A couple weeks ago, I had the opportunity to attend TedxUofM’s annual conference in the Power Center, and I was struck especially by Dr. Abdul El-Sayed’s talk. University alum El-Sayed, the health officer and executive director of the Detroit Health Department, told the crowded audience to “think upstream” when considering issues of poverty and public health.

It’s true that poverty and poor health go hand-in-hand, but the story is bigger than that. It is not a simple cause-and-effect relationship between poverty and poor health; rather, there are several underlying factors that cause and sustain poverty, and poverty itself has several effects that cause poor health.

Removed as many of us are from poverty, most University of Michigan students are at least aware of it as a problem. However, the problems of food scarcity and lack of health education in America seem even further removed from our privilege. It can be difficult to believe that there are people in the United States — a developed country — who do not have access to a basic human need: healthy sustenance.

However, these problems are closer than we think. A USDA “food desert” is defined as “a low-income census tract where either a substantial number or share of residents has low access to a supermarket or large grocery store,” and a map of food deserts in America shows a startlingly large amount across the country. Though they are more prevalent in the rural South, there is a food desert not less than an hour away in our very own Detroit.

There are several factors that culminated into Detroit being a food desert. Built by carmakers, Detroit is a large city with highways in and out of the city, but not a lot of public transportation for those living within the city. So, while many Detroiters may realize that they should be eating healthier, the grocery store is so far away and only about 40 percent of people in Detroit have regular access to a car. Systematic racism in the last century has concentrated people of low income and minorities in certain areas in Detroit where the crime rate is especially high. So, while many Detroiters may want to take a walk around the block for exercise, the neighborhood isn’t exactly the safest to stroll around at night.

For people in poverty in food deserts, being healthy is not a choice like it is for many of us. For example, if I have poor health, it’s because I didn’t visit the salad bar in the dining hall, or I was too lazy to cross the street to get to the NCRB. However, for those who are not as fortunate, poor health is a condition they’re forced into by their environment and circumstances.

It is easy to judge people of low income as lazy, not hardworking and unhealthy, to tell them to pull themselves up by their bootstraps and dig their way out of poverty. However, that is easier said than done, because the poverty they are in right now will keep them in poverty. The unhealthy diet maintained by a low income leads to poor health that could eventually lead to serious health problems and a stay in the hospital. Even with the Affordable Care Act, health care carries a hefty price tag that is a heavy burden for people who already struggle financially. Unable to work and having their savings zapped by hospital bills, people in poverty cannot “pull themselves up by the bootstraps,” because they are caught in the vicious negative feedback loop of poverty and poor health.

However, the cycle can be stopped. The theme of this year’s TedxUofM conference was “Dreamers and Disruptors,” which certainly encapsulates El-Sayed: He works to disrupt the current cycle of poor health and poverty and he dreams of a healthier Detroit. Public health policy has failed poor people in Detroit, but El-Sayed’s work with the Detroit Health System is all about stopping the vicious cycle that has forced people into poverty, so they have a chance to be healthy. A few projects in Detroit have sprung up as a result of his work, including Sister Friends, which mentors pregnant teens through pregnancy and childcare, and a partnership with Vision to Learn, which offers free eye exams and glasses to students in Detroit. These programs strive to break the cycle of poverty and poor health that wracks people of low income in Detroit.

In the meantime, it is important to learn about the importance of public health and erase stigmas of poverty. It is so easy to judge people stuck in poverty without realizing the extent of their situation — a situation that leads to poor health and minimizes the chances of upward social mobility. Instead of shaming those with low income, we must strive to understand the whole extent of their situation and be cognizant of the uncontrollable circumstances that have trapped them where they are. We must empathize and withhold judgment, because there are extenuating circumstances that we do not understand.

With the fate of the Affordable Care Act in the air, it is more important than ever to realize that while the law did have its flaws, accessible health care is a lifeline for people with low income, who are trapped in this awful feedback cycle of poverty and poor health. It is high time that we address a serious problem plaguing so much of this country, especially since it affects a city so close to home. Of all the wonderful talks at TEDxUofM this year, El-Sayed’s moved me the most, because I never realized the extent of what “privilege” meant. I knew that privilege opened doors to education, jobs and social mobility, but I didn’t know that privilege also offered choices for something as rudimentary as health. His talk inspired me to look deeper into the effects of health policy, because everyone deserves the chance to choose to be healthy.

Ashley Zhang can be reached at ashleyzh@umich.edu.

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