Poverty Kills

Bangladesh, 1974. Food per person was at an all-time high — it was a peak year in rice output and availability. It was also a peak year for starvation. 100,000 people starved to death, their skin cracking and their tissues breaking down. They were unable even to focus their eyes as the world watched on TV. Another million and a half died from starvation’s secondary effects. Another half-a-million died after the famine was over because their bodies had been made so weak. There was plenty of food to feed them. They starved because they were too poor to afford it.

Poor people die because they can’t get food, because they can’t get shelter, because they can’t get health care, because they can’t get homes in places that aren’t polluted, because they can’t get food without toxins, because they can’t get time off to supervise their kids, because they can’t spend money on safety, because they can’t spend money on education, because they can’t get a vacation from the stress that’s literally eating away at their brain. We don’t even know all the reasons poor people die. But we do know that they do.

It’s not polite to talk about that. We talk about the poverty rate or the poverty level or the poverty gap, not kids catching on fire and adults wasting away. We talk about economic development and markets and education, not the millions who die each year coughing blood as tuberculosis takes over their body. (They don’t die from tuberculosis. They die because they can’t afford the vaccine.)

Eben Kenah wants to change that. His thesis, “Poverty and the English Language” [PDF], is the best thing I’ve read in a very long while. Quite literally, it’s changed the way I look at what’s important in the world. He argues that the right way to think about poverty isn’t in terms of GDP or income or education or literacy, but in terms of death. That we should measure poverty by measuring who it kills. “It is easier to believe that poverty causes people to wear old clothes, live in small houses, or forego owning a television than it is to admit that people on the bottom of the socioeconomic ladder often die early as a result,” he writes.

A black man in Harlem is 4.11 times as likely to die in a given year as the average American male. A poor white in Detroit is twice as likely. Poor people are more likely to die than rich people, lower-class people than upper-class people, unemployed than employed, blacks than whites.

Mortality resolves a number of long-standing technical debates about the right way to measure poverty. In the US we calculate poverty by having experts at the Department of Agriculture figure out the cheapest products on sale in America that could meet minimal nutritional requirements. They add up how much they cost and multiply by three. People with less than that are defined as poor. Can the poor really follow that minimal diet in practice? How do you even decide what minimal nutritional requirements are? Why three? The answer is simple: just count deaths instead.

But thinking about things this way provokes broader, more fundamental questions, even broader than the issue of global poverty. It makes us ask: Why do people die? And how can we stop it?

The rich worry about this all the time. Vast sums are spent on their health care. There’s a whole industry in improving traffic safety. Billions of dollars are spent to remove minute amounts of chemicals from water.

But asking that broader question — why do people die? — provides a framework for all these other issues: health care, education, poverty, disease, crime, public services, stress, shelter, climate, mobility, famine, pesticides, fatty foods, toxins, pollution, daycare, quality of life. It all comes in corpses: clear, countable, comparable facts. We’re all dead bodies in the end.

A ticker at the bottom of the TV news screen gives people up-to-the-minute information about how well the stock market is doing. Nobody tells us how many people are dying right now (107 people every minute, 5 of them in the US). When a major stock drops, we hear which and how much and why and how it fits into the bigger market picture. Nobody does the same for deaths, either individual or in outbreaks. Nobody’s provided an overall look at why people are dying and how all our attempts to make the world a better place — from economic growth to clean water — are helping. Somebody should start.

You should follow me on twitter here.

August 12, 2009