Urban Injustice: How Ghettos Happen (6 page)
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Authors: David Hilfiker,Marian Wright Edelman
BOOK: Urban Injustice: How Ghettos Happen
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Poverty tends to be self-reinforcing, so people born into poorer neighborhoods have a higher probability of becoming poor themselves.
The concentration of poverty due to segregation has an especially pernicious effect on the educational facilities available to those who live in the ghetto. Because elementary and secondary schools are funded primarily through local taxes, cities with large numbers of poor people have fewer resources per child and, therefore, less money to fund education. Because ghettos are politically marginalized even within the city, local politicians can more easily neglect education there.
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Segregating poor African Americans in the ghetto means, of course, that ghetto schools will be almost completely black and poor. Not surprisingly, then, inner-city children bring more hunger, homelessness, exposure to violence, and other problems to school with them than, say, suburban students, and these “noneducational” problems demand resources that have to be pulled away from already meager educational allocations. Ghetto schools should be getting far more money than suburban schools because the problems they have to deal with tend to be more confounding and deeper. Instead, not surprisingly, they usually get less.
One current approach to improving urban education is the “magnet school,” which usually emphasizes a particular area of study like science or the arts, and takes selected students from a district’s many schools, grouping together those who have similar interests and abilities. Usually, these schools have more funds, are better staffed, get more access to supplies and equipment, and maintain better physical plants. They are of very significant benefit…to the children who are selected. Ostensibly, children are chosen on the basis of ability, but parents first have to know about the possibility of applying, believe that such a school will be worthwhile, have the time and energy to enter the application process, possess the skills to fill out the written application, and pay the extra fees usually involved. Unfortunately, by skimming off the best students, the most committed or assertive parents, and often a higher-than-average proportion of a school district’s budget, magnet schools also make the work of ordinary schools that much more difficult.
A similar weakening of the school system as a whole is the primary danger of any of the proposed educational voucher systems. Although certain demonstration voucher projects have successfully targeted the most difficult inner-city students, any widespread voucher program will also likely to lead to the siphoning off of the better students. Vouchers also threaten to weaken public schools financially. Each voucher usually represents the average amount of money the public school system spends per student. Parents can use it to pay tuition or partial tuition at any school, public or private, that will accept the child. Although not true of all parochial schools, most private schools cost far more than the amount of a voucher for “average public school costs.” Poor families unable to afford the added expense will not benefit, nor will the children of parents who, for whatever reason, cannot hunt out alternative schooling, nor will children who cannot get accepted at a private or parochial school. Since voucher money would be withdrawn from public systems, which have large fixed costs in buildings, maintenance, equipment, and teacher contracts, the danger is that the public schools that remain will have even less adequate funding, while having to educate many of the most difficult students who require the highest level of resources.
In its 1896
Plessy v. Ferguson
decision ratifying the legality of segregation in public facilities, the Supreme Court created the doctrine of “separate but equal.” Schools could be segregated as long as the education provided to black students was equal to that provided white students. Justice John Marshall Harlan, in a bitter dissent from that decision, noted that given the social and economic inequality between blacks and whites in the United States at that time, “separate” would never be “equal,” a prediction amply realized in the next century. In 1954, in
Brown v. Board of Education
, the Supreme Court recognized the failure of “separate but equal” and demanded the integration of public schools. Almost fifty years later, as Jonathan Kozol has pointed out, we have not only failed to meet the conditions of the 1954 decision, we have also failed to meet the conditions of the 1896 decision. Schools are still largely separate and unequal.
Plessy v. Ferguson
decision ratifying the legality of segregation in public facilities, the Supreme Court created the doctrine of “separate but equal.” Schools could be segregated as long as the education provided to black students was equal to that provided white students. Justice John Marshall Harlan, in a bitter dissent from that decision, noted that given the social and economic inequality between blacks and whites in the United States at that time, “separate” would never be “equal,” a prediction amply realized in the next century. In 1954, in
Brown v. Board of Education
, the Supreme Court recognized the failure of “separate but equal” and demanded the integration of public schools. Almost fifty years later, as Jonathan Kozol has pointed out, we have not only failed to meet the conditions of the 1954 decision, we have also failed to meet the conditions of the 1896 decision. Schools are still largely separate and unequal.
A
Black Alliance for Educational Options
nationwide study released in 2001 revealed that in fifteen of the forty-five largest school districts studied (including New York, Chicago, Cleveland, and Memphis) fewer than half of African-American students graduated from high school with a regular diploma.
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Without a decent education, a child is handicapped for life.
Black Alliance for Educational Options
nationwide study released in 2001 revealed that in fifteen of the forty-five largest school districts studied (including New York, Chicago, Cleveland, and Memphis) fewer than half of African-American students graduated from high school with a regular diploma.
12
Without a decent education, a child is handicapped for life.
According to the United States Census, in 2000 over 38 million Americans (14 percent) did not have health insurance
at any time
during the entire year.
