New Book Blog! Poverty, by America

Book Blog - Poverty, by America 

Heidi Kenaga, PhD | AIAMC NI IX Team Leader Ascension Providence Rochester/Wayne State University 

To live and strive in modern America is to participate in a series of morally fraught systems.

      --Matthew Desmond, Poverty, by America, p. 155

I read Poverty, by America - this short and elegantly written book by sociologist Matthew Desmond - on the plane on route to Tucson for the 2024 AIAMC Annual Meeting, having broken my longstanding rule against airport bookstalls purchases. As a [nonphysician] leader of our institution’s National Initiative IX team, I had sensed I was likely underprepared to fully grasp the initiative’s focus, the social and moral determinants of health. I recognized that some of this had to do with the privileges conferred by my class status, my education, and my race. 

Why did I break my rule?  The new book by Matt Desmond caught my eye. His 2016 book Evicted: Poverty and Profit in the American City, an exploration of how eight Milwaukee families struggled to pay rent in the face of possible eviction following the financial crisis of 2007-08. The book won multiple awards, including a Pulitzer Prize for Nonfiction and the National Book Critics Circle Award. Currently the Maurice P. During Professor of Sociology at Princeton, Desmond continues to publish on housing insecurity, racial inequality, and the broad impacts of public policy on working class Americans, largely through an ethnographic lens. 

Poverty, by America, in contrast, is closer to a political manifesto than an analysis of individual lives, while still both engaging and insightful. This is not to say that it’s a comfortable read; Desmond makes clear in the Prologue that he will address the design of poverty in America, insisting on the historical, symbiotic relationship between those “living lives of privilege and plenty” and the “needless suffering” of millions in our prosperous country. 

I’ve always liked books that offer a direct address to the reader, and when Desmond called upon me to understand how the “other other half lives, about how some lives are made small so that others may grow” I began to grasp his call to action:  we might become “poverty abolitionists, unwinding ourselves from our neighbors’ deprivation and refusing to live as unwitting enemies of the poor” (7-8). 

In early chapters, Desmond shows how poverty isn’t just about a lack of financial resources but is tightly bound up with a “knot of social maladies” – in crime, housing, education, healthcare -- which denies poor Americans not just safety and security but dignity and personhood. Government intervention is available in the form of welfare and other mandates, but Desmond rejects the “takers” vs. “makers” binary, noting that “today, the biggest beneficiaries of federal aid are affluent families” (93).  In his chapter “How We Rely on Welfare,” he details these benefits:  the mortgage interest deduction and homeowner subsidies, government-subsidized retirement benefits, employer-sponsored health insurance, student loans and 529 plans, child tax credits, and so on.  Yet many in the middle class (myself included) don’t consider themselves to be part of the welfare state, assuming they “deserve” such assistance as staunch members of the meritocracy, when the documented impact of these benefits is that there are fewer resources for the poor. This is the inherent design of poverty in America, our “social contract,” claims Desmond, and “we should at least own up to it” (102).  Reading Poverty, by America led me to consider the extent to which I am an implicit signatory to this contract, as it were, without overtly acknowledging it.  

In later chapters of the book, Desmond provides ample evidence (75 pages of endnotes!) documenting the many ways we might begin to renegotiate that contract, especially “investing in broad prosperity by turning away from segregation” (176), the latter having been shown time and time again as the main barrier to achieving economic justice.  

For me, Desmond’s passionate, engaged, and timely book has much relevance to the goals of National Initiative IX, especially regarding the moral determinants of health: We are connected, members of a shared nation and a shared economy, where the advantages of the rich often come at the expense of the poor . . . Where we decide to work and live, what we buy, how we vote, and where we put our energies as citizens all have consequences for poor families. Becoming a POVERTY ABOLITIONIST, then, entails conducting an audit of our lives, personalizing poverty by examining all the ways we are connected to the problem – and to the solution.  (156) 

I write this blog at a point when our political malaise, so much derived from class conflict, has seemed to reach a fever pitch. Desmond’s insistence on our connection, as “members of a shared nation and a shared economy,” implies that we also have a shared moral responsibility to both recognize and ameliorate the inequities manifest across socioeconomic institutions in the US which have generated such destabilizing grievances. 

Brief Bio

Heidi Kenaga, PhD, is Research Manager in the Office of Graduate Medical Education at Wayne State University School of Medicine in Detroit, MI.  She is the NI-IX team leader for Ascension Providence Rochester/WSU’s project on developing a community service curriculum and expanding outreach opportunities for their Family Medicine residency program at Ascension as a means to enrich residents’ understanding of the social and moral determinants of health.