chapter 5
POVERTY, HEALTH CARE, HOMELESSNESS, HOUSING, AND EMPLOYMENT

POVERTY

The U.S. Census Bureau first began tracking poverty data in America in 1959. The following year it counted 39.9 million Americans, or about 22.2% of the population, living below the poverty level. Changes in the definition of poverty levels over the years make pre-1980 comparisons difficult, but the percentage fell to 12.3% in the mid-1970s and fluctuated over the next two decades, hitting 14% in 1985. In 2001 the poverty rate stood at 11.7% and rose to 12.1% in 2002 and 12.5% in 2003. While the poverty rates for adults and senior citizens hovered around 10–11%, the poverty rate for children under age eighteen rose almost a full percentage point from 16.7% to 17.6% between 2002 and 2003. (See Table 5.1.)

Minorities in America have historically experienced higher rates of poverty. In 1959 the poverty rate for African-Americans was 55%, compared to 18% for whites. The African-American poverty rate tumbled in the 1960s and made another significant decline during the 1990s. In 2001, however, the poverty rate for African-Americans was 22.7% and 21.4% for Hispanics, while the rates for Asian and Pacific Islanders, white, and non-Hispanic white populations were at or below 10%. In 2002 and 2003 the African-American poverty rate stabilized at 24.4%. Similar poverty rates were recorded for Native Americans (23.2%) and Hispanics (22.5%). (See Table 5.1.)

Between 1980 and 2003 the Census Bureau's poverty threshold for a family of four increased 125%. The Census Bureau poverty threshold for 2003 was $18,660 for a family of four that included two children. (See Figure 5.1.)

Working Poor Families

Having a job did not necessarily shield a family from poverty. In 2001 about 6.8 million people were classified as working poor. They represented 4.9% of the workforce, an increase from 4.7% in 2000.

TABLE 5.1

Often lacking job skills and adequate child care and health care, the working poor faced problems such as low-wage jobs (43.8%), reduced hours of work (1.7%), and periods of unemployment (10.4%), according to 2004 data from the U.S. Department of Agriculture. (See Figure 5.2.) Only 2.6% of those who worked full-time year-round were below the poverty level, but 11.8% of those who either worked part-time, seasonally, or intermittently fell below the poverty mark.

Food Stamps

The Food Stamp Program was established in 1964 as part of the Lyndon Johnson administration's "War on Poverty." The program helps needy families and individuals pay for enough food to live on. The U.S. Department of Agriculture reported that in an average month in 2002, 8.2 million households received food stamp benefits. Fifty-four percent of these households included children,

FIGURE 5.1

and most were headed by a single female. Nineteen percent of households receiving food stamps were elderly people, most living alone. Twenty-seven percent of food stamp households were persons with disabilities, and more than half lived alone. The average monthly food stamp benefit in 2002 was $173.00. A household with children (average 3.3 people) received $254.00, compared to a two-person household with one or both persons disabled receiving $64.00 per month.

Increased Requests for Food Assistance in Cities

In The U.S. Conference of Mayors—Sodexho Hunger and Homelessness Survey 2003, an average of 39% of adults who requested food assistance were employed. Working parents in Charleston, South Carolina, had difficulty getting to the Food Stamp Office during business hours. San Antonio, Texas, reported a 30% child poverty rate and noted that many clients lost their food stamp eligibility due to welfare reform but were unable to provide adequate food for their families. In Portland, Oregon, 55% of households served with emergency food included children. The Greater Boston Food Bank reported a 50% increase in requests for milk, cereal, and nutritious snacks for children. Louisville, Kentucky, reported a 20% increase in distribution of baby formula.

Thirteen percent of requests for food assistance recorded in the survey came from the elderly. Many cities reported the elderly and disabled on fixed incomes struggled with the rising cost of prescription medications and

FIGURE 5.2

rising utility bills. The increase in senior citizen requests for assistance in Louisville, Kentucky, was proportional to the financial cuts in Medicare and Medicaid. Food resources were an issue for grandparents in Philadelphia, Pennsylvania, who were taking care of grandchildren while trying to remain healthy themselves. An estimated 14% of requests for emergency food went unmet. In addition to lack of agency resources, cities reported that some families were too proud to ask for help and some frail elderly people were unable to get to food pantries.

