Tapu Misa: Too many heads in the sand on poverty and inequality

The increase in infectious diseases is associated with poverty and the rise in inequality. Photo / Thinkstock

All this talk about poverty and inequality seems to be putting some people on the defensive. Which is a pity, given how important the issue is.

Last week the arrival of yet another report undermining our reputation as a modern, civilised nation prompted a fresh wave of poverty denial.

The study by Otago University researchers, published in the latest Lancet, found that hospital admissions for infectious diseases had increased by more than 51 per cent between 1989 and 2008. That's an extra 17,000 hospital admissions a year. In other developed countries, it is non-communicable diseases that are on the rise, while infectious diseases considered "third world" are waning.

As Maori, Pacific, and people living in the most deprived neighbourhoods are disproportionately represented in the figures, the researchers, and other health experts, suggested that the alarming increase is associated with poverty and the rise in inequality.

It wasn't a wild leap. Being poor is a well-established health risk. And, as Richard Wilkinson and Kate Pickett argue in their landmark book The Spirit Level, the more unequal a society, the sicker and more dysfunctional.

The results are sobering, but more information is needed to give a more accurate picture of what's going on.

Still, some people were a little too quick to dismiss the poverty link.

For example, a Herald reader from Stanmore Bay objected to the implication that "the only real solution was a redistribution of wealth", and suggested that lack of hygiene might be the culprit.

"If poverty were the cause," he wrote, "you would think obesity would not also be endemic in this community.

"Perhaps it could be reasoned that these diseases are not so common in working households because basic hygiene is also practised there."

Well, yes, it's entirely possible that thousands of people, who just happened to be Maori and Pacific, and/or living in poor neighbourhoods, suddenly started neglecting basic hygiene about the time benefit cuts were being made. Or, perhaps (apropos the PM's comments last year about foodbanks and lifestyle choices) they all fell victim to an epidemic of bad choices, which too many people seem to think is the cause of poverty.

But who said they weren't in "working households"? Despite disproportionately high rates of unemployment, made much worse by the recession, the typical Maori and Pacific household is, in fact, "working".

The idea that there's no poverty because poor people have high levels of obesity or cars or televisions ignores the complex nature of poverty and hardship in rich nations like ours.

According to the Business Roundtable, for example, "real" poverty seems to be the kind that happens overseas, and which is "often understood to describe those who are living on less than US$2 [$2.40] a day".

Poverty is an emotive term, says the Roundtable, and using "the language of deprivation and poverty when referring to the issue of obesity or income distribution in South Auckland might strike many as being more than a little insensitive to the plight of the billions in the world who face real poverty without obesity".

"To blame their plight on those who are working hard and productively, or to present the position of New Zealand's poorest as being in the same category as those facing desperate poverty elsewhere in the world, is to fail to focus on how best to help them."

The Roundtable prefers to refer to people at the "bottom of the income distribution" or "people who are less wealthy than others".

But "less wealthy" doesn't quite capture life for a recently widowed relative of mine who had to tell her 11-year-old son that she couldn't afford to send him on his school camp. She is still paying off the loan for his intermediate school uniform that cost more than $400, not to mention school fees and stationery. Food comes after the bills are paid; friends and family make up the shortfall.

Perhaps that's why health researchers focus on inequality, and relative, as opposed to absolute, measures of poverty.

Poverty has long been a hotly contested concept, and there's been considerable debate internationally about how best to measure it.

It's taken the US Census Bureau some 16 years to come up with an alternative measure to the official poverty line developed in the 1960s, which was based on three times the cost of an emergency diet. At the time it was set, the measure - just over US$22,000 ($26,000 now - was about 50 per cent of the median income for a family of four; it's now around 28 per cent. In the 1960s, food was one-third the average family's budget; now it's one-seventh, as more is spent on housing, transportation and childcare.

Times have changed. The new supplemental measure, introduced last year, seems to show that Government policies are keeping millions out of poverty.

That gives some hope, says the Centre for American Progress, which is spearheading a campaign to halve poverty in the US within 10 years.

"A dangerous myth that drives the national narrative is that 'the poor will always be among us' and that there is little the Government can do to systematically reduce poverty," it says.

The causes of poverty are multidimensional and complex. There's no doubt we need a more nuanced understanding. What constitutes a decent standard of living? What's the minimum required to live with dignity in our society?

But whether we choose to call it poverty or something else, the ill-effects being measured by health researchers are real enough.