Introduction Towns and cities have planning and zoning departments within their local government structures. The Planning and Zoning Department is responsible for ensuring that the city infrastructure, including telephone lines, roads, electricity, and water, reaches all necessary areas. It is also responsible for the local codes that keep large retailers like Walmart from moving into residential neighborhoods. Town planning helps minimize traffic on residential streets by creating shopping districts that are near but not in neighborhoods where people live. Food Desert in America Think about how far the nearest grocery store is from your home. Is it within walking distance? If so, how do you transport the groceries home? For many Americans, locating shopping districts outside of neighborhoods creates a need for vehicle transportation from home to the grocer. Many people living in low-income urban housing lack access to cars, and public transportation leaves much to be desired in many cities and is completely absent in many towns. Large retailers need a lot of customers to support the store and a lot of people to staff it. For this reason, many large grocers avoid urban areas and many rural areas where there are not a lot of potential customers nearby, opting instead to set up shop in densely populated suburban areas. This phenomenon has created a serious problem in many urban areas in cities and small town centers alike. Food deserts are residential areas with no readily available access to grocers who carry fresh fruits, vegetables, and meats. Many residents in food deserts subsist mainly on cheap processed foods that they can purchase at mini-marts and gas stations. A diet lacking in fresh healthy foods creates long-lasting health problems. As many food deserts also lack accessible health care, the health of the vulnerable populations in these areas is doubly impacted. The food desert issue is one of social, political, and economic factors. Socially, these areas have needs, such as access to affordable food, shelter, and clean water, that must be addressed. Politically, it is up to the government to change zoning codes and offer incentives to encourage grocers and health care providers to move into areas in need of access. Economically, it is difficult for retailers and service providers to grow in economically depressed areas. This chapter investigates ways in which social, political, and economic factors increase vulnerability for at-risk populations. My BookshelfTOC/Annotation menu DownloadsPrintSearchProfileHelp 3.1 Portrait of the Nation Previous sectionNext section 3.1 Portrait of the Nation The population's needs change as the makeup of the population itself changes. The country is evolving as both the country and the populace age. America has long been known as "the melting pot," where many people from different cultures live side by side. Never in the country's history has this been truer than it is today. A more diverse populace has more diverse needs, and it is not surprising that some groups have their needs met more effectively than others. The U.S. population increased at a rate of 5.3% from 2000 to 2005 (U.S. Census Bureau, 2007). This population growth is attributable to many factors, including more births than deaths, as well as immigration. It is also compounded by the fact that people live longer now than ever before. The baby boomer generation, which includes those individuals born between the years 1946 and 1964, is the largest current generation in the United States. As the baby boomers enter their senior years, America's population portrait is aging along with them. America experienced its highest median age ever at 36.2 on July 1, 2005, and it is expected to increase as the baby boomer generation ages. Average life expectancy is also increasing as medical and health science improves. The average American life expectancy in 1996 was 76 years; it is expected to rise to 82.6 in 2050. The fertility rate is not expected to change much from the current 2.1 births per adult female; therefore, America's population might see a slight decline when the baby boomer generation dwindles with age (U.S. Census Bureau, 2007). The ethnic makeup of the United States is changing as well. While America's largest race population has historically been Caucasian, census data shows that this population's growth rate slowed to just 1% from 2000 to 2005. In contrast, the African American population experienced a 6% growth rate during this time, which is higher than the national average. The Native American and Alaska Native population grew at 7%. America's Asian population boomed at 20% growth, and the Hispanic population had the highest increase at a rate of 21% (U.S. Census Bureau, 2007). In 2000, Caucasians made up 75.1% of the American population, and African Americans represented 12.3% of the nation's population. By 2010, the percentage of the population identified as Caucasian declined to 72.4%, while African Americans increased to 12.6% of the population. The percentage of the population identified as Asian rose from 3.6% in 2000 to 4.8% in 2010 (U.S. Census Bureau, 2011a). As the population growth rates for minority populations race to catch up with the Caucasian population total, the growth for Caucasians has slowed. This means that Caucasians will not be the majority population in the United States for much longer, and the face of America is becoming increasingly multicultural. 3.2 How We Live The makeup of the average American family has changed drastically over the last 40 years. In 1970, 40.3% of the population was married couples with children under age 18. By 2005, this group made up only 23.1% of the population. By 2010, the number of married couples with children under age 18 further declined to 21% (U.S. Census Bureau, 2010). The percentage of married couples without children increased from 53% in 2005 to 58% in 2010 (U.S. Census Bureau, 2012d). The percent of "other family households," composed of single parents, unmarried parents, or extended family households, rose from 10.6% of the population in 1970 to 16.7% in 2005. Populations of men and women living alone have also increased slightly, from 5.6% and 11.6%, respectively, to 11.2% and 15.2%, respectively (U.S. Census Bureau, 2007). Increases were seen in every "other family households" category in the 2010 census, including those with men or women living alone (U.S. Census Bureau, 2012e). Children under age 18 composed 24% of the 2010 American population (U.S. Census Bureau, 2011b). Although the majority (69%) of children in the United States continue to live with both parents, there has been a significant decline from 85.2% in 1970. The number of children living with one parent continues to favor the mother, at 10.8% of all children in 1970 and 24% in 2009 (U.S. Census Bureau, 2011c). In 1970, 1.1% of children lived with their fathers only. That number rose to 4.8% in 2005 (U.S. Census Bureau, 2007). In 2011, there were 1.7 million single fathers in the United States, representing 15% of all single parents (U.S. Census Bureau, 2012f). America's changing family structures both contribute to and are affected by the changes in housing, education, and income trends throughout the population. As we will see, the ties between people have significant effects on vulnerability, as social support can help us reach our goals and keep us safe. Where we live