Low-Income, Female-Headed Families

In 1947 the median family income was $3,031. The median income for a similarly situated family in 2001 was $51,407. The value of a dollar, however, changed over the years with inflation. For a more equitable comparison, Table 5.2 shows actual dollars converted to "constant" dollars (adjusted for inflation). The $3,031 family income from 1947 would be worth $20,402 in 2001 dollars. In 1947 the median family income for a female householder with no husband present was 72% of that earned by the average family, but declined by 1950 to 58%. The decline in family income for female-headed families continued downward to a low of 48% of average family income in 1990. In a slight upturn, however, female-headed families had median 2001 income equal to 50% of the average family income.

Health Insurance Challenges

The availability of affordable health insurance became a serious national concern as costs of health care rose in the

TABLE 5.2

FIGURE 5.3

1990s. The percentage of the nation's population without coverage grew from 15.2% in 2002 to 15.6% in 2003. Among people who were employed in 2003, 60.4% had some type of employment-based health insurance, but this figure was a decrease from 60.3% in 2002. For people in poverty who could least afford medical expenses, obtaining adequate health coverage was a significant challenge. The percentage of people on government insurance plans rose from 25.7% in 2002 to 26.6% in 2003. (See Figure 5.3.)

"Since 2000, the cost of health insurance has risen 59%, while workers' wages have increased only 12%," said Jon Gabel of the Health Research and Educational Trust in September 2004. "Since 2001, employee contributions increased 57% for single coverage and 49% for family coverage, while workers' wages have increased only 12%. This is why fewer small employers are offering coverage, and why fewer workers are taking up coverage."

While the number of people with health insurance grew by one million from 2002 to 2003, the number of uninsured increased by 1.4 million. The largest increase among Americans without insurance was primarily among white, non-Hispanic residents.

OBESITY—A TWENTY-FIRST CENTURY EPIDEMIC

As a society we can no longer afford to make poor health choices such as being physically inactive and eating an unhealthy diet; these choices have led to a tremendous obesity epidemic.

Vice Admiral Richard H. Carmona, MD, MPH, FACS, U.S. Surgeon General

The Centers for Disease Control and Prevention (CDC) reported in 2004 that chronic diseases accounted for seven of every ten deaths in the United States and more than 75% of medical care expenses. The CDC noted that many of these chronic diseases were preventable. Physical inactivity and unhealthy eating were identified as contributing factors to obesity, cancer, cardiovascular disease, and diabetes. Together these two behaviors were responsible for at least four hundred thousand deaths each year. Only tobacco use caused more preventable deaths. Among other factors, the CDC cited the increase in food portions as a major factor in unhealthy eating choices. The standard size soft drink, for example, long established as eight ounces, grew to a twelve-ounce size. Many restaurants promoted even larger sixteen- and twenty-ounce sizes.

Weight gain among Americans was noted as early as 1976, according to CDC data. Its 2000 data revealed that nearly 59% of Americans, both adults and children, were obese. Figure 5.4 provides a visual image of the growth of the obesity epidemic by state from 1991 to 2002.

Responsibility for America's Overweight Problems

In a 2003 survey Wirthlin Worldwide asked Americans to rank on a one to ten scale (one equaled "no responsibility" and ten equaled "total responsibility") how much responsibility various individuals and organizations should have for helping them to be healthy. When asked "Who is responsible for my health?" personal responsibility ranked highest at 8.2 on a 1-to-10 scale. Respondents, however, also wanted schools, the media, food and beverage companies, the government, and fast food restaurants to share the responsibility. (See Figure 5.5.) These views were more prevalent among lower income and less educated persons, who, the survey report noted, were often the most frequent customers for convenience foods and fast food restaurants.