13
We tend to assume that if people are poor enough, they are eligible for some kind of governmental health coverage. That assumption is wrong. Less than one-third of the people living in poverty are even
eligible
for Medicaid, the primary form of health insurance available to the poor, and the rate of uninsurance among the poor is over twice as high as among the general population. The low-paying jobs available to poor people rarely offer health insurance coverage as a benefit. It is, of course, out of the question for poor people to purchase health insurance on their own. Even modestly comprehensive family policies currently cost more than $650 a month, half the
total
income of a family of three living at the poverty level, so they remain largely uninsured. This means that in any sort of health emergency the poor must spend a significant percentage of their income on clinic or emergency room visits, especially when young children are involved.
at any time
during the entire year.
13
We tend to assume that if people are poor enough, they are eligible for some kind of governmental health coverage. That assumption is wrong. Less than one-third of the people living in poverty are even
eligible
for Medicaid, the primary form of health insurance available to the poor, and the rate of uninsurance among the poor is over twice as high as among the general population. The low-paying jobs available to poor people rarely offer health insurance coverage as a benefit. It is, of course, out of the question for poor people to purchase health insurance on their own. Even modestly comprehensive family policies currently cost more than $650 a month, half the
total
income of a family of three living at the poverty level, so they remain largely uninsured. This means that in any sort of health emergency the poor must spend a significant percentage of their income on clinic or emergency room visits, especially when young children are involved.
Even those who do qualify for Medicaid must undergo an application process that can be arduous and discouraging. Until the 1996 passage of the legislation known as Welfare Reform, most poor families who received what we usually think of as welfare (Aid to Families with Dependent Children, or AFDC) received Medicaid automatically. Because more than half of these families have been moved off the rolls, they must apply separately for Medicaid, a process that can, in some states, prove virtually impossible for a person who must go to work each day to complete.
Once covered by Medicaid, the poor face a sometimes-insurmountable hurdle: finding a doctor who will accept Medicaid payment. Although patterns vary from state to state, fewer and fewer doctors or hospitals accept Medicaid—largely because reimbursement is usually low—so those who are poor must usually go to hospital emergency rooms or public clinics for their care. But hospitals are not good places to receive routine health care, although they generally handle emergencies well, even for the poor. In fact, federal law requires that any hospital admit and care for emergency patients regardless of ability to pay, but it is now an unusual hospital that offers indigent patients much in the way of continuing care, preventive medicine, or help with routine medical problems. Patients with such problems are increasingly triaged out of emergency rooms. Public clinics can be excellent sources of health care for the patients they accept, but they rarely have the staff or other resources to provide care, much less follow-up, to all who need it. Waits are often long, a different doctor may be seen each time, and there is often no special provision for paying for other needed services like x-rays, lab work, or hospitalization, which can be enormously expensive. And even public hospitals and clinics often try to recoup whatever charges they can from poor clients. So although hospitals may not follow up with aggressive collection routines, patients receive bills anyway.
Thus cost prevents appropriate health care, leading to both poorer health and further poverty. The relationships between health and poverty, however, are complex, for each affects the other. The health of poor people is measurably worse than average: infant mortality, the single most commonly used indicator of population health, is 60 percent greater (and the death rate for newborns is twice as high) for families with incomes below the poverty level than for those above it.
14
Many forms of cancer are more common among the poor.
15
Individuals earning less than $9,000 annually have death rates three to seven times higher (depending on race and gender) than those earning $25,000 or more per year.
16
Poor prenatal care or maternal malnutrition can each lead to learning disabilities and decreased cognitive abilities in children, which in turn can contribute to poor educational achievement, further complicating the experience of poverty.
14
Many forms of cancer are more common among the poor.
15
Individuals earning less than $9,000 annually have death rates three to seven times higher (depending on race and gender) than those earning $25,000 or more per year.
16
Poor prenatal care or maternal malnutrition can each lead to learning disabilities and decreased cognitive abilities in children, which in turn can contribute to poor educational achievement, further complicating the experience of poverty.
We know intuitively that poverty can lead to poor health, but research over the last decade has documented that even economic inequality has a separate association with poor health. Studies comparing countries with similar standards of living, for instance, have found that in those with greater levels of economic inequality the health of the entire population (not just the poor) is worse.
17
Similar studies comparing different states in the United States have come up with the same results.
18
The size of the gap between rich and poor matters as well. According to the World Health Organization, the United States, despite its status as the richest country in the world, ranks thirty-second among all nations in the “equality of child survival,” a measurement of the distribution of health among different populations within a country. The United States ranks twenty-fourth in life expectancy, and thirty-second in infant mortality,
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the two most common measures of the health of a population. Over the last twenty-five years, as inequality in our country has increased, we have dropped even further in the rankings. Not only poverty, but also inequality decimates the health of our people.
17
Similar studies comparing different states in the United States have come up with the same results.