and our financial situations also affect vulnerability in terms of resource allocation. Statistically, snapshots of how we live offer insight into the ways in which personal resources–housing, education, and income–limit or increase vulnerability. This understanding allows us to seek ways to address the needs of those most vulnerable. Housing Aerial photograph of a residential subdivision of single-family homes. Courtesy of Dan Barnes/iStockphoto Almost two thirds of the housing units in the United States in 2005 were separate, single-family units. Of the 124.4 million housing units in the United States in 2005, 77.7 million were single-family detached units. Single-family attached units accounted for 7 million housing units. In that year, there were 31 million multifamily units. Owner-occupied homes were the majority, at 62% of all housing units. Renter-occupied units made up 28% of all housing units. The American Housing Survey (AHS) found that owner-occupied units were significantly more likely to be appropriately equipped with housing elements such as safe drinking water, functional plumbing, and cooking appliances. African Americans are more likely than other ethnic groups to live in housing with severe deficiencies, such as vermin, continuing water leaks, and exposed wiring (10.4%). Hispanics are a close second at 9.2%. Asians and Caucasians live in dwellings with severe deficiencies at rates of 4.6% and 4.4%, respectively (U.S. Department of Housing and Urban Development, 2012). The U.S. Department of Housing and Urban Development (HUD) works with local housing agencies to provide public housing for low-income individuals and families. HUD estimates that there are around 1.2 million families and individuals living alone that rely on public housing (2012). Education Statistics from 2005 show that Caucasians were most likely to graduate from high school, and Asians were a close second (90.1% and 87.6%, respectively). African Americans had a high school graduation rate of 81.1%, while Hispanics were at 58.5% (U.S. Bureau of Labor Statistics, 2012). The United States experienced a record number of individuals with bachelor's degrees and higher in 2004 and 2005. The Asian population led in postsecondary education completion with 50.2%. Caucasians were a distant second at 30.6%. The gap is smaller between Caucasians and African Americans, who had a 2005 postsecondary education rate of 17.6%. Hispanics had the lowest rate at 12% (U.S. Bureau of Labor Statistics, 2012). Income and Poverty It is important to consider inflation and the rise in the cost of living when comparing income across decades. Real median income is middle average income level for the United States, adjusted for inflation. America's real median income increased slowly from $35,379 in 1967 to $46,326 in 2005 (U.S. Census Bureau, 2007). Figure 3.1 shows the real median income disparity across America's most prominent ethnic groups. Figure 3.1: Real median income disparity across ethnic groups A bar graph illustrates the real median household income levels of four ethnic groups in the United States: Blacks, Asians, Non-Hispanic Whites, and Hispanics.The real median income for each group is: Blacks, about $30,000; Asians, about $60,000; Non-Hispanic Whites, about $50,000; and Hispanics, about $36,000.There is a significant disparity between the real median incomes of Asian households and African American households. U.S. Census. (2010). Retrieved from http://www.3.3 Social Conditions: Social Capital Lucinda and Brad are nurses at a large, urban children's hospital. One of their cancer patients, a 9-year-old named Josh, took a turn for the worse and was rushed into surgery to stop internal bleeding. At the end of Lucinda and Brad's work shift, Josh still had not awoken after surgery, and doctors were concerned that he would not make a good recovery. Both nurses left work exhausted and with heavy hearts for a patient they were fond of. Lucinda went home to her toddler and husband. Brad went home to an empty apartment. Recall from Chapter 1 that social capital is the measure of interpersonal relationships that people have with others; to phrase it differently, social capital is the support network of family and friends who take care of us when we are ill and hug us at the end of a bad day. In the example, Lucinda has more social capital than Brad because Lucinda is able to escape the trials of a bad day at work by enjoying the company of her child and husband through family activities like eating dinner together or playing a game. Having people to call on to lend a hand when we need assistance is important to every person's physical and emotional well-being. Patients with strong support networks are more likely to recuperate faster and have shorter hospital stays. Parents with family nearby are more likely to enjoy an occasional night out knowing that their children are well cared for in their absence. Caring friends and family can offer shelter or financial help when times are tough. Studies have found that people in at-risk populations generally have less social capital than those who are not generally part of vulnerable populations. Vulnerable Mothers and Children Many American children have parents who work outside the home. For working parents, child care is a necessity and can be difficult to maintain. Think back to your childhood. What did you do during the day before beginning primary school? Who did you stay with? Did your parents or guardians pay for that care, or were you cared for by a family member who did not charge for the service? When you fell ill, was a parent able to take off work to stay home with you? Many people in vulnerable populations lack the type of job stability that allows them to take off work whenever they might be needed at home. This is particularly problematic for single parents. It is difficult to maintain a healthy work-life balance without a strong, supportive social network to fill the gaps left by an absent parenting partner. Single parents who can call on friends and relatives to keep their sick children so they can go to work are more likely to maintain long-term employment. A look at employment rates of unmarried mothers by race supports the theory that Caucasians are more likely to have more social capital than their peers (Ciabattari, n.d.). Figure 3.2 shows that Caucasian single mothers are more likely to be employed than those of other ethnic groups. .gov/population/www/pop-profile/files/dynamic/MoneyIncome.pdf African American households had the lowest median income ($30,900). Asian households had the highest ($61,100). The median for non-Hispanic white households was $50,800. The median for Hispanic households was $36,000 (U.S. Census Bureau, 2007). Since 1970, the poverty rate in the United States has vacillated around the 12% mark. The number of people living in poverty is significantly higher than the poverty rate and experiences greater variances. The number of Americans living in poverty was lowest during the 1970s, staying around 25 million. By the early 1990s, that number had risen tSocial capital can also affect a person's health care choices. Married mothers are over three times more likely than unmarried mothers to receive prenatal care early and often. Caucasian adults are the group most likely to seek prenatal care during the first trimester. Studies show that Caucasian women are also the ethnic group