The Health Costs of Inequality

The word is out–according to economists from Standard & Poor, the stalled economic recovery in America after the Great Recession could be due to our staggering income inequality.
The rich get richer, and they already have everything they need, so they do not buy any additional goods and services, but instead put their money into bank accounts and stocks, and paper money grows while real money stays out of the economy.
In the meantime, the poor stay poor.
I began working at Chicago Family Health Center in September 2008. My patients are the people who lost their jobs when the economy contracted. When they lost their jobs, they lost their health insurance, and they landed in my care. Six years later they remain my patients. They remain unemployed despite a deep desire to work, because in the neighborhoods where they live, there are no jobs. There is no economic recovery.
In the South Chicago neighborhood, the unemployment rate nears 20% and the average income is $15,000. There are few small businesses in the neighborhood, because few people have much money to spend. People cannot afford cars to drive to where the jobs are, and public transportation is spotty. Although my patients pay the same city sales taxes as Chicagoans in wealthy neighborhoods, they receive fewer city services. Trash is not always collected, so the sidewalks are covered with broken glass and dangerous to walk on. Sidewalks are broken. Potholes remain unfilled at the end of the summer. Police are not trusted.
I couldn’t figure out why pundits kept saying “the economy is recovering!” until I looked at my stock portfolio. My paper money was back to pre-Recession levels, and growing.
I did not and do not see an economic recovery on the ground, where it counts.
The real economy is how easily people pay for their food and medicines and housing, their education and transportation.
One patient, studying to be a nurse, didn’t know where she would find the $2.25 she needed to take a bus the next day to the licensing exam she had already paid $200 to take.
One patient (pre-Obamacare) responded to the $4 prescription I gave him for his meds by saying “I can’t afford this, Doc. I’m zero income. Zero. I’ll have to steal to buy this.”
Patients stay in difficult living situations–with abusive partners, living with ex-spouses with new lovers, three families in three bedrooms–because all their minimal incomes together pay the rent, and if they don’t stay together, they are all homeless. Frequently when patients come in with bed bugs, it is because they have lost their homes, and travel from couch to couch on overextended networks of families and friends.
Patients cobble together disability and welfare and income to barely make housing payments and buy food and hold their families together.
It is not easy. I treat stress and depression and anger, alongside diabetes and obesity and hypertension. Life expectancy is 20 years less in my neighborhood than in the wealthiest neighborhoods of Chicago.
What we need to treat is income inequality to address the devastating differences in life opportunities that underlie our health disparities.

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