|Urban Injustice: How Ghettos Happen
By David Hilfiker, MD
When we Americans want to do something about poverty, we usually set
about "improving" poor people. We may offer education or job
training, establish programs to develop the parenting skills of
young mothers, require addiction treatment as a condition for
receiving housing, put time limits on welfare benefits in order to
motivate poor people to work, or refuse additional welfare payments
to discourage further childbearing.
This practice of improving poor people has a long history. Early
American reformers traced extreme poverty to intoxication, laziness,
and other kinds of unacceptable behavior. They tried to use public
policy and philanthropy to elevate poor people's characters and
change their behavior. As the years passed, different sets of
behaviors were blamed for poverty and successive methods suggested
to improve the poor. Later reformers looked to evangelical religion,
temperance legislation, punitive poor houses, the forced breakup of
families, and threats of institutionalization- all to improve poor
This approach has rested on the persistent belief that the
individual faults of the poor are the primary causes of poverty.
Ignorance, lack of training, addiction, laziness, defective
character, sexual promiscuity, too many children: the list goes on
and on. It is not surprising, of course, that a nation so strongly
committed to individualism should so often search for the roots of
poverty within the poor persons themselves.
In this short book, I want to consider poverty from a different
vantage point. I want to suggest that the primary causes of poverty
lie not in individual behavior at all, but in specific social and
historical structures, in forces outside any single person's
control. This is not to deny that most poor people's character could
use some improving (as could most of the rest of ours), but it is to
suggest that the essential causes of American poverty lie elsewhere:
in the paucity of jobs on which someone might support a family, in
inadequate access to health care and child care, in meager
educational resources, in specific government policies, in
nonexistent vocational training, in the workings of the criminal
justice system, and, for African Americans, in a painful history of
slavery, segregation, and discrimination.
The American stereotype of poverty has become the single-parent,
black, inner-city family. And, indeed, African Americans are three
times more likely to be poor than whites. In the 2000 Census,
however, almost half (46.8 percent) of America's poor were white,
close to another quarter (23.0 percent) were Hispanic, and 6.2
percent were Native American, Asian, and Pacific Islander. Only just
over one-quarter (26.2 percent) were African Americans. Of those
poor Americans, almost a quarter (22.0 percent) lived in rural areas
and more than a third (36.4 percent) in suburbs. Of African
Americans in poverty, less than half live in the urban ghettos that
have come to be the almost exclusive definition of poverty in the
This book is largely about those black Americans, only about 12
percent of all our poor people, who do live in the inner-city
ghettos. Many other books could be (and have been) written about
white poverty, about Hispanic poverty, about Native American
poverty, about poverty in general. Why, then, is this white,
middle-class physician writing about black, urban poverty?
The simplest answer is that it's what I know about.
In 1983, after seven years as a rural physician in northeastern
Minnesota, I moved to Washington, D.C., to practice medicine in two
small inner-city clinics. African Americans are Washington's
predominant population and-- aside from immigrant groups that have
recently been expanding-- the poor here are overwhelmingly black. For
five years, my family and I lived in Christ House, a medical
recovery shelter for homeless men. In 1990, we started Joseph's
House, a community and hospice for formerly homeless men dying with
AIDS, where we lived for three years. For almost two decades, then,
I have lived and worked among the black, urban poor. Their plight
has been my primary professional concern.
More important, what I know about and what concerns me the most
unfortunately fits all too well with both public and media
stereotypes of poverty. When most Americans think about poverty, or
see the poor on television, or read about them in the newspapers,
the images are of poor black men hanging around the street corner,
poor black teenagers selling drugs, poor black single mothers living
on welfare, poor black inner-city schools failing their children. In
spite of the statistics, in our country poverty has become
synonymous with black, urban poverty. Since the late 1960s, when
President Lyndon B. Johnson's War on Poverty ended in "failure,"
poverty has been almost a code word for the inner-city black ghetto,
its drugs and its crime. If, then, we are going to face the larger
questions of what to do about poverty in America, there's really no
way to go but through the ghetto-- both as it really exists and as
most Americans imagine it.
Finally, I'm writing about poverty and the ghetto because the
reasons for their existence and the links between them are not at
all mysterious but lie clearly in history. It's nowhere near as hard
as most of us imagine to grasp the causes of black, urban poverty
(or, for that matter, white, rural poverty), and it's important not
to attribute those causes simply to slavery. If we were to decide to
put our minds, our energy, and some of our nation's resources to
work, there are solutions we could choose. Right now.
Yes, most of us tend to ascribe poverty to the behavior of the poor
themselves, and yet, if we were honest, we would admit to at least
some puzzlement over, say, why young black children are four times
more likely to be poor than their white counterparts, or even why
the black ghetto exists in the first place.