that rates highest in social capital. A strong, supportive network of friends and family is more likely to encourage a healthy pregnancy and positive attitude than a weak, unsupportive group. In this way, a person's social capital can have a negative effect by discouraging early prenatal care and having negative opinions about the pregnancy. For example, a pregnant 17-year-old in her senior year of high school may feel that her friends no longer want her around, and perhaps that her parents don't want to talk about the pregnancy. This isolating situation may lead the young mother to make unhealthy choices in diet, medical care, and perhaps even in drug use as she strives to act as if she is not pregnant in order to fit in with her peers and pacify or rebel against her parents. Abused Individuals One of the earmarks of abuse is withdrawal from friends and family. Abusers often alienate their victims by harassing, bullying, or physically abusing them when they attempt to build or maintain personal relationships. Abuse victims often allow themselves to become isolated out of shame and a reluctance to be found out. Child abuse victims often have a tendency to isolate themselves from adults such as teachers as well as from their peers. Isolation is also a significant factor in the difficulty of reporting elder abuse, as many abused elders have been removed from their homes and away from friends due to physical needs. Chronically Ill and Disabled Persons A photo of an older woman lying with her eyes closed in a hospital bed. Courtesy of Silvia Jansen/iStockphoto It can be difficult to preserve social relationships when one suffers from a chronic illness or disability. People with strong relationships with others are more likely to maintain healthy lifestyle habits. For example, married men are more likely to eat healthier and get more exercise than their unmarried peers. Women with strong friendships often encourage each other to take time for themselves, keep their bodies healthy, and stay physically fit. The physical rewards of quality relationships mitigate the risk for chronic illness. Chronic illness and disability can diminish a person's social capital by making it difficult to maintain relationships. A marriage or domestic partnership may suffer if one member is unable to fully participate in the relationship due to chronic illness. Chronic diseases and disabilities can make it difficult for a person to leave home to engage in civic groups and activities or to travel with friends. This can be particularly true with degenerative diseases like multiple sclerosis (MS). MS causes dysfunction of the nervous system, and symptoms can range from shaking to paralysis of the limbs. A 47-year-old woman with MS may once have enjoyed dinners out with friends and romantic weekends away with her partner, but find it increasingly difficult to leave the house as the disease progresses. Missing the fun may add to her feelings of isolation, which contribute to her loss of social capital when she feels disconnected from her friends and partner. When a chronically ill or disabled person is no longer able to engage in activities with friends and family, that person loses social capital as those relationships weaken. Persons Living With HIV/AIDS During the 1980s, HIV was stigmatized as a "gay men's" illness. Many families abandoned members upon learning of their HIV positive status, leaving them to rely solely on friends and themselves for help and support as they combated the disease. Though society now knows that HIV affects people of all races, ages, genders, and behaviors, the stigma attached to HIV has only slightly dissipated, in part because men who have sex with men (MSM) are still the demographic with the highest HIV infection rate. Education programs within the lesbian, gay, bisexual, and transgender (LGBT) community focus on lowering the rate of infection, while specialized community health programs work to provide emotional support and help obtain appropriate care for people living with HIV/AIDS. Though treatments are available to lengthen the life expectancy of HIV/AIDS patients, the disease is fatal. Death usually follows a prolonged period of serious illness, during which the patient's medical care is both costly and time consuming. Many HIV positive children are born to low-income mothers who lack both the financial and social support resources to care for the children. HIV positive adults often lose much of their social support due to both the stigma attached to HIV and the intensity of the illness as their health fails. These factors contribute to a loss of social capital for people diagnosed with HIV/AIDS, which makes dealing with the disease significantly more difficult. Persons Diagnosed With Mental Conditions Our relationships with other people help define us. People who lack social capital report higher stress levels and more symptoms of depression and other mental illness than peers with fulfilling social netwSuicide- and Homicide-Liable Persons Suicide was the 10th leading cause of death in the United States in 2007 at a rate of 11.3 per 100,000 people (National Institute of Mental Health [NIMH], 2007). Risk factors for both suicide and homicide include abusive families, firearms in the home, substance abuse, and mental disorders. The risk of suicide is significantly increased for those who have a family history of suicide. Bullying increases a young person's suicide risk. This is particularly true for adolescents who identify as LGBT. However, a strong support network of family, friends, and teachers lessens a young person's suicide risk by providing the victim of bullying with the emotional support necessary to maintain his or her positive self-esteem. This is true for people of all ages and in all situations, not only adolescent bullying victims. Feeling valued by others and having somebody to turn to protects against suicide risk factors. More important, a person who is suicidal may have friends who can advise him or her to seek professional help. They may encourage him or her, for example, to contact the National Suicide Prevention Lifeline (1-800273-TALK), which is available toll free, 24 hours a day. Photograph of a young man sitting at a table staring at a group of pills with an empty pill bottle lying nearby. Courtesy of Mehmet Dislsiz/Fotolia In 2007, suicide was the 10th leading cause of death in the United States. Risk factors and a disconnect from social interactions and support can increase a person's likelihood of committing suicide. Loss of close relationships and loved ones, in addition to loss of independence, can cause depression leading to suicide in the elderly. Homicide rates are similarly associated with a lack of social capital. Disconnection from other people, combined with the trials of economic depression, creates a deficit of social trust that leads to violent crime. Gangs prey on members' needs for social ties and acceptance and encourage violent behavior as a means to earn respect. Low-income areas have a higher rate of familial dysfunction, creating a social situation wherein gangs can thrive and increasing the homicide rates in these areas. Persons Affected by Alcohol and Substance Abuse Social capital is closely linked to alcoholism and substance abuse. Evidence exists that a predisposition to alcoholism may be at least partially passed genetically from parent to child. Children who