Interrupting Poverty

The church is called to more at the intersection of poverty and health.

by Antony Sheehan
Terri Scott

I grew up in an English mining community, where I attended a Catholic school. From a young age, I heard people pray for members of the parish who were disabled by the dust they inhaled, which blocked their airways and slowly suffocated them. Later, after I left school, the mines closed and there were no jobs to speak of in that community.

What is the health question here? Obviously, the work was dangerous to individual health. But widespread unemployment is also dangerous to a community’s health.

The Robert Wood Johnson Foundation reminds us that, “Health is where we live, learn, work and play.” That describes a community. When we look at the question of health, especially in connection to poverty, we have to look at the community—the environment in which people live, learn, work and play. Medical professionals treat symptoms and consequences of disease in individuals. They do not treat the causes in the community.

The plain fact is that myriad health consequences trace back to poverty. The biggest difference we can make in health comes by interrupting poverty. Living in poverty is not due to deficient character, but a systemic malady that affects entire communities when multiple socioeconomic factors add up to more than the sum of their parts.

“Social determinants of health” include a range of social issues. Research shows us that each one may impact health outcomes, but we also know that the determinants usually come as a package. For instance, a family with unstable employment is likely to live in a neighborhood with higher rates of crime, lower performing schools, and alarming dropout rates. Parents work in low-income jobs. Children see or experience violence at higher levels than in other neighborhoods. Fresh food may be unavailable or unaffordable. Transportation options are sparse, which in turn limits access to health care and social services.

It’s easy to see poverty stamped on this litany, and we know poverty traps generations. We also know that people who live in poverty have worse health outcomes than those who do not.

Social determinants are complex—and stressful. When people encounter multiple stresses, such as unstable housing, unemployment, poor education, food insecurity and violence, health deteriorates rapidly. Toxic stress syndrome manifests in observable ways. Daily living conditions, and the distribution of resources, affect both mental health and physical outcomes, such as respiratory, cardiovascular and infectious disease, cancers, obesity, and diabetes. Toxic stress increases risks for smoking, substance abuse, suicide, teen pregnancy, sexually transmitted infections, domestic violence, and depression. Growing up in a toxic stress environment reduces a child’s chances of succeeding in school, employment opportunities, and the ability to maintain stable relationships.

A long-term study by Hallam Hurt, a neonatologist in Philadelphia, followed children of mothers addicted to crack, expecting to demonstrate that the effects of being born addicted to crack follow the children into adulthood and explain poorer IQ, educational achievement, employment, and health outcomes. The startling result of the 25-year-study was that crack was not the culprit. Poverty was.

The good folks in the church of my childhood prayed for people suffering the consequences of where they worked—but everyone still relied on the income the mines provided. Looking back, I can’t avoid the question: Can the church do more than pray?

My own career first took me into the field of mental health as a nurse. Mental and behavioral health illnesses occur at the same rates in faith congregations as they do in the general population—about one in four people. Social inequalities are associated with higher risks of many common mental and behavioral health disorders. While in the past providers of mental health care were encouraged to disregard issues of faith, in recent decades we recognize more and more the role faith plays in healing and recovery of mental health.

Just as I grew up listening to prayers for people with illnesses related to working in the coal mines, I assumed for many years the church was helping people with mental and behavioral health issues, who statistically turn first to pastors and priests, not psychologists. In reality, often people with mental illness find churches to be unwelcoming. Though they may not always be successful, churches are communities with unique potential to be places of welcome. Spirituality does not automatically insulate people from mental health disorders, but it can make an indispensable contribution to recovery.

So again I find myself asking: Can the church do more?

When I worked in the department of health in England I was responsible for child health policy including healthcare for children awaiting adoption. But my professional interests became more personal through a journey that took my wife and me into the foster care system in England. We were eager to create a family through adoption, but at the same time that we prayed for a good outcome for ourselves, we learned compelling facts about the impact on health—and life—of children who do not have homes with stable family relationships and provision for basic needs. The difference between children who spend years in the foster system and those who do not is dramatic. For instance, if a girl is in a safe, family home when she’s 16, she’s likely to do well as she views the future. If she’s in foster care, she is much more likely to be pregnant or already have children of her own at 18—which introduces a host of social determinants to another generation.