Seventy-nine percent of Americans surveyed by Wirthlin Worldwide in 2003 said obesity was an extremely or very serious problem. When asked to rate factors that contributed to health, women ranked weight highest (7.7 on a 1–10 scale), while men identified quality of diet as

FIGURE 5.4

most important (7.2). Use of nutritional supplements was least important to both men and women.

The problem of obesity affected all ages, races, sexes, and socioeconomic levels. The CDC budgeted $34 million in 2003 and $39 million in 2004 to fund state initiatives to address problems of physical activity, poor nutrition, and obesity.

HOMELESSNESS

Poor people are frequently unable to pay for housing, food, child care, health care, and education. Difficult choices must be made when limited resources cover only some of these necessities. Being poor means being an illness, an accident, or a paycheck away from living on the streets.

"Why Are People Homeless?," The National Coalition for the Homeless, September 2002

The incidence of homelessness began to increase in the 1980s, and by the beginning of the twenty-first century homeless people could be found on the streets of virtually every American city. The National Coalition for the Homeless identified two trends that were largely responsible for the rise in homelessness in the preceding twenty to twenty-five years: a growing shortage of affordable rental housing, and an increase in poverty. Between 1970 and 1982 demolition of many low-rent, single-room hotels in major cities contributed to the shortage of rental housing, according to Homelessness in America (Oryx Press, 1996), a publication of the National Coalition for the Homeless. New York City, for example, lost 87% of its $200 per month or less rooms that had housed low-income people, including many suffering from mental illness or substance abuse. Eroding employment opportunities and declining public assistance were identified as two factors contributing to the rise in poverty.

The U.S. Conference of Mayors (USCM) began studying the problems of hunger and homelessness in 1980. Their annual surveys of twenty-five major cities

FIGURE 5.5

produced sixteen years of comparative data published in annual reports. The U.S. Conference of Mayors—Sodexho Hunger and Homelessness Survey 2003 indicated that while the federal definition of affordable housing was housing that cost 30% of a family's income, the average low-income family in cities surveyed by the U.S. Conference of Mayors spent 46% of their income on housing. In 2001 the National Low Income Housing Coalition estimated that in the median state a minimum-wage worker had to work eighty-nine hours each week (more than the equivalent of two full-time jobs) to afford a two-bedroom apartment at 30% of his or her income.

In 60% of cities included in the U.S. Conference of Mayors' 2003 survey, families might have to break up in order to be sheltered—some shelters, for example, took only women and children, forcing fathers to go to another shelter for men. In 48% of cities families might have to spend their daytime hours outside the shelter. Although the waiting time for public housing averaged twenty-four months in surveyed cities, people in shelters remained homeless an average of five months.

Locating the Homeless Population

Counting homeless people presents special challenges for the Census Bureau. Typically, shelters have been the source of data on the number of people without homes.

FIGURE 5.6

However, except in the coldest of weather, some homeless people avoid shelters in favor of more independent living in parks, under bridges, and in other remote locations. The Census Bureau reported that between 1990 and 2000 the number of people living in emergency and transitional shelters decreased 4.4%, from 178,638 to 170,706. In 2000 the Northeast claimed the largest proportion of the nation's shelter population (30.7%), while the Midwest had the least (16.7%). Nearly one-fifth (18.7%) of the population in emergency and transitional shelters lived in New York State.

Hunger and Homelessness in Major Cities

The U.S. Conference of Mayors' 2003 survey indicated that in the twenty-five major cities surveyed, requests for emergency food increased an average of 17% from the preceding year. Requests for emergency shelter increased an average of 13% from the preceding year. An estimated 59% of requests for food came from families with children.

USCM data provided a picture of the changing profile of the homeless population. As the proportion of single men dropped from 51% in 1990 to 41% in 2003, families with children rose from 34% to 40%. During that period the incidence of homeless single women and unaccompanied youth each rose two percentage points. (See Figure 5.6.) The same survey estimated that in 2003 nearly half

FIGURE 5.7

of the homeless population was African-American, while 35% was white and 13% was Hispanic. (See Figure 5.7.)

