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Where is the outrage?

We know and acknowledge that our Presidential campaign has been nationally embarrassing, distracting, and virtually policy-silent. The tenor and substance of the campaign, especially post-Bernie, have conveyed virtually no empathy or awareness of the realities of our most vulnerable individuals, groups, and communities. The growing disparities in our economy and the extreme hardship faced by many in our society have fallen out of public eye and certainly out of the public policy discussion. There is quite another reality on the streets and in the front lines of call centers and social service organizations.

Walking the streets of downtown St. Louis is a daily reminder of the extraordinary hardships that so many individuals and families are facing, with virtually no safety net. It is most visible in the morning when the shelters are cleared and in the evening when so many people – including young children – are mustering to figure out where they are going to sleep for the night. Visible are all the co-occurring conditions that make progress so hard: untreated mental illness, substance use, etc. I have been struck by the number of times I have recently heard the expression “throwaways” to refer to kids and teenagers who have ended up living in this survival mode outside of our systems of education, child welfare, or social services.

So many leaders and line workers of service organizations and advocacy groups express fatigue and intense frustration with this state of affairs. The commitment, effort, and compassion of these front-line workers and leaders is amazing, though there are limits to their endurance. The social services sector is experiencing a massive wave of retirements and other exits of its workforce. In many states, the budget crises are flowing downstream resulting in cuts in in social services and safety net programs.

Our overall performance:

While we are all generally aware that our country is not performing up to our rhetoric and our aspirations, the true extent of our shortfall – its size and scope – continues to slip out of the public eye as horserace politics and personality-news dominates our attention.

To remind us, here is a short international list, a little dashboard of just how poorly the U.S. is doing at supporting our population, achieving equity, and improving our quality of life.

  • Ranked 37th in health system performance
  • Ranked 43rd in life expectancy at birth
  • Ranked 17th in education
  • Ranked 1st in incarceration rates
  • Ranked 1st in wealth inequality
  • Ranked 4th in income inequality


While rankings tell one story – how our nation performs relative to other industrialized nations – it is also important to remember that behind the data are actual people and lives experiencing our economy and social environment.

  • Although notoriously difficult to count, at least one half million persons are homeless on any given night in the U.S. Underneath these overall statistics are concentrations of homelessness among youth, veterans, and particular cities like Washington DC and Santa Monica California.
  • 42 million Americans live in food insecure households, with a quarter of a million households with children experiencing very poor food security.
  • 8 million Americans did not receive, or delayed needed medical care last year due to cost.

Racial and ethnic disparities

Across so many indicators of social, economic, and public health outcomes, the same disparities that were tackled in the 1960s still persist, a half century later. African Americans have consistently had infant mortality rates two times whites, and the gap has not appreciably changed. In education, by various measures such as the achievement gap, African Americans and other students of color experience systematic disadvantage. Latino immigrants experience actually experience worsening health status after one or two generations living in the U.S.

Geography is Destiny

Concentrations of poverty and race are associated with places – urban and rural – that have poor educational systems, a lack of job opportunities, violence, criminal justice practices, poor public health resources, environmental exposure, stress and trauma.

Jason Purnell’s important project For the Sake of All, and Clare Bambra’s new book Health Divides: Where You Live Can Kill You are just the latest examples from a long line of social science and public health literature that demonstrate the complex combinations of risks in particular places that add up to systematic place-based discrimination and disadvantage.

November 9, 2016

So as the nation hopefully turns a corner and we can get back to the business of public policy, it is worth reminding ourselves that tremendous hardship and vulnerability still exists in our country, in virtually all corners – urban, rural, north, south, coastal and interior.

It is worth asking why there is not more outrage that these conditions and disparities persist? There is so much to be done, yet social policy has stood virtually still at the federal, state, and local levels. In the meantime, trust and confidence in our basic institutions – government, media, finance, the judiciary, etc. – have deteriorated badly, making the project of new social policy that much harder and more distant.

The immediate challenge is to bring the circumstances of so many Americans into the public consciousness. This challenge will not be solved by more statistics, analyses, and reports. Our access to facts, information, opinions, and media has become so channeled and compartmentalized it is hard to imagine how to cut through the noise and bring broad attention to the issues of social and public health justice. We read our own sources, watch our own networks, and follow our own social media.

What is needed is the modern day equivalent of Michael Harrington’s The Other America, which shocked many in this country in 1962 (including our political class) and created a jolt in our broader national conscience. It is credited with stimulating the War on Poverty. We need to find out a way to make a 2017 Other America salient and visible in our compartmentalized country. A modern version of the Other America will need to utilize all of the power of video, social media, celebrity culture, and sophisticated issue-marketing. (Think of the temporary bump in international awareness and outrage about the human consequences of the Syrian war that followed publication of just one compelling video of the young Syrian boy, Omran Daqneesh.)

The question coming out of this dark experience of American politics and policy is can we create the narrative, communications, and solutions that will stimulate our federal, state, and local policy enterprise to make significant, not marginal, steps to address poverty, racism, and social injustice. Otherwise, we will be wringing our hands at the number of people on who are homeless – including children – and the lack of social progress we have made fifty years from now.






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