grow up in households where adults abuse alcohol, smoke cigarettes, or use illicit drugs are significantly more likely to do the same in their adulthoods. Social capital is also linked to substance abuse in terms of emotional and physical support gained from close personal relationships. Many people turn to alcohol and illicit drugs as a coping mechanism to deal with adversity when their needs are not otherwise met. The people who contribute social capital can also be a strong force in overcoming alcohol and drug addictions. Indigent and Homeless Persons Social isolation and lack of social capital are earmark characteristics of indigent people. The lack of close social ties contributes directly to the condition of homelessness, as well as to the many risk factors, such as alcoholism and poverty, that can create homelessness. Many teenagers who report homelessness cite abusive living situations as the reason for leaving home. Some of these teens stay for short periods of time with various friends and relatives but never stay in one place for very long. Many others end up in the streets because they lack the social capital to find places to stay, meaning nobody is willing to take them in, care for them, and keep them safe. Surveys of sheltered homeless report that many adults experiencing homelessness also experienced homelessness or transient homelessness in childhood. Transient homelessness is a state of being homeless but staying with friends or family for short periods of time before moving on. The social isolation of indigent people also contributes to difficulty in counting and tracking homelessness in America. Much of the information gathered on the homeless in America comes from surveys of sheltered homeless individuals. Immigrants and Refugees Immigrants often leave behind friends and family to come to America. Once here, they must establish new social networks in order to rebuild social capital. Though many informal groups exist to help immigrants connect with others from their home countries, America's immigration policies are a roadblock to building such social networks. As we will discuss in later chapters, many immigrants and refugees live in low-income housing because once they are on American soil, they find a dearth of government resources to help them establish new lives. Additionally, America's social attitudes toward foreign nationals are often isolating. The mental distress that many refugees experience from having lived through events such as guerrilla warfare that caused them to seek refuge outside their home countries also makes it difficult for them to establish new, meaningful relationships. Many legal immigrants move to the United States to find that they cannot practice their professions in the United States due to licensing regulations (as is often the case for physicians and attorneys). Illegal immigrants face similar challenges, as they attempt to stay under law enforcement's radar. The mental stress of losing income can lead to loss of self-respect and the perceived loss of the respect of one's peers. In addition to legal barriers and barriers to resources, immigrants to America must also overcome language barriers and differing customs to build social capital and the benefits that come with it. orks. The disruption of the family unit is associated with mental conditions that can last an entire lifetime. Many mental conditions, such as depression, have the negative effect of causing sufferers to withdraw from family and friends. Often, the more a person withdraws, the worse the illness becomes. Maintaining close personal ties is closely associated with mental health. Consider the earlier example of the pregnant 17-year-old. In addition to the stress of being pregnant and a teenager, she also now has the stress of feeling alienated from her friends at a time when her friends should be boosting her self-esteem. All the added stress combined with the loss of close friendships puts her more at risk for developing depression. o nearly 40 million people. In 2005, an estimated 37 million Americans were living in poverty (U.S. Census Bureau, 2007). 3.4 Political Conditions: Social Status Social status can improve with higher amounts of social capital and human capital. It can also decline if the same factors decline. A person with a high level of education, reasonable wealth, steady employment, and strong family and friend connections has more social status than a low-income individual with little education and no wealth. Social status is also tied to age. The very young and the very old hold less social status in our society because they are dependent on others for help with daily living. Race also affects social status, for both socioeconomic reasons and the history of discrimination as well as discriminatory attitudes that still exist in American culture. Gender is tied to social status in much the same way that race is. African Americans were formally given the right to vote by the 15th Amendment in 1870, whereas women did not receive that right until the passing of the 19th Amendment in 1920. This fact alone shows that gender and politics are strongly intertwined. Vulnerable Mothers and Children Social status plays a fundamental role in the lives of high-risk mothers and infants. African Americans had the highest rate of teen pregnancy until 2005, when the teen birthrate among the Hispanic population bypassed that of African Americans. Figure 3.3 illustrates recorded teen birthrates by race. Figure 3.3: Teen births by ethnicity A bar graph illustrates the total teen births for each of five ethnic categories (White, Black, American Indian/Alaskan Native, Asian/Pacific Islander, and Hispanic) and further divides the ethnic categories into births by those under 15 and those ages 15 to 19.Whites had the highest total number of teen births (over 130,000), followed by Hispanics (about 119,000), Blacks (just under 100,000), American Indian/Alaskan Native (about 8,000), and Asian/Pacific Islander (less than 8,000).The vast majority of teen births occurred in teens ages 15 to 19.While white, black, and Hispanic teens have similarly high rates of teen pregnancy, American Indian/Alaska Native and Asian/Pacific Islander teens each give birth to less than 10,000 children each year. Center for Disease Control and Prevention. (2011). Retrieved from http://www.cdc.gov/nchs/data/nvsr/nvsr60/nvsr60_01.pdf#table15 African Americans have the highest rate of gestational hypertension, or high blood pressure during pregnancy (Centers for Disease Control and Prevention [CDC], 2012a). This might be due to a genetic predisposition, but lifestyle choices linked to area of residence cannot be ignored. Many food deserts are in urban areas populated by low-income African Americans, many of whom are high-risk mothers. Unemployment; unsafe housing and neighborhoods; lack of access to fresh fruits, fresh vegetables, and lean meats; and lack of health care access are also all likely contributors to the high fetal mortality rate among African American women. Lack of social status and lack of human capital are closely linked in the lives of high-risk mothers and babies. Abused Individuals Abuse is about power and the roles people play within relationships. As discussed, the very young and very old lack social status partly because they depend on others for their daily care. This puts them at a distinct disadvantage within the social