Innovation Ecosystem

We have a big data problem: poverty

Racial disparities of concentrated poverty in Rhode Island tear a gaping hole in the best-laid plans for health care reform, public education reform and projections of future economic prosperity

Image courtesy of Rhode Island Kids Count

A data snapshot of poverty using 2013-2017 U.S. Census numbers revealed that Rhode Island has a "big data" problem with concentrated poverty.

By Richard Asinof
Posted 9/30/19
The latest revelations about the high level of concentrated poverty in Rhode Island, and with it, the growing racial gaps, should shock and surprise no one. The question: is a new data benchmark needed to create the political will to address the problems?
If 80 percent of health outcomes are determined by what happens outside of a clinical setting, does that same ratio hold true for educational outcomes, with the majority of outcomes determined by what happens outside of school? What are the dangers are turning education into a commodity, similar to what has happened with health care? What is the value proposition of health care in Rhode Island and how is it supported by data research? When will the demographics of an aging population in Rhode Island be calculated as a function of future economic prosperity?
The continuing living, learning experience of being a patient recovering from major surgery keeps providing new insights about what is missing in the analysis of health outcomes as a function of data. A visit by a physical therapist to evaluate my home conditions, paid for by health insurance, revealed that a list of services that might be provided through Medicare was not available; I would have to call Medicare directly to find out about those services.
A visit to my primary care provider following successful surgery did not result in any acknowledgement or even a proverbial pat on the back for all the remarkable health outcomes: a drop in my weight, an improvement in my blood pressure, and the elimination of most of my chronic pain symptoms before surgery. What was missing was an acknowledgement that the patient's advocacy for the surgery had been correct, supported by the outcomes.
A follow-up call from the skilled nursing center where I had done my rehab asking questions about my stay led to a bit of an impasse. I said that I would be preparing a letter to go over my observations and my recommendations, rather than trying to answer such questions over the phone.

PROVIDENCE – No one, really, should have been surprised or shocked by the two separate snapshots of U.S. Census data provided about concentrated poverty for families and children living in Rhode Island, which was shared and analyzed last week by Rhode Island Kids Count.

The first, released on Tuesday, Sept. 24, as part of a national analysis of Census data for the five-year period from 2013-2017 by the Annie E. Casey Foundation, identified some disturbing trends:

Rhode Island has large racial disparities when it comes to communities of concentrated poverty: 13 percent of all children in Rhode Island, 28,000 children in total, are growing up in neighborhoods of where more than 30 percent of the population is living in poverty.

When it comes to racial disparities around concentrated poverty, Rhode Island has deeper disparities than the national as a whole, including 34 percent of Black children, 32 percent of Hispanic children, 10 percent of Asian children, and 3 percent of White Children living in concentrated poverty during 2013-2017.

The consequences of such concentrated poverty play out across the spectrum of Rhode Island’s economic, health, and education futures.

Children in high-poverty neighborhoods tend to lack access to healthy food and quality medical care and they often face greater exposure to environmental hazards, such as poor air quality, and toxins such as lead, according to the Annie E. Casey Foundation. Financial hardships and fear of violence can cause chronic stress linked to diabetes, heart disease and stroke. And when these children grow up, they are more likely to have lower incomes than children who have relocated away from communities of concentrated poverty.

Translated, all the best laid plans to transform the Providence Schools and the state’s health care delivery system face what might be called a “big data” problem. More, better teachers and administrators and consolidated health care delivery systems cannot succeed with a fundamental overhaul of the economic assumptions within Rhode Island around prosperity and wealth.

The latest snapshot
The snapshot of the U.S. Census Bureau’s 2018 American Community Survey, released on Thursday, Sept. 26, looking at poverty, income and health insurance coverage, reinforced some of the findings in the 2013-2017 data: some 18 percent of Rhode Island’s children, an estimated 36,135 children, were found to be living in poverty, an increase from 2017, when some 16.6 percent of the state’s children lived in poverty.

