between obesity rates and poverty in the US.

(American Diabetes Association, 2011).

Malnutrition: The other end of the spectrum

On the other end of the obesity epidemic there is undernutrition, which includes low weight-for-height otherwise known as wasting. A growing child must receive sufficient and adequate food, or their body weight will be temporarily reduced. Undernutrition also includes low height-for-age, which is stunting. If nutritional deprivation or illness are repeated or prolonged, the result will be growth failure. Another form of undernutrition is low weight for age, which is underweightness.

"Fifty-four percent of mortality in children under 5 in the whole world is attributed to small weight for age"

(Peña and Bacallao 2002, 243).

Poverty affects nutrition throughout a person's life, and manifests itself in various ways, including increased susceptibility to infectious and noncommunicable diseases, a reduced work capacity and productivity, a lower learning capacity, and an increased vulnerability to environmental risks (Peña and Bacallao 2002, 243). These individuals are not only more prone to illness, but also often employed in the secondary labour market, where low wages translate into inadequate nutrition, high levels of stress and the inability to have timely medical services.

Malnutrition affects people from when they are developing fetuses, to their early infancy through adolescence and into adulthood. The individual risk and transgenerational implications of poor health and poor productivity affect families in multiple ways.

Stunting affects more than thirty percent of preschool children (Peña and Bacallao 2002, 244). Furthermore, adolescence comes with a heavy increase in nutritional demand which is often not satisfied in the poor, whom have to already fight the effects of deprivation throughout childhood and inaccessibility to adequate nutrition and sanitation. Poor women often are still growing during their first pregnancy due to a longer growth period and often have to compete for nutrients with the developing fetus. These women who are not fully developed at reproductive ages are at high risk of having low birth weight babies, with a lower chance of survival than normal weight babies. Furthermore, if the woman has a low height for age or low preconceptional weight, this risk is heightened (Peña and Bacallao 2002, 244). Malnutrition, which is frequent in low-income, low-education groups, can carry on throughout pregnancy, where poor nutrition may lead to retarded growth and low birth weight. These newborns have greater mortality risk, are less resistant to infectious diseases, and are more likely to acquire chronic illnesses. Thus, poor pregnant women suffering from malnutrition create a cycle of malnutrition, with intergenerational undernutrition contributing to illness and greatly affecting people's physical and mental development.

Malnutrition during a child's first year has dire consequences. Poor children without access to adequate nutrition are more likely to have less access to nutritional information. Poor families who are struggling to provide the necessities of life are often unable to provide adequate nutrition in this first year, affecting the intellectual capacity of the child, with manifestations of this appearing two or three years later (Peña and Bacallao 2002, 243). Frequent infections during in preschool children often return when the child is in an older grade in school, taking a toll on school attendance and performance. 

A short video on the health effects of malnutrition:  https://www.youtube.com/watch?v=L3abZswA5XY

Capitalism, the Haves and the Have-Nots

In the political economy- capitalism, it's important to remember that the underlying goal always remains maximization of profit. Eitzen and Zinn (2010)  state that "unlike Canada, the Scandinavian countries and the nations of Western Europe, The US focuses more on individual achievement and competition" (558). These are the grounds capitalism needs to thrive, and the U.S. feeds into them quite heavily.

 The neoliberal approach to governance in the United States has enabled capitalism to flourish. The belief in individualism, rational choice, market liberalization and dominance and a minimal role for government in the development process, all work to perpetuate inequality. Individuals with economic and political power are able to determine and distribute the rewards, resources, privileges, and opportunities in society for their own benefit, using ideology to maintain their favored positions at the expense of others.

In order for pure capitalism to exist, four conditions must be met. They are: 


1) Private Ownership of Property

--> individuals are encouraged to private their property and possessions. This creates the grounds necessary to produce and distribute goods and services (Eitzen and Zinn, p 393).

 2) Personal Profit

--> Individuals are free to maximize their personal gains (Eitzen and Zinn, p. 393). 

3) Competition

--> In a market of supply and demand, competition allows for companies to determine what is produced and how much products can be sold for. 



4) Government Policy of Laissez-Faire

--> allows the marketplace to operate unhindered.

Furthering Marx's idea of class systems in capitalism, Weber expands on Marx's Bourgeoisie and Proletariat, to: classes privileged through property and education; technician specialists and lower-level management; the petty bourgeoisie (small shopkeepers, self-employed artisans) and the working class.

While Marx and Weber differ in the structure of class, both create paradigms in which a lower, less privileged class, and a higher, very privileged class exists. Furthermore, we can look at capitalism as a reason behind this polarization for the following reasons.

Capitalism as the political economy of society, prioritizes profit, thus maintaining and promoting poverty. In capitalism, private profit is what determines who receives what, rather than who is truly in need. This primacy of profit is what allows poverty to persist in that its basis depends on economic inequalities.

In that maximizing funds is the goal of capitalism, it can be applied to thoroughly understand the cycle of poverty. We can understand that employers in capitalist economies are driven to pay their employees as little as possible, to maximize the funds of the company on a whole. The epitome of overworked and underpaid is demonstrated by the many individuals who work full time, yet still live on or below the poverty line. Working long, hard hours doesn’t necessarily equate to sufficient funds for a comfortable, average life, pushing millions of people into both relative and absolute poverty daily.

In that capitalism's biggest goal is maximizing funds as previously stated, the wellness of its citizens take a back seat to this motive. In other words, the less privileged do not, and will not receive much help from the government, as capitalism runs under a laissez-faire style of government. This helps the cycle of poverty, whether relative or absolute, remain in that citizens are often unable to break the cycle.

The exploitative nature and inherent inequalities of capitalism means that health and access to health-care become an issue. The World Health Organization (2017) defines health as a “state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Therefore, health involves not only the absence of disease, but a positive sense of wellness. In the trifecta of poverty, malnutrition and inequality, capitalism can be perceived as a component of inequality, resulting in poverty for the have-nots, leading to malnutrition in that they are unable to afford or access food with nutritious value.

Malnutrition as an effect of Charles Tilly's Durable Inequality Theory (DIT)

Charles Tilly’s Durable Inequality Theory (DIT) asserts that inequality is the result of institutions that use categories such as age, race, and gender, to maintain control of valuable resources for the dominant group. According to Tilly (as cited in Lorant and Bhopal 2011, 672), inequality is sustained through four basic mechanisms. They are:

• Exploitation: When individuals use their resources to extract something of value from others.
• Opportunity hoarding: When a category of people monopolize resources.
• Emulation: The copying of established organisational models from one setting to another
• Adaptation: A routine that facilitates social interaction, ensuring the normalisation of  inequalities within daily discourse

DIT states that matching interior categories within institutions with exterior categories reinforces inequality making inequality durable through the facilitation of exploitation and opportunity hoarding (Lorant and Bhopal 2011, 672).
The mechanisms that sustain inequality perpetuate malnutrition through exploiting subordinate categories therefore restricting full access to the resources necessary for food security, and by keeping a monopoly over food and non-food resources, thereby controlling food prices and access to food. This is seen where people find themselves living in food deserts without access to affordable nutritious food. Meanwhile, emulation and adaptation work to normalize and perpetuate which categories experience malnutrition, as the hierarchy in the current global capitalist food system emulates the general global market and lower classes are forced to think of food as energy for survival, while higher classes may use food as symbols of status (Bourdieu, as cited in Koc 2016).