Step Two: Deprivation, Human Capabilities and Health

A Continuation of the Arkansas Study – Summer and Fall 2004

Principal Investigators:

Gilbert Gee, Department of Health Behavior & Health Education in The School of Public Health The University of Michigan

Larissa Larsen, Schools of Natural Resources and Environment and Urban and Regional Planning, The University of Michigan

Kathryn Lively, Department of Sociology, Dartmouth University

Abstract

Thinking seriously about poverty requires untangling the difficult concepts of needs, wants, inequality, entitlement, freedom, and measures of health and well-being. The official definition of poverty is based on an economic measure of pre-tax income. Since the adoption of the poverty threshold in 1964 in the United States, many have challenged the validity of this measure. These debates are not merely academic, but profoundly impact the provision of social services.

Conceptualizing a comprehensive measure of deprivation requires moving beyond economic measures. Amartya Sen’s human capability framework provides a strategy to move beyond the limitations of economic measures by defining deprivation as a many-sided concept bound to an individual’s opportunities and access to resources. Sen’s ideas have shaped recent international comparisons of human capabilities. The Capabilities Potential Index is the most recent refinement of this approach. This index includes measures of:1) survival, measured by the percentage of people expected to die before age 40, 2) knowledge, as revealed by the percentage of literate adults, and 3) economic provisioning. Economic provisioning is a sub-index created by the combined measures of 1) percentage of children under age 5 who are malnourished, 2) percentage of population with access to health services, and 3) percentage of population with access to safe water. However, the coarse nature of these comparisons impede their ability to reflect regional scale effects and limit their effectiveness to reveal relative levels of deprivation in a developed country, like the United States.

Some of the most insightful work on measuring deprivation has occurred in the United Kingdom, lead by Peter Townsend. This work has resulted in the creation of a deprivation measure that is currently used to make additional support payments to poor individuals in areas of concentrated poverty. Townsend compared indicators of material deprivation to morbidity and mortality health indicators. Four measures constituted Townsend’s Material Deprivation index: unemployment, car ownership, home ownership and overcrowding. Each of the four material deprivation measures produced a significant correlation with each of the health measures.

However, while deprivation is often understood as an individual phenomenon, it is often studied ecologically. This leaves open the threat of the ecological fallacy. One way to address this problem is to examine indicators of deprivation at both the individual and the ecological level. We extend the literature two ways: (1) by examining economic and non-economic imensions of deprivation and (2) by incorporating dimensions of deprivation at multiple levels.

In an effort to understand the relationship between poverty, deprivation, health, and food security within the United States, the state of Arkansas was selected as research site. In the summer of 2004, we surveyed over 400 individuals using emergency food services in Arkansas to assess several dimensions of deprivation, including health status, food insecurity, income, material deprivation and social capital. These individuals were then geocoded to their appropriate census tracts. We then append indicators of ecologically derived deprivation from the 2000 Census, including neighborhood poverty and the Townsend Index of Deprivation. Hierarchical linear modeling will be used to analyze the association between well-being and deprivation at multiple levels.

Our preliminary results indicate that poverty, by itself, is an incomplete measure of deprivation. Low social capital and food insecurity also present important components of deprivation. Planning decisions relying solely on poverty will likely shortchange disadvantaged populations. However, consideration of other dimensions of deprivation may yield social policies that address the needs of the truly disadvantaged.

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