structure of any relationship, most especially those with caregivers. A photo of a little girl looking distressed in the foreground while two parents fight in the background. The father is holding a little boy and the mother is speaking to the father while angrily pointing to the little girl. Courtesy of Goodshoot/Thinkstock Society's endorsement of strict gender roles and the way children should behave may contribute to the unbalanced power dynamic that make abusive situations possible. Social workers and clinicians report a significant trend in intimate partner abuse wherein the victim is somehow of lesser social status than the offender. The difference in status may result from financial inequality (for example, the victim is financially dependent upon the abuser) or even from a difference in education levels. Many reports indicate that social ideology about the woman's role in the household (tend the home and children, obey the man), the "right" way for men to act (strong, in control, and domineering), and the way children should behave (seen-notheard, obedient) contributes to the power disparity that allows for abusive situations to occur. Chronically Ill and Disabled Persons The most severely disabled children rely heavily on help from adults to achieve basic activities of daily living, and many continue to do so into adulthood. Chronically ill and disabled adults may find it difficult to maintain employment. The U.S. Census Bureau reports that 9.9% of people ages 16 to 64 in the noninstitutionalized population reported disabilities in 2009 (U.S. Census Bureau, 2007). Of the population reporting disabilities, 17.8% were employed in 2011, compared with 63.6% of the population with no reported disabilities in the same year (U.S. Bureau of Labor Statistics, 2012). Vulnerable populations are at increased risk for negative outcomes regarding chronic illness and disability. Lack of health care access and the living conditions associated with poverty put vulnerable groups at increased risk for developing chronic illnesses and disabilities. Lack of social and human capital makes it more difficult for them to cope with long-term ailments. In this way, the very young and very old who suffer chronic conditions are particularly vulnerable. Persons Diagnosed With HIV/AIDS A photo of a person sitting on the ground in a run-down building while another person stands nearby.The window in the background has bars on it and the walls and floor are dirty. Courtesy of Peeter Viisimaa/iStockphoto A large number of the people living with HIV/AIDS are minorities. This may be due to the fact that injectable drug use, prevalent in low-income, minority-populated areas, is the second leading cause of HIV/AIDS infection. HIV is more prevalent in low socioeconomic urban areas than in neighborhoods with higher levels of education and income. Injection drug users have the second highest HIV/AIDS incidence, and injection drug use is rampant in America's economically depressed areas. The number of minorities living with HIV/AIDS is due to the prevalence of minorities in economically depressed urban areas, as well as the higher rate of injectable drug use among many young minorities. As low-income urban neighborhoods have higher numbers of minority residents, lack of access to preventive education programs and health care increases the HIV/AIDS transmittal rate among the socially and economically disadvantaged. Persons Diagnosed With Mental Conditions Childhood events help shape mental health later in life. Children dealing with poverty, family disruption, abuse, chronic illness, or minority group status are more likely to exhibit symptoms of mental illness. Many symptoms of mental conditions first appear in adolescence, a time when young people's bodies and minds are rapidly changing. The Administration for Children, Youth, and Families reports that single mothers raising children in poverty have a particularly high incidence of mental illness due to the stressors associated with their situations. While situational stressors resulting from social status can induce mental illness, so too can mental illness reduce a person's social status. Withdrawal from friends and family can cause a loss of social capital that contributes to a loss of social status. Maintaining employment can be impossible in cases of severe mental illness. Loss of income and dependency on others for financial support reduces a person's social status. Suicide- and Homicide-Liable Persons Social status based on race, gender, education and income levels, and power directly influences violence. Intimate partner abuse is based on the power differences between those in the relationship. Children and the elderly have less social status than people ages 20 to 65, who are more likely to be abusers. Disadvantaged minority groups have higher suicide and homicide rates than members of higher social standing. Hispanics' moderate suicide rates are attributed to a communal respect for family. Hispanics with risk factors, including substance abuse, mental conditions, low human capital, and broken families, have higher suicide and homicide rates than those with few risk factors. Suicide and homicide in Alaska Native and Native American communities are associated with broken communities and the disintegration of their traditional cultures and family structures. These communities are plagued with the effects of systemic economic depression. Suicide and homicide risks for this ethnic group include mental illness, family violence, and substance abuse. Persons Affected by Alcohol and Substance Abuse A photo of a middle-aged man in a collared shirt and tie holding a glass of whiskey and staring at it.A half-filled whiskey bottle sits nearby. Courtesy of Digital Vision/Thinkstock The pressure of adhering to societal gender roles and entertaining an embellished sense of self contributes to a person's likelihood to use alcohol and drugs. Adolescents experience increased risk for experimenting with alcohol and other substances because, at this developmental stage of life, they are testing boundaries and are eager to fit in with their peer group. Adolescents with risk factors, including family violence, poor educational opportunities, and poverty, are significantly more likely to try and to continue use of alcohol, cigarettes, and illicit drugs. The effects of these substances on developing brains add to the likelihood of continued use and considerably negative outcomes. The elderly occupy a similar rung on the social status ladder as adolescents. Though alcoholism and substance abuse rates are lowest among the elderly, access to habit-forming prescription drugs increases their risk of substance abuse. Separation from family and friends, loss of intimate partners and independence, and the depression associated with leaving a lifelong home contribute to alcoholism and substance abuse by the elderly. Social status associated with gender and ethnicity also contributes to alcohol and substance abuse. Individuals may be influenced by cultural norms to use certain drugs or alcohol, such as Native Americans who use peyote for religious purposes. Similarly, expected gender roles and idealized concepts of self contribute to a person's likelihood to use drugs and alcohol. Indigent and Homeless Persons The global economic recession of the early 2000s saw many middle-class Americans lose their jobs and slip into