Urban Poverty & Health Inequalities

By Joseph Mwita Kisito, February 2020

Joseph Mwita Kisito reviews Urban Poverty and Health Inequalities: A related Approach (by Darrin Hodgetts and Ottilie Stolte) in this third review of the books from the Critical Approaches to Health  series. The series is co-edited by Kerry Chamberlain and Antonia Lyons, and published by Routledge, in association with the International Society for Critical Health Psychology. (ISCHP members receive a discount on the purchase price of books in the series.)

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Hodgetts and Stolte provide a detailed and critical account of structural and psychological causes of poverty and their impact on people’s social welfare. Poverty is portrayed as a precursor to health inequalities which encompass the physical, social and psychological realms of human existence in minority global settings. The book is an empirical literary piece, drawing insights from across various literatures in order to help us understand and appreciate current debates on the social determinants of health, especially as viewed in the context of urban neighbourhoods.

The book is divided into six chapters, with each chapter mirroring varied interrelated aspects of the concept of poverty: its mediating factors, people’s experiences of this phenomenon, homelessness as the pinnacle of poverty, and the responses, resistance and reforms needed to counter or conquer this problem. From the outset, the authors introduce us to the meaning of urban poverty and associated inequalities and how these impact the urban residents’ lives.

What follows is an examination of the consequences of historical greed on human survival. Here, Hodgetts and Stolte argue that historically the rich have entrenched urban poverty through their practical narcissistic tendencies and skewed policy orientations. Perhaps to bring this point closer home, the duo postulates that “we are living in a period where underclass and perversity rhetoric reigns” (pg. 21). Globally, the majority of the people are experiencing a decline in living conditions and associated soaring health inequalities. This argument is aptly put forth in this read, with the authors further arguing that people’s unliveable wages, poor housing, and food insecurity are pushing them into the abyss of doomed lives – something akin to the debased labourers and slaves of yore. Although this analogy may sound far-fetched, nonetheless it is safe to argue, just like Hodgetts and Stolte, that urban poverty and health inequalities is a reality in many parts of the world today.

Stereotyping and vilification of people living in poverty is common in modern society. And, Hodgetts and Stolte did not disappoint in highlighting this point, by arguing that corporate and individual public and policy leaders are not doing enough to address the plight of the poor in urban areas. They further advocate for the need for the social welfare providers to assess urban communities’ lived experiences as the best way to understand their unique interventional strategies. Regardless, the authors heap much of the blame on the haves—or the Marxist bourgeoisie—as the principal perpetrators of social and health imbalance among the poor, hence relegating them to perpetual poverty and health inequalities. In this sense, Hodgetts and Stolte posit that there is a need to address dysfunctional intergroup relations in order to engender the spirit of social justice for the less endowed groups in society.

‘there is still more to be done … including structural reforms and advocating for anti-oppressive approaches to poverty’

Globally, it is evident that everyone is struggling to overcome their socio-economic and health challenges. However, it is disheartening that in many instances the struggle is limited by both circumstantial and designed factors. Hodgetts and Stolte intimate that dominant groups in the name of corporate entities and the mainstream media may be deliberately or inadvertently misrepresenting poverty and health inequalities. As major social justice players, their inadequacies in setting the tempo on poverty eradication and health equalities end up stifling the ‘equality’ and ‘equity’ debates. Yet, what is critical in fighting urban poverty and inequality is an informed public – and here lies the role of the media, to stop “reimagining people living in urban poverty from a neoliberal perspective” (pg.70).

Having a place to call home is not only socially fulfilling but it is a basic human right. To Hodgetts and Stolte, being homeless is the peak of health inequality. They further allude that being homeless predisposes one to all sorts of vagaries of nature. However, it remains unclear why the duo gave special emphasis on ‘shelter’ at the expense of other basic needs as predictors of health equality or social justice.

As a solution to poverty and health inequalities, Hodgetts and Stolte argue that the onus lies with health scholars to advocate for more socially equitable and healthy societies. Further, the authors conclude that there is still more to be done especially on the health systems, including structural reforms and advocating for anti-oppressive approaches to poverty eradication and social justice for everyone.

In the end, the authors have lucidly addressed urban poverty and health inequalities as inhibitors to social justice. They have helped to move the debate from only focusing on ailments, modern medicine, treatment and health-seeking behaviours as ways of addressing healthcare issues to a more broad-based approach where the relationship between the poor and the rich, in terms of policy and practice, also significantly counts.

About the author

Joseph Mwita Kisito holds a Master of Science degree in Gerontology from the University of Southampton and a Masters in Medical Sociology from the University of Nairobi. He is an adjunct Lecturer at The East African University (TEAU) and Moi University (Kenya), where he teaches courses in Research Methodology and Contemporary Gender Issues at undergraduate level. With more than 12 years research experience in NGO settings, Joseph also works as a Research Consultant for Swift Research Consulting (Kenya).

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