When you think of poverty in modern-day Alabama, what picture comes to your mind? A Black Belt shack with a yard full of barefoot children in ragged clothes and a flea-bitten dog chained to a tree? A house in the hill country with two broken-down cars parked in front and a rusted washing machine sitting on the porch (and perhaps a large-screen television, tuned to one or the other lowest-common-denominator “reality” shows visible through a cracked window)? A rural schoolhouse with crumbling facilities, where an understaffed faculty teaches from outdated textbooks and most students have little hope of advancing their academic careers beyond a high school diploma? A decaying urban neighborhood where every fourth lot is occupied by a burned-out house, streets haven’t been repaved for 40 years and odd corners are occupied by terminally unemployed men of various ages?
Certainly all of these conditions continue to exist in our state, latter-day echoes of the crushing conditions that have prevailed — and which been perpetuated by the same cycle of poor leadership, political corruption and a governing structure rigged for the benefit of the mighty at the expense of the weak — since time immemorial. By the time they were immortalized by the impressionistic prose of James Agee and the honest-as-dirt photography of Walker Evans in the 1941 book Let Us Now Praise Famous Men, Alabama already had sunk to the level of easy stereotype, and in real, human terms, we’re lying to ourselves if we think that the basic equation as changed much. Poor is still poor.
That’s as true right here in the city of Birmingham as anywhere in Alabama. Maybe more so, if numbers are any indicator (and they are). Start with the most glaring: The rate of poverty in the city of Birmingham is 27.3 percent, which is 155 percent of the statewide rate. Per capita income in our city is only 85 percent of the statewide average, and median household income only 74 percent. The rate of home ownership is 28 percent lower than in the rest of Alabama, as is the median value of owner-occupied homes.
All of this snaps into even starker perspective when you stop to consider that Alabama is one of the most poverty-ridden states in the nation, along with all of the social issues that status brings with it. Most tragically, these include a multitude of factors related to public health — things like teenage pregnancy, infant mortality, and the incidence of diabetes, obesity and cardiovascular disease, to name just a few. The residual effects of generations of segregation don’t help either, as many of the factors that contribute to the persistence of poverty affect blacks — and, increasingly, the Hispanic population — disproportionately.
These issues were at the core of a symposium presented last week by the UAB Minority Health and Health Disparities Research Center and the National Institute for Minority Health and Health Disparities. The centerpiece of the symposium was a panel discussion that featured a mix of local, national and international experts on medicine, human behavior and public health.
The wide-ranging discussion centered on what panelist Gemma Hurst, a faculty member at England’s Staffordshire University, termed “community-led, asset-based approaches.” This means addressing socioeconomic issues from the ground up through policies in areas ranging from education to public transit to urban planning, with goals built around providing information and opportunities that help people make healthier choices.
“The further down you are in the social structure, the less control you have,” observed William Cockerham, chair of the UAB Department of Sociology. “If you’re poor, it’s difficult, perhaps impossible, to make healthy choices.”
Increasing the ability of impoverished populations to make such choices means changing behaviors, said Teresa Seeman, a professor at UCLA’s David Geffen School of Medicine. Seeman said that communities need to work on both the “macro” level — providing opportunities — and the “micro” level — getting people to take advantage of them.
“You can build environments that encourage people to be more active,” said Seeman. “But some people are not going to do that. You have to foster the attitudes that prompt that behavior.”
Behaviors can be changed, Hugh Barton agreed. But that’s a long-term process, requiring thinking, planning and commitment of resources that goes far beyond immediate needs — a process measured in decades.
“Can it be changed next week? No,” said Barton, who is an emeritus professor at the University of West England in Bristol, UK, and a special advisor to the World Health Organization. “Can it be changed over months? Marginally. Can it be changed over a generation? Yes. But it’s not going to happen on its own.”
As it relates specifically to Birmingham, Jefferson County Department of Health CEO Mark Wilson summed up both the magnitude of the problem and the hope for both short-term progress and long-term solutions. Suggesting the need to focus on “one big thing” to unite the disparate elements of the Birmingham region and start the ball rolling in the right direction, he pointed to early education as a challenge around which the Birmingham region should be willing and able to unite.
“Birmingham is a divided community,” Wilson acknowledged. “Not just racially and economically, but in terms of government and education. But we also have huge resources, with one of the highest levels of philanthropy in the country. We have a strong faith community, including growing interest by some of the large suburban churches in focusing on addressing some of the social issues we’re talking about. If we can get together and have success on one big thing, we can begin to get our arms around all of these disparities.”