poverty. As people struggled to stay in their homes, a mortgage crisis erupted, fueled by illegal and unethical lending and foreclosure practices. The strain on America's lowincome housing programs increased, while government spending on social welfare programs decreased. Becoming unemployed and losing a home creates a loss of social status that affects most aspects of one's life. Homeless children are particularly vulnerable to deficiencies in health care and poor nutrition. They are also more likely to experience mental distress and have many unexcused school absences. These factors hinder a child's ability to gain a meaningful and complete education, contributing to low human capital later in life. Like the number of homeless family units, the number of unaccompanied youth is also growing. Counting both those who are part of homeless family units and unaccompanied homeless youth, estimates put the annual number of children experiencing homelessness for at least one night around 1.6 million (Paquette, 2010). Many unaccompanied homeless youth are runaways, but a great many have been expelled from their homes or family units by adults. A majority of these young homeless are fleeing severe mental, physical, and sexual abuse. Abuse is also a driving factor in the homelessness of women and minorities. Once homeless, women become particularly vulnerable to drug abuse, assault, unwanted pregnancies, adverse pregnancy outcomes, and negative health outcomes. Homeless women and children's particular vulnerability creates an even greater social status deficit for these individuals, which greatly increases their risk of disease. Immigrants and Refugees Even well-educated immigrants to America experience a loss of social status due to language barriers, cultural differences, and negative social attitudes regarding immigration and particular ethnicities. The loss of social capital caused by leaving one's home country also contributes to a loss of social status. Many refugees find it difficult to subsist in a country where very few people grow their own food and build their own shelter, especially when they come from regions where the ability to do so was the foundation of social status and life. Refugees fleeing wars in Somalia and Liberia often find it difficult to transition to a lifestyle where food comes wrapped in plastic and everybody wants an enormous house. Female refugees are particularly vulnerable, as many are uneducated and do not speak English at all. Refugee women and children often suffer severe emotional distress caused by the brutality from which they are fleeing. Depression as well as language and education barriers make it difficult to build new relationships and access programs and resources that ease the strain of building a life in a foreign place. As many refugees come from impoverished regions, they often arrive with serious health care needs. The American health care system is particularly difficult to navigate if you do not speak its language. 3.5 Economic Conditions: Human Capital An individual's human capital is measured by level of completed education, employment status and position, and living conditions. These factors are tied together because a person's ability to maintain a high-paying job increases relative to how much he or she has invested in his or her education. For example, consider the fact that a child's ability to learn during the school day is directly tied to both the condition of the school and the education offered, which are both tied to society's investment in the school by way of government funding. For both children and adults, public and private investment in the living conditions of neighborhoods and housing units deeply affects all aspects of life, from the ability to focus during the school day to the ability to maintain viable employment. Economic conditions directly affect human capital, and vice versa. Vulnerable Mothers and Children Human capital is directly linked to the timing and quality of prenatal care, the ability of the mother to recuperate after the birth, and the ability of the mother to care for the infant. Lowincome regions have a lower rate of early and sufficient prenatal care than wealthier areas. Mothers living at or below the poverty line are significantly less likely to receive any prenatal care at all. A 1988 study found that only 53% of expectant mothers with less than a high school diploma sought early prenatal care, compared with 92% of expectant mothers with at least some college education (CDC, 2012c). Abused Individuals Though abused individuals exist at all socioeconomic levels, there is a direct causal relationship between poverty and lack of education and reported abuse. This is thought to be due to the additional stresses associated with inadequate housing and food, the perils of dangerous neighborhoods, and increased violence and drug abuse rates in low-income neighborhoods. The risk of abuse increases when the offender has more education and income than the victim, as the disparity in human capital causes a disparity in social status. Chronically Ill and Disabled Persons America's public school systems are intended to provide education for all children, regardless of aptitude. Most public schools offer specialized programs for children with disabilities. The focus of these programs is basic knowledge and daily living skills rather than the dissemination of advanced theories and thought processes. In this way, America invests in the education of disabled children. America also invests in disabled individuals through the Social Security system. The Supplemental Security Income program (SSI) provides financial support for disabled citizens. However, that program pays very little. Most people who depend on SSI also rely on government aid for housing and food. As poverty puts people more at risk for developing chronic illness and disabilities, conditions which in turn contribute to personal poverty, health vulnerability poses a particularly distressing situation for at-risk populations. More investment in human capital by way of neighborhood improvements and education funding for low-income neighborhoods is necessary to stop this cycle. A photo of a man lying down in a hospital bed while a doctor stands by his bed examining him and reading his medical chart. Courtesy of Thomas Nor cut/ThinkstockFederal Federal funds and resources are available to help people living with HIV/AIDS. Persons Diagnosed With HIV/AIDS The financial cost of HIV/AIDS treatments is unmanageable for many patients, even those with health insurance coverage. However, treatments are more effective and less costly the earlier they are begun (U.S. Department of Health and Human Services, Agency for Health Care Research and Quality, 2011). Though the civil rights bill specifically forbids termination from a job based on HIV status, the effects of the disease can make it difficult to maintain employment. As many HIV/AIDS patients belong to low-income vulnerable groups, education and income levels were likely low before the onset of the disease. Low-paying jobs and loss of employment put people at risk for losing health insurance coverage and health care access. The United States offers several federally funded resources to help those living with HIV/AIDS. Low-income HIV/AIDS patients are eligible for both housing assistance and disability-based income assistance through the federal