Sir Michael Marmot, chair of the World Health Organization’s Commission on Social Determinants of Health, has been researching health inequalities for three decades. He says, “Disempowered, people who don’t have autonomy, people who have little control over their lives, are at increased risk of heart disease, increased risk of mental illness … Autonomy, control, empowerment turns out to be a crucial influence on health and disease.”

And once again the question rises: Can the church do more?

This has become a persistent question for me as both a person of faith and a professional in the field of health. My understanding of the social determinants of health has unfolded over the years and continues to grow. At each stage, faith interrupts and challenges me to consider how my faith should inform my response to the consistent research about poverty and health outcomes.

Jesus said, “You will always have the poor with you.” Unfortunately this sometimes is quoted as a reason not to try to solve the social issues of poverty and health. That is not at all what Jesus was saying. Instead, I believe Jesus’ words hearken to Deuteronomy 15: “If there is among you anyone in need, a member of your community in any of your towns within the land that the Lord your God is giving you, do not be hard-hearted or tight-fisted toward your needy neighbor. You should rather open your hand, willingly lending enough to meet the need, whatever it may be … Since there will never cease to be some in need on the earth, I therefore command you, ‘Open your hand to the poor and needy neighbor in your land’” (vv. 7–8, 11).

Compare the image of the tight fist in verse 7 and the open hand in verses 8 and 11. The hand is closed when it hangs onto something. It is open in generosity and liberation.

The Scriptures speak consistently of God’s care for the poor. God called on the people of Old Testament Israel to break into the systems that oppressed the poor. Harvesters were to leave enough grain in the fields for the poor to glean and therefore have sufficient food to eat. Every seven years, debts were forgiven and indentured servants set free. Every 50 years, property reverted to the original owner. God commanded the people not to engage in usury. Widows, orphans, and foreigners turn up repeatedly in God’s instructions for caring for people on the financial fringes of society.

God’s calling on the Israelites was to look at this question of poverty, disrupt unjust systems, and make adjustments that reflected a kingdom of love, respect and justice. Amos, the prophet of justice if ever there was one, preached God’s chastisement because “they sell the righteous for silver, and the needy for a pair of sandals—they who trample the head of the poor into the dust of the earth, and push the afflicted out of the way” (Amos 2:6–7).

In the New Testament, Jesus heralded the kingdom of God. Healings and miracles of provision showed Jesus to be on the side of the poor, unwell and oppressed, and he sent his disciples out to do the same. Jesus broke into human history and disrupted social systems that kept people from the wholeness God intends for them to experience. One of the first things the early church did in the book of Acts was organize itself to care for the poor. God lifts up the lowly.

What Jesus really meant when he said the poor would always be with us is that we would be able to continue his work and show love and generosity many times over. Rather than resigning ourselves to the perpetual presence of poverty, we have the ongoing opportunity to change the systems for people who live in poverty. No one alteration, whether in education, housing or food, will resolve the compound effects of poverty. If improved health comes from improvements in where we live, learn, work and play, should we not dream big and change entire neighborhoods?

Can the church do more? The answer is yes, because we begin with a strong foundation of assets.

  1. Calling. God calls us to act on our faith and interrupt destructive social systems.
  2. Care. Our own faith journeys take us into an experience of God’s care and provision and compel us to demonstrate God’s care to others around us.
  3. Community. Congregations are gatherings of diverse gifts that can be harnessed and organized for significant impact.

One of the many exciting dimensions of living in Memphis, my home of the last two years, is seeing firsthand how faithful the community is. The Church Health Center, where I serve as president, is a major partner in an effort to revitalize a part of Memphis known as Crosstown. An iconic but decaying building that housed a distribution center for Sears is undergoing transformation. When it is complete, it will be the new home of the Church Health Center, along with a charter school, small businesses, art and performance studios, mixed-income housing, recreational space, and other features of a thriving community. Economic and social benefits will spill over into surrounding neighborhoods. Many of the people at the core of this ambitious undertaking are people of faith committed to helping people experience lives of health and wholeness. The Church Health Center is excited to put skin in the game of community transformation for better health. We value the opportunity to carry calling, care and community into the city we serve in this compelling way.

Social determinants are shaped by who holds money, power and resources in the community. What is in our fists as people of faith? What would spill out of our open hands and into the lives of those in need of health and wholeness?

 

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