What Causes the Poor Health of the Poor?

What is the cause of unhealthy eating? Richard Florida attempts to answer that, based on new research. He makes some good points, but maybe he is missing some of the context.

Let me begin with one thing that seems correct in the analysis. He points out that food deserts are found in poor areas. Dietary health is an issue of socioeconomic class. Yet even when better food is made available, either by grocery stores opening or people moving, the habits of foods bought don’t tend to change. That isn’t surprising and not particularly insightful. If changes were to happen, they would happen across generations as they always do. It took generations to create food deserts and the habits that accompany them. So, it would take generations to reverse the conditions that created the problem in the first place.

Florida sort of agrees with this, even though he doesn’t seek to explain the original cause and hence the fundamental problem. Instead, he points to the need for better knowledge by way of educating the public. What this overlooks is that in generations past there was much better eating habits that were altered by a combined effort of government dietary recommendations and corporate advertising, that is to say an alliance of big government and big business, an alliance that did great harm to public health (from the largely unhelpful food pyramid to the continuing subsidization of corn and corn syrup). The bad eating habits poor Americans have now come from what was taught and promoted over the past century, diet info and advice that in many cases has turned out to be harmfully wrong.

Florida sees this as being more about culture, as related to knowledge. It’s those dumbfucks in rural middle America who need to be taught the wisdom of the coastal elites. It’s a liberal’s way of speaking about ‘poor culture’, a way of blaming the poor while throwing in some paternalistic technocracy. The healthy middle-to-upper classes have to teach the poor how to have healthy middle-to-upper class habits. Then all of society will be well. (Not that the conservative elite are offering anything better with their preference of maintaining oppressive conditions, just let the poor suffer and die because they deserve it.)

Florida’s solution ignores a number of factors, such as costs. When I lived under the poverty level, I bought the cheapest food available which included some frozen vegetables but lots of cheap carbs (e.g., Ramen noodles) and cheap proteins (e.g., eggs) along with cheap junk food (e.g., Saltine crackers) and cheap fast food (e.g., 2 egg and sausage biscuits for $2). Crappy food is extremely inexpensive, a motivating factor for anyone living hand-to-mouth or paycheck-to-paycheck. It’s about getting the most calories for the buck. The healthiest food tends to be the most expensive and least filling (e.g., kale). I couldn’t afford many fresh fruits and vegetables back when I was barely making ends meet, a time when I was so lacking in excess money that I was forced to skip meals on a regular basis. Even when there isn’t a drastic difference in costs, saving a few bucks when shopping adds up for the poor.

Someone like Florida is unlikely to understand this. Maybe the middle-to-upper class could use some education themselves so as to comprehend the lived reality of the poor. But no doubt more and better knowledge should be made available to everyone, no matter their class status. We have way too much ignorance in this society, sadly with much of it to be found among those making public policies and working in corporate media. So, yes, we have room for improvement on this level for all involved. I’m just not sure that is the fundamental issue, as the state of knowledge at present is a result of the state of society, which is to say it is more of a systemic than individual problem.

Anyway, some of the data in the research cited seems a bit off or misleading. Florida’s article includes a map of “Average Health Index of Store Purchases by County.” It doesn’t entirely match various other mapped data for health such as infant mortality. The Upper Midwest, for example, looks rather mixed in terms of the store purchases by county while looking great according to other health indicators. Also, the Upper Midwest has low rates of food deserts, which is supposedly what Florida was talking about. Even though there are poor rural areas in the Upper Midwest, there are also higher rates of gardening and farmers’ markets.

Also, it must be kept in mind that most people in rural states don’t actually live in rural areas, as would have been the case earlier last century. Mapping data by county is misleading because a minority of the population visually dominates the map. The indicators of health would be lower for that minority of rural county residents, even as the indicators of health are high for the entire state population mostly concentrated in specific counties. In that case, it is socioeconomic conditions combined with geographic isolation (i.e., rural poverty) that is the challenge, along with entire communities slowly dying and entire populations aging as the youth and young families escape. That is no doubt problematic, although limited to a small and rapidly shrinking demographic. The majority of Upper Midwestern lower classes are doing fairly well in their living in or around urban centers. But of course, this varies by region. No matter the data, the Deep South almost always looks bad. That is a whole other can of worms.

That set of issues is entirely ignored by Florida’s article, which is severely limiting for his analysis. Those particular Middle Americans don’t need the condescension from the coastal elites. What is missing is that poverty and inequality is also lower in places like the Upper Midwest, while being higher elsewhere such as the Deep South. Socioeconomic conditions correlates strongly with all aspects of health, physical health and mental health, just as they correlate to with all aspects of societal health (e.g., rates of violent crime).