When infamous bank robber Willie Sutton was once asked why he robbed banks, his answer was: Because that is where the money is. You may want to ask: Why is there a continued, persistent, concentrated poverty in some communities in Rhode Island? Because, in many ways, Rhode Island is still very much a place where opportunity exists to provide a better life for one’s family.

The other side of the answer to that question is a bit more difficult to acknowledge: the continued lack of investment by the R.I. General Assembly and the business community in more healthy, safe, accessible affordable housing; the low wages for entry level jobs in many industries; and the design of many programs to encourage new job growth from a top-down rather than a bottom-up perspective.

The solutions are not difficult to envision or to implement:

If you want to improve third-grade reading levels for all Rhode Island students, get rid of the lead in substandard housing to prevent childhood lead poisoning and its lifelong detriments.

If you want to decrease chronic absenteeism by students and teachers in schools caused by asthma, the leading cause of such absenteeism, mitigate and correct the air pollution triggering such chronic asthma attacks.

If you want to decrease health care costs by limiting the spread of chronic diseases such as diabetes, invest in efforts to expand primary care services in those neighborhoods of concentrated poverty, such as the efforts being led by Clinica Esperanza.

Rhode Island is a national leader in implementing its Health Equity Zone initiative, developing community-based solutions based upon community needs, a model that is being replicated across the country, based upon the proven research that 80 percent of health outcomes are determined by what happens outside of a clinical setting.

The question is: Is it racism that the success of health equity zones in Rhode Island are never discussed as a regular part of the political conversations in weekly columns, radio and TV shows? [On the sage advice of my copy editor, I am not naming names here, but you know who you are.]

Asking the right questions
In Gravity’s Rainbow, novelist Thomas Pynchon offers the proverb: If they can get you to keep asking the wrong questions, they don’t have to worry about the answers.

In discussing the latest data-based evidence about the high levels of concentrated poverty in Rhode Island, ConvergenceRI wondered whether to change the outcomes, it required a different kind of dataset, one where the externalities which are linked to the concentrated levels of persistent poverty are made visible, as a kind of longitudinal “Quality of Life” index for Rhode Island.

As one expert in data synthesis from the Brown University School of Public Health responded: “I guess it could be useful if it was a more compelling guide for policy than what we have now, but, honestly, we have plenty of data that illustrates our problems. What we lack is the will to act upon it.”

The bottom line, beyond the missing “will” to act upon the data findings, is that there is a strong undercurrent of interest in defining the “value” of a sense of health and well-being in Rhode Island. Blue Cross and Blue Shield of Rhode Island, in partnership with the Brown University School of Public Health, is creating an index focused on Rhode Island’s perceptions about health and well-being in the state. The first edition of the index will be shared publicly in late October.

And, ConvergenceRI put the questions about changing the dataset around poverty in Rhode Island to the experts at Rhode Island Kids Count. Here are the responses, as prepared by Stephanie Geller and Paige Clausius-Parks, coordinated by Katy Chu.

ConvergenceRI: Is there a need to develop different benchmarks around what is meant by poverty?
RI Kids Count:
The official poverty threshold was set by the federal government in 1963 and was based on the cost of a minimum diet for a family of four. The cost of food was multiplied by three, since at that time about one-third of after-tax expenditures of families were spent on food.

The poverty threshold is adjusted annually according to the increase in the Consumer Price Index. The method of calculating the poverty threshold has not been adjusted to address the changes in family expenditures since its development in the 1960s, particularly the rising costs of housing, transportation, childcare, and medical care. It also does not consider geographic variations in the cost of living.

To address these limitations, on 2011, the U.S. Census Bureau began releasing a Supplemental Poverty Measure [SPM]. Tax payments and work expenses are included in family resource estimates and expenditures on basic necessities [food, shelter, clothing and utilities] and are adjusted for geographic differences. The SPM does not replace the official poverty measure but serves as an additional indicator of economic well-being and provides a deeper understanding of economic conditions and the impact of policy decisions and shows the effects of taxes and in-kind transfers on the poor.

