As part of my internship with the Virginia Home, I hold a program every Wednesday called Lifetime Learners. The premise of the program is to provide residents with a greater sense of agency due to increased knowledge about the world, and to remind them of their ability to actively engage in their community and learn more about issues that effect them and those they love. I aim to increase their political efficacy and ability to cast votes meaningfully by helping them understand complex political issues. Last week we talked about healthcare.
I presented the residents with the disparity of life spans across the city of Richmond, and asked them why they thought this could be. One of my friends, Bob*, replied, “I think that at the end of the day it boils down to race. Everywhere I’ve been I have seen race play a huge role in amount of income. Income leads to time… time to volunteer and travel to increase your utility and time to exercise. You can see the income & health outcome disparity within my own family… my great grandfather was incredibly wealthy, he had an indoor pool and long driveway, and he lived through his 90’s. That doesn’t happen without wealth, and my immediate family wasn’t as wealthy. It comes down to ability to afford healthy food, exercise, and wealth.” The accuracy and understanding with which he worded this response struck me. I again was humbled by the knowledge and understanding of society that my wheelchair bound friends had. Most of the residents I was talking to had grown up in Virginia, some Richmond, so I shouldn’t have been surprised that the issue of race immediately surfaced. Racial tensions are so entrenched into the society of Richmond that is impossible to remain unaware of them, even for a population group that is also marginalized.
We delved more deeply into the factors that lead to health outcomes being heavily determined by place and environment. My friend Zach* told us the story of his childhood and how where he lived set him on the path to permanent disability. The quality of care available to him, education, social connections, cultures of exercise (or a lack thereof), and even the weather of a particular place each played a big role in his story.
Zach began, “I think if I had better healthcare as a child I wouldn’t have developed diabetes. My family was always moving around because my dad was in the military. I was born in Japan and got very sick when I was two, and Japan didn’t have good healthcare because they were a poor country then. I lived in Costa Rica later in life and I was mauled by a dog and didn’t receive adequate medical care there either. I was hit twice in a row with bad luck.” Zach went on to explain how he believes that the lack of good care available to him in Japan and Costa Rica started him down a path of bad health.
He continued, “I lived in Hawaii, which was great, it was beautiful and sunny and I went swimming every day. Then I moved to Oregon, and life was good. I went to a great school, had great friends, and lived in a beautiful neighborhood. I remember running up Mount Ursula, I was still very strong and lifted heavy weights then and could run. Then I moved to Georgia, and lived in a shitty neighborhood and didn’t have any friends and went to a shitty school. That’s why I’m in this chair today. I gave up on walking, I stopped trying. I used to be suicidal, but found life through exercise. I drove over to that lake one day and tried to throw myself in and drown myself, but I am happy now. I started exercising and getting stronger.” The Virginia Home’s culture of positivity and emphasis on physical fitness and mental health saved Zach’s life. His environment had enormous implications for his physical and mental health.
I think that Zach’s story shows many parallels to the issues that residents of areas with concentrated poverty face. They face mental health issues onset by extreme stress and lack of social connection. The low quality of education available to them gives them no way out of the cycle of poverty they are caught up in. They suffer from shame at their inability to effect their circumstances, which leads to depression and more stress and disconnection from social constructs. Without a culture of fitness and the expectation of health, it is easy to stop trying or feel like every attempt at change results in a deeper entrenchment in the web of poverty. It seems like the stories of the marginalized all ring with a common theme. Income, quality of care, and environment effect them all.