I've Been Thinking

In 1968 a conference of Latin American Roman Catholic Bishops convened at Medellin, Colombia. The conference’s express goal was to interpret the Second Vatican Council (Vatican II) for the Latin American context. The conference is notable for the emergence of the statement “the preferential option for the poor” as a theological context for Latin American. Foundational to this statement was the observation/statement that poverty is death.

…poverty—certainly in El Salvador—means literally to be near to death. In other countries, in other societies poverty means that you do not belong yet to the middle class, that you cannot allow yourself some luxuries. In other countries poverty has to do with wealth which has not been reached. In El Salvador, poverty has to do with death. Poverty means leading a type of life which is daily threatened by death. The poor ones are those who are destined to die before their time. (Jon Sobrino)

The poor ones are those who are destined to die before their time.

That poverty is death is not just a theological statement, but an evident fact, in these United States. That is, there is evidence for this claim. In a research article published in the Journal of the American Medical Association, Novel Estimates of Mortality Associated with Poverty in the U.S., the authors estimate that 183,000 annual deaths result from current poverty among people 15 years and older, and annual deaths from cumulative poverty, poverty lasting ten years or longer, are estimated at 295,431.¹

Only heart disease, cancer and smoking are associated with a greater number of annual deaths than poverty. For those in a state of cumulative poverty, poverty was the fourth leading cause of death in the U.S., resulting in more annual deaths than diabetes, drug overdoses, suicides, firearms and homicides.²

The authors conclude, sadly, “…one limitation of this study is that our estimates may be conservative about the number of deaths associated with poverty.”³ In fact, the number of annual deaths resulting from poverty may be greater than those indicated above. Imagine that.

In a guest essay in the New York Times, Dr. Lindsay Ryan describes the death of a man who lived on the streets.⁴ The man was suffering from a life-threatening bone infection that was not responding to antibiotics. Amputation was his only chance for survival. He rejects this option; because, as he explains to the hospital staff:

With a disability, he’ll be a target—robbed, assaulted. He’d rather die, unless, he says later, someone can find him a permanent apartment. In that case, he’ll proceed with the amputation⁵.

The hospital staff concluded the man was rational and not suicidal. The staff was unable to find him so much as a room. Such situations had already been taken. “Eventually, the palliative care doctors see him. He transitions to hospice and dies.”⁶ The choices the man made are those that poverty imposes on its victims.

And let’s be clear, almost all of those in poverty are victims. They are not poor by choice; neither are they poor because of some moral deficiency. Although such a belief makes it easier for many to live with their own callous indifference to suffering.

“A death certificate would say [the patient] died of sepsis from a bone infection,” Dr. Ryan writes “but my friend and I have a term for the illness that killed him: end stage poverty.”⁷

End stage poverty.

Dr. Ryan works at “a public hospital in the medical safety net, a loose term for institutions that disproportionately serve the patients on Medicaid or without insurance.” ⁸He describes the difficulties of the patients he serves:

People struggle to keep wounds clean. Their medications get stolen. They sicken from poor diet, under-vaccination, and repeated psychological trauma. Forced to focus on short-term survival and often lacking cellphones, they miss appointments for everything from Pap smears to chemotherapy. They fall ill in myriad ways—and fall through the cracks in just as many.⁹

And so, poverty kills.

Poverty is death.

1. David Brady. “Novel Estimates of Mortality Associated with Poverty in the US”. Journal of the American Medical Association Volume 183 no. 6 (June 2023): 618-619. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2804032 ↩︎
2. Ibid. ↩︎
3. Ibid. ↩︎
4. Ryan, Lindsay, “Many Patients Don’t Survive End-Stage Poverty.” New York Times. 11 Apr. 2024. Guest Essay. ↩︎
5. Ibid. ↩︎
6. Ibid. ↩︎
7. Ibid. ↩︎
8. Ibid. ↩︎
9. Ibid. ↩︎