I applaud any attempt at new understanding, but not all attempts are equal. Part of my complaint is directed toward the conservative-mindedness of much of the liberal class. There is too often a lack of concern for and lack of willingness to admit to the worst systemic problems. Let me give a quick example. Florida wrote another article, also for City Lab, in which he discusses the great crime decline and the comeback of cities. Somehow, he manages to entirely avoid the topic of lead toxicity, the single most well researched and greatest proven factor of crime decline. This kind of omission is sadly common from this kind of public intellectual. In constantly skirting around the deeper issues, it’s a failure of intellect and morality going hand in hand with a failure of insight and imagination.

To return to the original topic, I suspect that there are even deeper issues at play. Inequality is definitely important. Then again, so is segregation, distrust, and stress. Along with all of this, loss of community and social capital is immensely important. To understand why inequality matters, an analysis has to dig deeper into what inequality means. It isn’t merely an economic issue. Inequality of income and wealth is inequality of education and time, as the author notes, while it is also inequality of political power, public resources, and individual opportunities. A high inequality society causes dysfunction, especially for the poor, in a thousand different ways. Inequality is less of a cause than the outward sign of deeper problems. Superficial attempts at solutions won’t be helpful.

In response to why the poor eat less well, one commenter suggested that, “It’s literally because they have less time” and offered supporting evidence. The article linked was about data showing the poor don’t eat more fast food than do the wealthier, despite more fast food restaurants being located near the poor, which implies the wealthier are more willing or more likely to be travelling further distances in their eating fast food at the same rate. What the article also shows is that it is busy people, no matter socioeconomic class, who eat the most fast food.

That is a key point to keep in mind. In that context, another commenter responded with a disagreement and pointed to other data. The counter-claim was that the lower classes have more leisure time. I dug into that data and other data and had a different take on it. I’ll end with my response from the comments section:

A superficial perusal of cherry-picked data isn’t particularly helpful. Show me where you included commute time, childcare, eldercare, housework, house maintenance, yard work, etc. The linked data doesn’t even have a category for commute time and it doesn’t disaggregate specific categories of non-employment work according to income, occupation, or education.

Also, what is called leisure is highly subjective, such as the wealthier having greater freedom to take relaxing breaks while at work or eating a healthy meal out at a restaurant for lunch, none of which would get listed as leisure. Wealthier people have lives that are more leisurely in general, even when it doesn’t involve anything they would explicitly perceive and self-report as leisure. They are more likely to be able to choose their own work schedule, such as sleeping in later if they want (e.g., because of sickness) or leaving work early when needed (e.g., in order to bring their child to an event). They might be puttering around the house which they consider work, as the nanny takes care of the kids and the maid cleans the house. What a wealthier person considers work a poor person might consider leisure.

None of that is accounted for in the data you linked to. And it doesn’t offer strong, clear support for your conclusions. Obviously, something is getting lost in the self-reported data in how people calculate their own leisure. It shows that the poorer someone is the more they are likely to go to work at a place of employment on an average day (and apparently for some bizarre reason that includes “single jobholders only” in terms of income): 93.9% of those making $0 – $580, 90.6% of those making $581 – $920, 85.4% of those making $921 – $1,440, and 78% of those making $1,441 and higher. Imagine if they included all the lower class people working multiple jobs (the data doesn’t list any categories that combine income bracket and number of jobs).

About those formally working on an average day, to put it in context of occupation, this is: 75.5% of management, business, and financial operations, 76.9% of professional and related, 90.1% of construction and extraction, 93.2% of installation, maintenance, and repair, 91.2% of production, and 88.7% of transportation and material moving. Or break it down by education, which strongly correlates to income brackets: 85.5% of those with less than a high school diploma, 89.8% of those with high school graduates, no college, 85.4% of those with some college or associate degree, 77.2% of those with bachelor’s degree only, and 70.7% of those with advanced degree. It is even more stark separated in two other categories: 85.6% of wage and salary workers and 49.9% of self-employed workers.

No matter how you slice and dice the data, non-professionals with less education and income are precisely those who are most likely to do employment-related work on an average day. That is to say they are more likely to not be at home, the typical location of most leisure activities. It’s true the wealthier and more well educated like to describe themselves as working a lot even when at home, but it’s not clear what that might or might not mean in terms of actual activities. Self-report data is notoriously unreliable, as it is based on self-perception and self-assessment.

