Poverty, Health and Choice

Poverty is a cruel, but effective teacher.

Materially poor people do not enjoy the same health status as the materially rich.

No surprise there, huh?

But, why?

No doubt a diet limited and defined by available cash plays a role. Convenient and ready access to health care providers or, better, the lack of such access is another factor back of this documented deficiency.

Safe neighborhoods lending themselves to outdoor activities, exercise and routines of physical fitness also play a part in the health outcome disparities that characterize low-income communities when compared to more affluent areas. Accessible parks and health clubs do make a difference.

An even larger factor is often not recognized by most people, including some public health officials and political leaders. Choice, self-determination, options--these are the key determinants of health.

Typically, these factors are all related to income.

But, we are learning.

People with few material resources can find hope in simply getting together.

Collective efficacy matters. Political power and the choice it delivers is a key factor in improving community health.

Poor people who band together, who pool even limited resources and cooperate to achieve community goals, also enjoy improved health outcomes. Connections to and membership in neighborhood groups such as crime watch organizations, PTAs, churches and civic groups contribute to improved health status. These are the sorts of connections that the materially rich take for granted and seldom, if ever, relate to their own health.

At Central Dallas Ministries we operate a large community health ministry complete with doctors, medical assistants, pharmacy, dentists and testing services. However, we are learning that community connections and organizing is likely to be even more important for the long term health of the community than our clinical efforts.

While we will continue to provide highly accessible, community-based clinical services to our low-income neighbors, we know that we must also engage our friends at a deeper, relational level.

Building community among and with "the poor" is the legitimate work of people committed to seeing health status improve in the inner city.

At times this work will offend some who observe us. We will do our best to explain with patience and kindness, but we will not stop.

Improving the health of low-income Americans must involve political mobilization.

For us this work exemplifies not only our most cherished values, but our brand of spirituality.

Meditation for today: Isaiah 65:19-25