Missing the Mark

In poor communities, healthy alternatives to cheap junk foods are hard to come by.

It’s easy to look at a person who is diabetic because of obesity and think that this person’s problem is self-control. It’s harder to make such a simple judgment once you realize that there are no places to buy healthy foods. On the Blackfeet Indian reservation in Montana, it’s a half-day drive to the nearest supermarket.¹ Nutrition programs are helpful, but they don’t solve the food-access problem in a community with only fast food and convenience stores.

Childhood obesity is epidemic in poor communities—in fact, children in poor communities are just as likely to be obese as hungry. Schools use contracts with soft drink vendors to finance basic needs that state and district funding don’t cover. Paying to keep a library open, field a football team, or make sure there’s enough chalk to write on the blackboard often depends on these contracts—i.e., on students’ consumption of unhealthy soft drinks. Outsiders may bemoan the large numbers of children who just sit in front of a television after school, until they realize that it’s too dangerous to play outside. Finally, the connections between community conditions and obesity start to be recognized.

The EITC is one way to compensate for jobs that pay low wages. The EITC is designed to give low-income families an incentive to get and keep jobs, but many jobs do not pay enough for a family to get by. What happens to a community where there are no jobs with wages that will support a family?

Having health insurance is no guarantee that one will be able to see a doctor. In Perry County, AL, for example, the problem isn’t lack of health insurance. Perry County is one of a cluster of rural counties that form Alabama’s “Black Belt,” among the most stubbornly poor places in the country. The poverty rates in Perry County have been high for as long as the Census Bureau has been keeping track, so the county has the official designation of a persistent-poverty county. However, most of the county’s residents qualify for Medicare, Medicaid, and/or SCHIP. In fact, Perry County has a higher percentage of residents with health insurance than the United States as a whole.

The problem is access. In 1998, Perry County lost its only hospital. When a county loses such an essential part of its infrastructure, the effects on the local economy are like aftershocks, leading to the crumbling of even more of its infrastructure.² The absence of basic health care services discourages investment in the community. New businesses don’t want to come there. The loss of a hospital also harms existing businesses. The president of Judson College, located in Marion, the Perry County seat, told Bread for the World Institute:  “Imagine how it feels to meet with a young person and her parents interested in coming to our college, knowing that if she gets ill the closest facility to us is an hour away.”

What makes the loss of the hospital so much more poignant in Perry County is the poor health of the residents. High poverty rates often correspond to a host of chronic health conditions, and this is true of Perry County and the rest of the Black Belt. The infant mortality rate is higher than in some developing countries. Cardiovascular disease is the number one killer—as it is in the rest of the country—but Perry County hasn’t a single cardiologist. Nor does it have a pediatrician. Specialists aren’t interested in practicing in places like this for the same reason the hospital closed down. Politely, they call it the “payer-mix.” Translation: there are too many poor people.

Issues