Government Efforts to Address Homelessness

The first federal task force on homelessness was created in 1983 to provide information to local communities on how to obtain surplus federal property. The Homeless Eligibility Clarification Act of 1986 removed the requirement for a permanent address and other barriers to existing programs such as Supplemental Security Income, Aid to Families with Dependent Children, veterans' benefits, food stamps, and Medicaid. The Homeless Housing Act, passed that same year, also helped fund emergency shelters across the nation.

The 1987 Stewart B. McKinney Homeless Assistance Act required federal agencies to identify and make available surplus federal property, such as buildings and land, for use by states, local governments, and nonprofit agencies to assist homeless people. The Act and its subsequent amendments also provided community block grant programs for health care and mental health services to the homeless and amended the Food Stamp program to facilitate participation by homeless persons. The 1990 amendments specified in greater detail the obligations of states and local educational agencies in assuring the access of homeless children and youth to public education.

The Bringing America Home Act (H.R. 2897) was introduced in 2003 during the 108th Congress. The comprehensive bill designed to end homelessness proposed, among other features, a requirement that use of any federal dollars for demolition of existing housing would require a replacement resulting in no net loss of housing units.

Homeless Crime Victims

Battered women who lived in poverty often face the choice between remaining in abusive relationships or becoming homeless. In 2001 the National Coalition Against Domestic Violence estimated that half of all women and children experiencing homelessness were fleeing from domestic violence. In its 2003 survey of hunger and homelessness, the U.S. Conference of Mayors reported that domestic violence was cited as the main cause of homelessness by 58% of responding cities.

On the streets homeless people were vulnerable to becoming victims of crimes such as theft and assault. A National Coalition for the Homeless study reported that between 1999 and 2003 the number of homeless people who died from violent attacks decreased from forty-eight to nine. However, the number of incidents of violent attacks against homeless people tripled from twenty to sixty-one. Such statistics were only an indication of the problem, though, since many more crimes were thought to be unreported.

Employed but Unable to Feed the Family

Many of the mayors who participated in the survey on homelessness reported that the strong economy of the late 1990s had not benefited the homeless in their city. They cited increasing housing costs, for example, which made it more difficult for the poor to afford housing. In 1999 every participating city reported a lack of affordable housing. Low-skill jobs, generally the only type of work for which many homeless people could qualify, were difficult to find. Welfare reform had also sparked an increase in the number of requests for emergency food assistance.

In 2004 the U.S. Department of Agriculture estimated the minimum cost of feeding a one-year-old child at $75 per month. By the time a child reached age nine, and on through the teenage years, the minimum monthly cost of feeding that child ranged from $120 to $130. The monthly minimum food costs for a family of four—two adults and two children—ranged from $422 to $488 depending on the ages of the children.

Unemployment

Many cities surveyed reported shelters were filled due to significant community job losses, low wages in the area, and lack of affordable housing. The U.S. Department of Labor's Bureau of Labor Statistics documented the increase in the nationwide unemployment picture from 2000 to 2003. Some of the hardest hit areas were Alaska, Washington, Oregon, Michigan, the District of Columbia, South Carolina, and Louisiana.

As unemployment rose, American workers were concerned about the loss of jobs to overseas locations where labor costs were cheaper. A Department of Labor report titled Extended Mass Layoffs Associated with Domestic and Overseas Relocations for the First Quarter 2004 revealed 51% of mass layoffs were permanent closures of worksites affecting 10,019 workers. Just 2.5% of the 182,456 workers separated from nonseasonal jobs between January and March of 2004 were the result of relocating work overseas. One-third of layoffs related to movement of work occurred in the Midwest and another 31% were in the South.

HOUSING

Owning one's own home has long been a cornerstone of the American dream. In 1890 less than half of householders owned their homes. Home ownership dwindled slowly until 1920, when a robust economy spurred greater home buying. The Great Depression of the 1930s drove the rate of home ownership to the century's low of 43.6% in 1940. The post–World War II economic boom, favorable tax laws, easier financing, and a revived home-building industry started a home ownership explosion that exceeded 60% within two decades. By 2000 at least two out of three householders had attained the goal of home ownership. (See Figure 5.8.)