Besides, anyone who knows anything about social science research knows that there are a lot of stresses involved in a life of poverty, far beyond less time, although that is significant. There is of course less wealth and resources, which is a major factor. Plus, there are such things as physical stress, from lack of healthcare to high rates of lead toxicity. Living in a food desert and being busy are among the lesser worries for the working poor.

To return to the work angle, I would also add that the poor are more likely to work multiple shifts in a row, to work irregular or unpredictable schedules (being on call, split or rotating shifts, etc), to work on the black market (doing yard work for cash, bartering one’s time and services in the non-cash economy, etc), along with probably having a higher number of family members such as teens working in some capacity (paid and/or helping at home, formal and/or informal work). There is also the number of hours spent looking for work, a major factor considering the growing gig economy. Also, what about the stress and uncertainty for the increasing number of people working minimum wage (many employees at Walmart and Amazon) who make so little that they have to be on welfare just to make ends meet.

None of this is found in the data you linked. In general, it’s hard to find high quality and detailed data on this kind of thing. But there is plenty of data that indicates the complicating and confounding factors.

Survey: More Than One-Third Of Working Millennials Have A Side Job
by Renee Morad

“majority of workers taking on side gigs (68%) are making less than $50K a year.”

Millennials Significantly Outpacing Other Age Groups for Taking on Side Gigs
by Michael Erwin

“Workers of all income levels are taking on side work. Nearly 1 in 5 workers making more than $75k (18 percent) and 12 percent of those making more than $100k currently have a gig outside of their full time job. This is compared to a third of workers making below $50k (34 percent) and 34 percent earning below $35k.”

Who Counts as Employed? Informal Work, Employment Status, and Labor Market Slack
by Anat Bracha and Mary A. Burke

“Among informal participants who experienced a job loss or other economic loss during or after the Great Recession, 40 percent report engaging in informal work out of economic necessity, and 8.5 percent of all informal workers report that they would like to have a formal job. However, about 70 percent of informal work hours offer wages that are similar to or higher than the same individual’s formal wage.

“[…] informal work participation complicates the official U.S. measurement of employment status. In particular, a significant share of those who report that they are currently engaged in informal work also report separately that they performed no work for pay or profit in the previous week. In light of such potential underreporting of informal work, the BLS’s official labor force participation rate might be too low by an economically meaningful (if modest) margin, and the share of employed workers with full-time hours is also likely to be higher than is indicated by the official employment statistics.”

What Is the Informal Labor Market?
by Paulina Restrepo-Echavarria

“Survey of Informal Work Participation within the Survey of Consumer Expectations revealed that about 20 percent of non-retired adults at least 21 years old in the U.S. generated income informally in 2015.2 The share jumped to 37 percent when including those who were exclusively involved in informal renting and selling activities.

“When breaking down the results by the Bureau of Labor Statistics (BLS) employment categories, about 16 percent of workers employed full time participated in informal work. Not surprisingly, the highest incidence of informal work was among those who are employed part time for economic reasons, with at least 30 percent participating in informal work. Also, at least 15 percent of those who are considered not in the labor force by the BLS also participated in informal work.

“[…] Enterprising and Informal Work Activities (EIWA) survey, which revealed that 36 percent of adults in the U.S. (18 and older) worked informally in the second half of 2015.3 Of these informal workers, 56 percent self-identified as also being formally employed, and 20 percent said they worked multiple jobs (including full-time and part-time positions).

“[…] There were slightly more women than men among informal workers, though the share of women was much larger in lower income categories.

“The majority of informal workers were white, non-Hispanic (64 percent), while the share of Hispanic workers tended to be slightly higher than that of African-Americans (16 and 12 percent, respectively). The racial breakdowns were consistent across most income categories, with a higher incidence of informal work among minorities in the lowest income categories.”

Irregular Work Scheduling and Its Consequences
by Lonnie Golden

– “By income level, the lowest income workers face the most irregular work schedules.”
– “Irregular shift work is associated with working longer weekly hours.”
– “Employees who work irregular shift times, in contrast with those with more standard, regular shift times, experience greater work-family conflict, and sometimes experience greater work stress.”
– “The association between work-family conflict and irregular shift work is particularly strong for salaried workers, even when controlling for their relatively longer work hours.”
– “With work hours controlled for, having a greater ability to set one’s work schedule (start and end times and take time off from work) is significantly associated with reduced work-family conflict.”