Today, I attended the first part of a three part series of presentations focused on the nature of poverty in Richmond, Virginia. Today's presentation was focused on a review of the data; the next will discuss the history that led to this situation, and the final presentation will discuss suggested interventions that might address this issue. The nature of poverty in the city is especially notable because concentrated poverty compounds desperation and leads to hopelessness and alienation. The presentations are based on the work of Dr. John Moeser, of the University of Richmond's Bonner Center for Civic Engagement.
The data is focused on the Richmond Planning District. In 2010, the poverty level for a family of 4 was a yearly income under $22,314. In Richmond City, the rate of those living in poverty increased from 22.1% to 25.8% 2009-2010. Poverty rates rose 18.2%-25.8% 2000-2010. Poverty in the city is at an historical high since 1970. Just as important is the fact that the proportion of those living in poverty in surrounding counties increased from 2000 to 2010 by 94% in Henrico and 71% in Chesterfield. 46% of those in poverty in the Richmond area live in the city; 54% of the region's poor now live in the suburbs. This shift in poverty in the Richmond area reflects a national trend of increasing poverty in suburbs.
There is also a significant level of wealth inequity in the region. In Richmond City, the wealthiest census tract has an average income 17x greater than the poorest. Wealthiest census tract in central VA has an average income 21x the poorest. Despite this great difference between the riches and poorest residents in the city, there is very little physical distance: there are only 3 1/2 miles separating the wealthiest census tract in the city (Windsor Farms) and the poorest (Gilpin Court).
Further details regarding who is poor in Richmond is also striking. Currently, 38% of children in Richmond City live in poverty; this is double the rate from 1990. If one looks at poverty by race, it is notable that 48% of the poor are black. However, the % of all whites and Hispanic community living in poverty have increased. In particular, the % Hispanic community living in poverty increased from 8%-23.5% from 1990-2009. [Editorial note: I think this might represent the fact that the Hispanic community has nearly doubled throughout the Richmond metro area in the last 10 years; many of these newly-arrived individuals and families earn annual incomes below the poverty level.]
Most poor whites live in the suburbs (69%) in suburbs; 61% of all black poor live in the city. Asian and Latino poverty is largely suburban. Overall, Hispanic and black poverty are typically higher density, whether in city or in suburbs; while white poverty less concentrated. More than 20% of the population living in poverty in Richmond City is concentrated in south and east Richmond. 5 census tracts in the city have more than 50% of their residents living in poverty; Gilpin Court has 69% of its residents living in below the poverty line. Concentrated poverty in the City of Richmond is largely found east of Chamberlayne Ave, and on both sides Jefferson Davis Highway south of the river. These areas of concentrated poverty align with the locations of public housing developments. There is no concentrated public housing in counties, but concentrated poverty in the city spills over from the city to the older inner ring of suburbs. There are some census tracts in the city where poverty rates declined, and older housing stock is renovated via gentrification. At the same time, there are some census tracts that have increased in the % of their residents living under the poverty line. Overall, "South Richmond is the city's new East End" with increasingly concentrated poverty. This shift appears to be largely related to increased Hispanic poverty.
For anyone who believes (as I do) that the social determinants of health matter, then this information is striking and relevant. Improving communities' and individuals' health will require more than disease-focused outreach and prevention programs. We will need to refocus on affecting and influencing public policy in such a way as to take health, education, income, etc. into account whenever policy decisions are made. This is less immediate, and perhaps less gratifying, then working one-on-one with patients...but it is equally (or, perhaps, even more) important work. Physicians need to involve ourselves in discussions about policy changes and we need to hold our elected leaders accountable for making decisions that will improve the health status of all people--both by improving healthcare, and by including healthcare considerations when discussion all policy issues.