Despite the drive for home ownership, the Census Bureau reported that in 1940 45.3% of houses lacked completed plumbing facilities—indoor running water, sinks, bathtubs or showers, and toilets. By 2000 just 1.2% of housing units had incomplete plumbing. In 1960 many households lacked amenities considered essential in the twenty-first century. Twenty-two percent of homes did not have telephones in 1960 (and party lines far outnumbered private lines) compared to just 2.4% in 2000. In 1960 21.5% of households did not own or have access to a motor vehicle. In 2000 just 10.3% of households—primarily city dwellers who used public transportation—had no vehicle while, 17% of households had three or more.

According to the National Housing Institute, by 2004 the nation's poor faced the country's biggest job and housing crisis since the Great Depression. "Today, a worker making minimum wage cannot afford housing at fair market rent anywhere in the United States," said Donald Whitehead, executive director of the National Coalition for the Homeless (NCH) in late 2003.

Census 2000 recorded 115.9 million housing units—defined as a house, an apartment, a mobile home, a group

FIGURE 5.8

of rooms, or a single room intended as separate living quarters—in the United States. Multifamily housing was more prevalent in the Northeast. Sixteen percent of housing structures had two to four units and 21% had five or more units. While single family detached homes were predominant in the Midwest, South, and West, the West nearly matched the Northeast with 20% multifamily housing with five or more units. The Northeast and the Midwest were characterized by older homes built before 1940, while more new home construction was found in the South and West. (See Table 5.3.)

The Mobile Home Phenomenon

Classified as "trailers" in 1950, mobile homes became the fastest-growing type of housing in the later decades of the twentieth century, according to Census Bureau data. They were less expensive than other types of housing, could be located on small, inexpensive lots in parks designed for mobile homes, and they could be moved to a new location. From 315,000 in 1950, the mobile home inventory grew to almost 8.8 million by 2000. During peak growth periods of the 1970s and 1980s, 2.5 million new mobile homes were added each decade. (See Figure 5.9.) By 1990 more than half of all mobile homes were located in the South, and mobile homes accounted for 11.6% of all housing in the South. Figure 5.10 illustrates the states with the highest concentration of mobile homes as a percentage of all housing in the state. By 2000 Florida had the most mobile homes at 849,000.

Crowded Housing

The Census Bureau reported that between 1990 and 2000 crowded housing rose from 4.9% of all occupied

TABLE 5.3

FIGURE 5.9

units to 5.7%. Crowding, in Census terminology, is defined as more than one person per room. In California and Hawaii more than 15% of all housing units were deemed to be crowded in 2000. Crowded housing was most common in the Southwest, and in Alaska, Florida, and New York. (See Figure 5.11.)

In 2000 2.7 million households were classified "severely crowded," with more than 1.5 persons per room. Multifamily housing with five or more apartments or units was most likely to be "severely crowded." (See Figure 5.12.) Almost 36% of all severely crowded housing units were in California. The state had 1.7 million crowded and one million severely crowded households. People who rented were more likely to live in crowded or severely crowded conditions. While 3.1% of homeowners lived in crowded conditions, 11% of renters averaged more than one person per room. Just 1.2% of homeowners were severely crowded compared to 5.8% of renters.

Cost of Housing

The cost of housing, whether owned or rented, presents challenges to many families. Housing costs include utilities, fuel, water, garbage collection, and rent or mortgage payments plus real estate taxes and property insurance for those who own their homes. Table 5.4 and Table 5.5 compare median housing costs for renters and homeowners. Ranked from highest to lowest by state, New Jersey was the most expensive place for homeowners in 2003 at a median cost of $1,723 per month—43% over the national median monthly homeowner cost. The highest median monthly rental cost was $811 in Hawaii—25% over the national median monthly rental. For both home owners and renters West Virginia was the least expensive state in which to live.