18
The size of the gap between rich and poor matters as well. According to the World Health Organization, the United States, despite its status as the richest country in the world, ranks thirty-second among all nations in the “equality of child survival,” a measurement of the distribution of health among different populations within a country. The United States ranks twenty-fourth in life expectancy, and thirty-second in infant mortality,
19
the two most common measures of the health of a population. Over the last twenty-five years, as inequality in our country has increased, we have dropped even further in the rankings. Not only poverty, but also inequality decimates the health of our people.
Examples of poor health among the poor are everywhere: congenital disease and infant AIDS are far more common among the poor, as are the chronic diseases of childhood. Lead poisoning, asthma, malnutrition, anemia, and chronic middle ear infections are not only expensive to diagnose and treat, but can also lead to permanent impairment. Poor children are twice as likely as affluent children to suffer lead poisoning,
20
for instance, and the long-term, deleterious effects on the brain of lead deposits are well known. Severely poisoned children may suffer seizures, coma, and mental retardation, but even those with milder degrees of lead poisoning are at risk for learning and behavior problems. Language acquisition can be delayed, hyperactivity may result, motor coordination may be affected, aggressive or impulsive behavior is more common, and children may have generalized difficulty learning. In addition to being severe problems in their own right, all these symptoms lead to difficulties in school. These difficulties are compounded when the schools in the poor areas lack the capacity to give the individual attention needed; these children may do poorly or drop out altogether. Lead poisoning means that a child enters the challenge of adulthood in the ghetto even less prepared than peers to cope with it.
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for instance, and the long-term, deleterious effects on the brain of lead deposits are well known. Severely poisoned children may suffer seizures, coma, and mental retardation, but even those with milder degrees of lead poisoning are at risk for learning and behavior problems. Language acquisition can be delayed, hyperactivity may result, motor coordination may be affected, aggressive or impulsive behavior is more common, and children may have generalized difficulty learning. In addition to being severe problems in their own right, all these symptoms lead to difficulties in school. These difficulties are compounded when the schools in the poor areas lack the capacity to give the individual attention needed; these children may do poorly or drop out altogether. Lead poisoning means that a child enters the challenge of adulthood in the ghetto even less prepared than peers to cope with it.
Childhood asthma has increased dramatically over the last thirty years.
21
Both poverty and inner-city residence are independent risk factors for asthma, and poor African-American children are more than twice as likely to get asthma as other non-poor children and more than four times as likely to be hospitalized. The death rate from asthma is four times higher among African Americans than among whites.
22
Asthma is not only a serious, potentially life-threatening illness in itself, but among chronic health conditions it causes the most school absences. It is the second leading cause of hospitalization for children aged five to nine and may account for a third of all emergency room visits. For the uninsured, the several medications often combined to treat asthma are prohibitively expensive. Asthma becomes highly disruptive to the life of the child and his or her family, adding further chaos to their lives.
21
Both poverty and inner-city residence are independent risk factors for asthma, and poor African-American children are more than twice as likely to get asthma as other non-poor children and more than four times as likely to be hospitalized. The death rate from asthma is four times higher among African Americans than among whites.
22
Asthma is not only a serious, potentially life-threatening illness in itself, but among chronic health conditions it causes the most school absences. It is the second leading cause of hospitalization for children aged five to nine and may account for a third of all emergency room visits. For the uninsured, the several medications often combined to treat asthma are prohibitively expensive. Asthma becomes highly disruptive to the life of the child and his or her family, adding further chaos to their lives.
While measuring “hunger” is necessarily subjective, the United States Department of Agriculture’s annual survey of hunger reports that approximately ten million U.S. households, (accounting for 18 percent of the children) are “food insecure” at some point during the year,
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meaning that they do not have access to enough food to meet their basic needs. Over three million of these households experience hunger at some point during the year. On any given night, 562,000 American children go to bed hungry.
24
Compared to other low-income children whose families do not experience food shortages, hungry children suffer from over twice as many individual health problems—unwanted weight loss, fatigue, headaches, irritability, inability to concentrate, and frequent colds.
23
meaning that they do not have access to enough food to meet their basic needs. Over three million of these households experience hunger at some point during the year. On any given night, 562,000 American children go to bed hungry.
24
Compared to other low-income children whose families do not experience food shortages, hungry children suffer from over twice as many individual health problems—unwanted weight loss, fatigue, headaches, irritability, inability to concentrate, and frequent colds.
Iron deficiency anemia is also a common result. In the middle-class rural community where I practiced for seven years, anemia was rare. I was shocked, upon moving to the inner city, to discover that well over a third of my young inner-city patients were anemic. Average hemoglobin levels (measuring anemia) were significantly lower than my rural patients’. All of the symptoms of hunger, especially when exacerbated by anemia, mean that hungry children are less able to cope with the difficulties of their environment. School performance suffers, with the expected consequences on future earning power.
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