government. The Ryan White HIV/AIDS Program, administered by the Health Resources and Services Administration, provides funding to states and community-based organizations to improve health care access and provide life-saving medications for HIV/AIDS patients in low-income areas. A Closer Look: National HIV/AIDS Strategy President Barack Obama implemented the National HIV/AIDS Strategy (NHAS) on July 13, 2010. NHAS was implemented to reduce the amount of new HIV infections annually, restrict the HIV transmittal rate, and improve health care access for those living with HIV/AIDS. For information on ways NHAS is addressing the HIV/AIDS epidemic, visit the White House Office of National AIDS Policy NHAS website at http://www.aids.gov. Persons Diagnosed With Mental Conditions Mental illness is more prevalent among low-income groups, but the causal relationship between poverty and mental illness is uncertain. The social stress theory posits that the stressors experienced by low socioeconomic groups–inadequate housing, drug abuse, neighborhood crime, lack of education, and unemployment and underemployment–cause mental health disorders. The opposing argument is the social selection theory, which argues that mental illness causes people to fall into low socioeconomic status. Generally speaking, both theories are correct. The problems caused by poverty cause high stress levels, which can lead to adverse mental health outcomes. At the same time, the onset of mental illness can cause a person to withdraw from society and have difficulty maintaining gainful employment, causing the individual to lose socioeconomic status. Suicide- and Homicide-Liable Persons Low income and education levels can create competition for resources, including affordable housing and jobs. Many low-income neighborhoods lack the human capital necessary for improvement and, as such, experience a faster rate of deterioration than higher socioeconomic areas. As businesses vacate economically depressed regions, they take employment opportunities with them, further limiting investment in the community. This trend correlates to urban ghettoization, which in turn correlates to increased violence. Suicide among males is nearly four times the rate of suicide among females (CDC, 2010). Native American and Alaska Native males have the highest suicide rate, which is attributed to social beliefs and low socioeconomic status within those cultures (CDC, 2012b). Caucasian males have the second highest suicide rate, which is attributed to internalized frustration and a perceived loss of power in response to changing social expectations. In contrast, African American males of the same age group are more likely to externalize frustrations with the social deficits in education and employment opportunities plaguing this group. This externalization contributes to increased homicide rates among African American males. Rates of violent crime types differ between ethnic groups, partially due to the internalizing versus externalizing responses to social constraints and the issues facing different ethnic groups (see Figure 3.4). Figure 3.4: Violent crime by ethnic group A bar graph illustrates the total arrests for violent crimes divided by race (White, Black, American Indian/Alaskan Native, and Asian/Pacific Islander), and then subdivided into four categories of violent crimes (murder and negligent manslaughter, forcible rape, robbery, and aggravated assault).Whites had the highest total arrests for aggravated assault (about 205,000) and forcible rape (about 5,000), and Blacks had the highest total arrests for robberies (about 105,000).Whites and Blacks had about the same total arrests for murder and negligent manslaughter (about 5,000).Aggravated assault is the most commonly committed violent crime across all ethnic groups. U.S. Census. (2012). Retrieved from http://www.census.gov/compendia/statab/2012/tables/12s0325.pdf Persons Affected by Alcohol and Substance Abuse Varying levels of human capital contribute to differences in alcohol and drug abuse. Cigarette use is inversely related to education and income levels. The opposite is true with alcohol use, which increases with education and income levels (CDC, 2012c). Different illicit drugs are favored by members of different socioeconomic groups. In the 1980s, cocaine was associated with wealth, whereas crack continues to be more accessible to those of low socioeconomic standing. Methamphetamine is thought of as "a poor man's drug" because it is inexpensive to make. However, it is so highly addictive that methamphetamine use is growing among all socioeconomic groups. Substance abuse is higher in economically depressed areas where underemployment and unemployment are rampant. The causal relationship between employment status and drug abuse is multidirectional. Substance abuse can create an environment where gainful employment cannot be maintained. It is also used by many as a coping mechanism for dealing with economic disparity and the loss of self-esteem associated with underemployment and unemployment. A Closer Look: Monitoring Methamphetamine The National Survey on Drug Use and Health began monitoring school-age children for methamphetamine use in 1999. As Figure 3.5 shows, reported methamphetamine use is declining among American children. This positive trend is attributable in part to preventive education programs that aim to keep children from trying methamphetamine even once. These programs are important because methamphetamine is highly addictive, and many addicted users claim to have become addicted after just one use (National Institute on Drug Abuse [NIDA], 2010). Figure 3.5: Methamphetamine prevalence of abuse among 8th to 12th graders A bar graph illustrates the percentage of methamphetamine abusers among 8th to 12th graders, divided into three time-based categories (use in the past month, past year, and lifetime) and subdivided into categories for 8th graders, 10th graders, and 12th graders.Students in 10th grade had the highest percentage of abuse of methamphetamine in the past month, the past year, and in their lifetimes, while 8th graders had the lowest in each category.10th graders have a higher incidence of methamphetamine use than 8th or 12th graders across all three measured time periods. National Institute on Drug Abuse [NIDA]. (2010). Retrieved from http://www.drugabuse.gov/publications/infofacts/methamphetamine Indigent and Homeless Persons A trend has been established that differentiates the current condition of homelessness from the homeless experience between 1950 and 1970. During that time, a majority of homeless people did have shelter, however inadequate it might have been. As the homeless rate increases and government spending on social welfare programs struggles to keep up, the current homelessness experience is significantly more likely to involve actually sleeping outdoors. America's subsidized low-income housing has aged, and little has been done to remedy the inadequacies of faulty wiring, disintegrating roofs, and rusted plumbing. Instead of renovating crumbling structures, much of America's low-income housing has been demolished to make way for trendy, new urban homes for the upper-middle class. This is directly responsible for the diminished availability of affordable housing in socioeconomically depressed neighborhoods. At the same time that America's low-income housing began being replaced by more