Poverty and illness are such close companions that we link them in our everyday speech, using “poor health” to describe populations with short life expectancies and high rates of infant mortality. There is a worldwide correlation between nations’ per capita incomes and nations’ health outcomes. Economic growth that affords public health measures, including waste disposal and clean drinking water, improves population health. As more babies survive the infections of infancy and more adults live into their old age, there is greater worker productivity and further economic growth. In the 20th century, the interaction of economic growth and population health precipitated an upward spiral in each, for an unprecedented 30-year increase in life expectancy1. Economists and epidemiologists enthusiastically anticipated that developed nations with similar rates of economic growth would continue to enjoy similar rates of health improvement.

Health outcomes in United States, however, are an aberration to anticipated progress. The nation with the world’s largest gross domestic product watches more of its babies die, and more its adults die young, than does any other nation in the group of seven (G7) industrialized countries (United Kingdom, Canada, Japan, Germany, Italy and France). Despite its economic growth, U.S. health outcomes rank only 37th among the world’s countries, lagging not only behind notable economic powerhouses, but also behind subtler economic powers such as Belgium, Andorra, and Slovenia (2006).

Upon closer examination, researchers noted that the developed countries with the best health outcomes are the countries with the least distance between their wealthy and their poor. In developing countries, the absolute poverty of lacking conditions necessary for survival, results in high rates of death from infectious diseases. In wealthy countries, the relative poverty of exclusion from means and privileges available to the dominant society, results in high rates of death from cancer, violence, cardiovascular disease, diabetes and respiratory problems. Social inequality is the scourge that has delimited health outcomes in the United States.

Relative poverty is a phenomenon peculiar to highly developed countries, but it is a real poverty nonetheless. When I ask my mother about growing up during the Depression, she says her family was probably poor, but they had as much as their neighbors had, and she never felt poor. Though her parents may have realized they were doing without, my mother and her peers did not experience a relative poverty. The situation is different today. The percentage of children living in poor and nearpoor families increases even as do the goods and services enjoyed by the middle-class and wealthy. Our relatively poor children develop physical adversities disproportionate to their middle-class peers, which persist into adulthood despite eventual adult incomes or health behaviors.

The U.S. has not been able to buy its way out. The government spends more on health than does any other government in the world, and private sectors likewise spend more on health than do other nations’ private sectors, without offsetting the effects of exclusion from society’s means and privileges. Exclusion is experienced most dramatically by children who are poor or who are members of minority groups. Relatively poor children are more apt to experience illness than are their non-poor peers, and black and Latino children are more apt to experience illness than are their white peers. The further injury is that the children most likely to embody society’s health inequalities are the children least likely to receive health care. Having a usual source of care is the mark of access to health care for pediatric populations. Poor families spend disproportionately high percentages of their incomes for child health care, yet children in poor families are less likely than are children in middle-class families to have a usual source of care.

The world’s wealthiest nation has responded with indifference toward its ongoing health inequalities, in part because of “at risk” labels that imply a population suffers from its own characteristics rather than from its disenfranchisement. Defining health risk as a function of individual characteristics and behaviors quiets outcry against class hierarchies reproduced by prevailing social structures. The U.S. can neither spend enough nor reframe well enough to cover the truth that inequality is making us all sick.

Churches must counter rather than reflect the dominant culture, as religious institutions that reflect the dominant culture are destined to reproduce its injustices. To counter the dominant culture, churches must raise their consciousness about the people society would make invisible. Churches cannot welcome excluded subgroups if they do not see them. Discipleship calls us to see the people society would have us overlook. Holiness calls us to view our church facilities through the eyes of people the culture has chosen to exclude. Consciousness-raising includes understanding the challenges to health that exist in economically poor communities.

A trip to the produce section of the grocery in an economically poor neighborhood might be a good place to begin some intentional consciousnessraising. Think about the difficulties of taking public transportation to get to the produce you see around you, and how many bags of groceries a person can reasonably carry back home on the bus. Look at the offerings available in that grocery, considering both the price and freshness of the store’s offerings. On the way back to your car, observe the opportunities available for healthful activities, such as walking and biking. Tell your church community what you observed, and take someone with you the next time you go.

Church communities must also be intentional about countering some of the effects of exclusion by other segments of society by providing opportunities for wellness group membership. Parish nursing programs are excellent ways to be intentional about supporting health. Exercise and nutrition groups likewise provide the physical and emotional benefits of group membership. Asking young people about their health-care benefits can empower them to advocate for themselves at work, or think about other health-care benefit alternatives. Talking to people about their insurance is not imprudent unless you are trying to sell them something. Finally, pay attention to your clergy’s health-care benefits, particularly women clergy or clergy without an employed spouse.

It is impossible to speak up for those who cannot speak up for themselves, unless we see them and understand the ways they have been silenced. Churches can speak up by first recognizing the groups that society has excluded, and understanding the effects of exclusion. Churches can offset some of the effects of exclusion by involving the disenfranchised in groups designed around health and well-being, from groups within the church to outside groups that provide insurance. U.S. churches must counter social structures that reproduce social class hierarchies and distance the poor from the means and privileges of society.

by Karen Stipp
Social welfare Research
University of Kansas Adjunct Professor
Nazarene Bible College

1. Kim, J., Millen, J., Gershman, J. & Irwin, A. Dying for growth: Global inequality and the health of the poor. (Cambridge: Common Courage Press, 2000).

Sources Consulted:
Farmer, P. Infections and inequalities: The modern plagues. (Berkeley: The University of California Press, 1999).
Kim, J., Millen, J., Gershman, J. & Irwin, A. Dying for growth: Global inequality and the health of the poor. (Cambridge: Common Courage Press, 2000).
Scheper-Hughes, N. Death without weeping: The violence of everyday life if Brazil. (Los Angeles: University of California Press, 1992).
World Health Organization. The World Health Report 2006. Geneva: World Health Organization. Retrieved online on April 14, 2007 from .