ConvergenceRI: How does health equity become part of the metrics when measuring the economic impacts of health disparities, rather than gauging income?
RI Kids Count:
Children who experience poverty in early childhood and for extended periods of time are more likely to have physical and behavioral health problems, experience difficulty in school, become teen parents, and earn less or be unemployed as adults.

Also, children who live in areas of concentrated poverty [census tracts with overall poverty rates of 30 percent or more], often lack access to healthy food and quality public schools and medical care and are at higher risk for exposure to environmental hazards, such as poor air quality and lead. These children also may experience chronic or toxic stress associated with financial hardship and fear of violence that has been linked to increased risk of diabetes, heart disease, and stroke later in life.

We also know that in Rhode Island and nationally, children of color are more likely to grow up poor than White children, [and that they] are more likely to live in areas of concentrated poverty.

We see large and persistent disparities in children’s health outcomes by race and ethnicity. Women of color are more likely than White women to receive delayed or no prenatal care and to have infants with low birth weight. Native American, Black, and Hispanic women are more likely to have preterm births than White and Asian women. Black children are more likely to die in infancy than White, Hispanic, or Asian children. Black and Hispanic children in Rhode Island are more likely to go to the Emergency Department for asthma than White children.

All of Rhode Island’s children deserve to live in communities where they can learn, play, and grow, but far too many of our children, particularly children of color, live in areas of concentrated poverty and do not have these opportunities. About one-third of Latino children [32 percent] and Black children [34 percent] in Rhode Island live in concentrated poverty.

Children thrive when they grow up in neighborhoods with high-quality schools, abundant job opportunities, reliable transportation, and safe places for recreation. We must expand options for low-income families to move to areas that already have the resources needed for them to thrive. We can do this by expanding access to affordable housing and by ending housing discrimination.

ConvergenceRI: Is there a need to include the consequences of environmental and toxic harm as an economic condition of impoverishment, i.e, the relationship to harmful air pollution as a major factor as a causal agent for asthma? And, the prevalence of lead in older housing, which is often substandard rental properties in Rhode Island’s urban areas, where there is ample research and statistical evidence showing the long-term impact of childhood lead poisoning and a lack of educational achievement and economic attainment?
RI Kids Count:
Children who live in areas of concentrated poverty [census tracts with overall poverty rates of 30 percent or more], many of whom are children of color, often lack access to healthy food and quality public schools and medical care and are at higher risk for exposure to environmental hazards, such as poor air quality and lead. These children also may experience chronic or toxic stress associated with financial hardship and fear of violence that has been linked to increased risk of diabetes, heart disease, and stroke later in life.

ConvergenceRI: In measuring “poverty” and the “externalities” as a true economic measurement of poverty and wealth, how do you include data and measurements on the number of people who need to work multiple jobs in order to survive economically?
RI Kids Count:
While Rhode Island’s unemployment rate has declined, many workers remain unable to find full-time employment and struggle to make ends meet with inadequate and unpredictable income. Conditions at low-wage jobs, such as fluctuating work hours, lack of paid time off, and strict attendance policies can harm children’s development by making it difficult for parents to find and keep affordable, high-quality childcare and education for their children.

ConvergenceRI: Also, how to quantify the deficits in access to being able to buy healthy, local nutritious vegetables and fruits?
RI Kids Count:
Nutrition and physical activity are important components of supporting a healthy weight. Many children and adolescents consume diets with too many calories and not enough nutrients. In 2017, 88 percent of Rhode Island high school students reported eating less than three servings of vegetables a day, the recommended amount.

That same year, 54 percent of Rhode Island middle school students and 59 percent of high school students reported less than five days of physical activity in a week. Policy strategies to reduce obesity include improving access to nutritious and affordable foods and beverages and increasing options for physical activity before, during, and after school as well as in early learning programs.

We need to look at policy strategies for improving access to safe and walkable neighborhoods and recreational areas and to healthy food. WIC, school meals, and the Supplemental Nutrition Assistance Program [SNAP] help families obtain better access to healthy food, but we must also develop strategies for encouraging more grocery stores, farmer’s markets, and other stores that offer healthy foods to open and stay in low-income neighborhoods.

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