I am no stranger to the individual weaknesses of the poor and black
in America. Itís the nature of a doctorís work to see people who
are in trouble one at a time, and it has often seemed to me that the
immediate causes of my patientsí poverty did lie in their own
behavior. For some, addictions consume their time and energy. Others
would not (or could not) cooperate with my medical treatment plans.
Still others lacked parenting skills or discernible job skills. And
some just didnít seem to want to work.
But the more time I spent with even the most troubled of my
patients, the more obvious it became that virtually all of them were
doing close enough to the best they could in the overwhelmingly
difficult environment they inhabited. The odds against which they
struggled, however, are massive. If you havenít lived it or even
seen it firsthand, thereís almost no way to imagine it. Living in
the ghetto, one faces problems with public housing, family
violence, drug and alcohol abuse, the drug trade, negligent
landlords, criminals, illness, guns, isolation, hunger, ethnic
antagonisms, racism, and other obviously negative forces. Even
forces that might seem positive in other circumstances-- the law, the
media, government, neighbors, police-- can, in the ghetto context,
make life miserable for the poor. And one has to contend with all of
these forces-- any one of which might be overwhelming-- all at once,
without a break. Turn to deal with one problem, and three attack you
from behind. Experience a little unexpected bad luck, and you find
yourself instantly drowning. The cumulative effect of the "surround"
is more than the sum of any of these individual forces. There is
simply no space to breathe.
When I first arrived in Washington, I was already familiar with many
of the structural causes of poverty. But like so many of us, I was
convinced that if the individual could be strengthened enough, he or
she could make it out of the ghetto, and if enough people could be
strengthened, the ghetto itself would collapse. I have spent the
better part of a professional career trying to strengthen individual
poor people. While that may have been a positive endeavor, I no
longer believe that individual efforts to improve individual poor
people will substantially reduce poverty.
The argument that inner-city poverty comes primarily from the
personal weaknesses of poor people simply cannot be sustained. Among
African-American children under the age of six, half live in
poverty. Among African-American males between the ages of eighteen
and thirty-four in the city of Washington, half are in the criminal
justice system. There are only two possible explanations for these
and many similar statistics. Either African Americans are
genetically predisposed to poverty, or specific forces in their
environment have kept large numbers poor!
For centuries, whites have consciously or unconsciously found the
explanation in theories of racial inferiority.
In this book, I will argue what has long been evident to African
Americans and should long since have been obvious to everyone else:
something awful has been done to the black poor in this country.
Allowing for that monumental injustice, however, how does one
explain the individual behavioral deficiencies that seem so
prevalent among poor African Americans (and other groups of
Americans in poverty)? How can one account for the extraordinarily
high rates of single parenthood, widespread substance abuse,
problematic parenting, and criminal behavior within the black
ghettos? If the reason is not some genetic inferiority, what does
cause these problems in the first place? And why do they persist?
Even after a decade of practicing medicine in the inner city, I
found I couldn't answer those questions in ways that satisfied me.
This proved so frustrating that, in a foolhardy moment, I
volunteered to teach a course on the causes of urban poverty. It was
undoubtedly my way of putting myself on a collision course with what
I felt I still needed to learn. In search of answers, I plunged into
an extensive, often impressive, and remarkably consistent library of
books and articles of all sorts on the nature, causes, and
consequences of urban poverty. I was often shocked at how little I
The result is this book, for which I make no claim to originality.
Quite the opposite. What I've tried to do is take the work of many
scholars and journalists-- often long, sometimes inspiring, but also
sometimes dry or written for academic peers-- and condense the essence
into a single, short work that might explain urban poverty to
anyone: exactly the book that in all those rushed years of doctoring
I might have longed for and used.
Complex as urban poverty and the behaviors that surround it might
seem, there is, in fact, a certain basic simplicity to the problem
and to the sorts of solutions that are (this perhaps surprised me
more than anything) not hopelessly utopian and suitable only for an
unimaginable, distant future. These solutions are, instead,
remarkably close at hand, practical, and capable of being instituted
were we only of a political mind to do so.
After a decade of unprecedented economic prosperity in the richest
country the world has ever known, the poverty rate at the time of
the 2000 Census was at its lowest in a generation. Nevertheless,
11.3 percent of all Americans, more than one out of every nine
people, lived below an official poverty level that severely
underestimates what most of us would consider poverty. Even more
distressing, almost one out of six American children under eighteen
(16.2 percent) and almost one out of three of African-American
children under eighteen (30.9 percent) lived in poverty. Why?