EMPLOYMENT

In a 2001 address to the Council for Excellence in Government, Secretary of Labor Elaine Chao reported that the American workforce was strong. She noted, however, that workplaces had

transformed overnight from physical plants and offices to mobile packages of twenty-first century technology and work trends that tell us old notions of the workforce cannot meet the needs and expectations of a new generation of workers…. Years ago, unemployment meant no jobs. Today, in many cases, unemployment means a disconnect between the new jobs our economy is producing—and the current skill levels of Americans in the workforce. The "skills gap" is too wide for too many Americans.

Chao went on to discuss future anticipated labor shortages. As the post–World War II "baby boom" generation moved into retirement, the number of people in the labor force was projected to decline substantially.

Growth in the Labor Force

Over the last four decades of the twentieth century, the massive numbers of baby boomers and women entering

FIGURE 5.10

the workplace accounted for substantial growth in the American labor force. ("Labor force" includes persons who hold part- or full-time jobs and those who are unemployed but looking for work.) In 1999, 83.1% of the 71.3 million American families had at least one employed member; 93% of those families had at least one member who worked full-time (thirty-five hours or more). The Bureau of Labor Statistics reported that in October 2002 there were 143.1 million people in the civilian labor force, with 134.9 million employed and 8.2 million unemployed.

In a 2002 article for Monthly Labor Review Online, Abraham T. Mosisa reported that much of the rapidly changing ethnic and racial diversity of the workforce could be attributed to the increase in foreign-born workers. In 1960 one in seventeen workers was foreign born; in 2002 one in eight workers was born outside the United States. In 1960 three-fourths of foreign workers came from Europe, which dwindled to one out of every six foreign-born workers in 2002. Shifting immigration patterns brought more immigrants from Latin America and Asia. Foreign-born workers accounted for nearly half of the growth in the labor force between 1996 and 2000.

New Trend in Home Workers

Facilitated by advancing computer technology and Internet access, working from home emerged as a new trend in the 1990s. In 1960 the Census Bureau reported that 4.6 million people worked from home—half of them, however, operated family farms. The number of people working from home dropped more than 50% to a low of 2.1 million by 1980 as the number of family farmers dwindled. By 1990, however, 3.4 million people worked from home. Census Bureau demographer Phillip A. Salopek said in Increase in At-Home Workers Reverses Earlier Trend (March 1998) that "the decade of the 1980s marked a rebirth of work at home in the United States. It is noteworthy that this impressive growth occurred before the expansion of the Internet."

FIGURE 5.11

By 2001 19.8 million people reported they worked at home at least once a week. Of these, 3.8 million people, including many self-employed persons, used their homes as their base of operation. Another three million employees of businesses regularly worked from home an average of eighteen hours per week.

Of the home workers in 2001, 30% (5.9 million) were self-employed. Thirty-three percent of men and 27% of women who worked at home were self-employed. Close to half of the self-employed people operated their businesses from their homes.

Parents Working at Home

Another one million people who were employees of businesses reported that they performed their work at home or used the home as a base of operation. Five percent said they sometimes worked at home in order to attend to family needs, and 2% worked from home to reduce commuting time or expense. Ten million employees of businesses also said they worked from home on an unpaid basis; half took work home to finish or catch up on assignments. (See Table 5.6.)

Norman Nie of the Stanford Institute predicted in 1999 that "by 2005, at least 25% of the American workforce will be telecommuters or home office workers." Nie said "telecommuting may be the first social transformation in centuries that pulls working fathers and mothers back into the home rather than pushing them out." The challenges of recruiting and retaining baby boomers during the latter part of the twentieth century prompted employers to offer family-friendly work schedules, including flexible work hours and options to work from home all or part of the time. In 2001 24.8% of women and 19.1% of men who worked from home at least part of the time had children under the age of six. (See Table 5.7.)

Of those who worked at home in 2001, three-quarters used telephones and computers to conduct business. The Internet or e-mail were used for business purposes by 62.5% of home workers. Just 40% of home workers used fax machines. (See Table 5.8.)

FIGURE 5.12

TABLE 5.4

TABLE 5.5

TABLE 5.6

TABLE 5.7

TABLE 5.8