expensive options, federal funding for social welfare programs and housing subsidies began a steady decline. Housing subsidies were cut 80% from 1980 to 1989. State and federal governments have continued to struggle with paying for housing subsidies and other social welfare programs, while tax income has decreased due to rampant unemployment and corporate tax incentives. Immigrants and Refugees There are essentially three immigrant statuses in America. Overdocumented immigrants have official refugee status. This term reflects the large amount of screening and paperwork required of this group to prove the health status and the ability to support themselves. Undocumented immigrants are often referred to as "illegal aliens" and have not completed the official immigration process. Documented immigrants have come to the United States through legal channels but have not had to undergo the rigorous level of screening experienced by refugees or overdocumented immigrants. A photo of a migrant worker pushing a cart full of green grapes on a farm during the grape harvest. Courtesy of Richard Thronton/Shutterstock Undocumented immigrants lack much of the human capital necessary to feel productive and included in society. Of these three types, undocumented immigrants have the least amount of human capital. Many cross the border from Mexico to escape that country's violent drug war and seek employment. In response, the U.S. federal government seeks to control illegal immigration through the 1986 Immigration Reform and Control Act. The flow of illegal immigration into the United States and frustration over current federal immigration laws have resulted in many states, including Arizona, enacting laws to address the increasing number of illegal immigrants in their states. In 2010, the Arizona legislature enacted stringent immigration laws. The Arizona law does not allow law enforcement officers to stop someone just to check on documentation papers, but officers may ask for documentation papers if someone is stopped for some other violation of the law. Suspected illegal immigrants are turned over to the Federal Immigration Services. In response to Arizona legislation, President Obama called on Congress to overhaul federal immigration laws that would clearly restrict state powers regarding illegal immigration. Even as Americans argue over immigration law, undocumented immigrants continue to hold the country's lowest paying, least desirable jobs. Many work in hot, dusty fields as agricultural day laborers. They are paid in cash and are not provided with any stability, security, or benefits. Still, many seek the shelter of America's slums over the bloodshed and economic instability of their home countries. Critical Thinking Arizona's 2010 immigration law has become a hotly debated topic. Do you think states or the federal government should have authority over enforcing immigration violations? Case Study: Food Deserts Put Children at Risk for Lifelong Health Problems A close-up photo of a young boy getting ready to eat a cheeseburger by holding it with both hands and bringing it towards his mouth. Courtesy of cheitt/fotolia Neighborhoods without access to fresh fruits, vegetables, meat, and other healthy foods are known as food deserts. It's 8:00 on a humid Saturday morning in August, and a group of volunteers is gathering with spades, shovels, buckets, and gardening gloves. Their mission: Build a community garden that will both provide a source of fresh produce in a low-income neighborhood and teach local residents how they can improve their health with a little effort and a lot of sunlight. As they work, children walk over to stare and wonder. The volunteers invite the kids over and begin explaining how to grow tomatoes. The children's mothers arrive, checking on their little ones, and the gardeners take advantage of the opportunity to engage the resident adults in the community garden. The volunteers explain that not only will the garden provide fresh, healthy food, but those who contribute to the work will also be engaging in pleasant exercise as they till and weed. These volunteers are part of a nationwide movement to improve eating and exercise habits across the nation, and especially in underserved areas. Teaching healthy eating habits is fundamental to progress as America works to do away with food deserts and combat childhood obesity. Community programs, such as Food is Elementary, and urban gardens work to encourage children to make healthy eating choices and to help their families do the same. Simply building grocery stores in low-income neighborhoods is not enough. Healthy eating habits are much like the old adage, "You can lead a horse to water, but you can't make him drink." That is why First Lady Michelle Obama's Let's Move! campaign worked not only to encourage children and adults to adopt healthier lifestyles, but also funded public programs that gave people the skills to make healthy lifestyle choices and positively affected public policy that increased access to fresh fruits and vegetables to residents in low-income areas. Most of America's food deserts are located in low-income areas. A study published in Rural Sociology in 2009 studied the body mass index (BMI) of students living in identified food deserts in rural Pennsylvania. Researchers found students who reside in identified food deserts have a higher rate of obesity than their peers who live in non food desert areas (Schafft, Jensen, & Hinrichs, 2009). This research drives home the fact that food deserts do not completely lack access to food of any sort. Rather, food deserts are marked by a lack of fresh, healthy foods. Convenience stores that stock processed foods with long shelf lives do exist in food deserts. So, too, do fast-food restaurants that serve processed meals, which are high in fat, sugar, and cholesterol. A diet that relies on high-fat, processed food is more likely to create obesity than a diet rich in fresh fruits, fresh vegetables, and lean meats. Obesity contributes to a range of health problems, including heart disease, diabetes, and arthritis. Childhood obesity predisposes America's youth to chronic diseases early in life. As eating habits are difficult to change, it is likely that the overweight children of today will grow into obese adults. Obesity, and the health risks associated with it, puts an increasing strain on America's health care delivery system. Chapter Summary Negative health outcomes are caused by factors on both micro and macro levels of society. Social capital refers to the social factors and resources that people rely on for emotional support and help through hard times. Close family ties can alleviate stress, lessening the risk of developing mental conditions. Strong social networks provide help with everything from child care to finding gainful employment. The political factors that affect health are based on the social status of the individual and the groups they are associated with. Women, children, and the elderly are particularly vulnerable regarding social status factors. Human capital is greatly enhanced by high levels of social status, as higher social-status groups generally have more education and income to invest in themselves and others. There is a defined spectrum of social, political, and economic factors and vulnerability that represents the haves and have-nots. 
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