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Malia Jones, an assistant scientist at UW-Madison's Applied Population Laboratory, has been involved in projects on poverty, health insurance coverage and migration.

PHOTO BY SAIYNA BASHIR

An analysis of Census data by the University of Wisconsin-Madison Applied Population Laboratory showed some troubling trends on poverty in the state.

Researcher Malia Jones, an assistant scientist and social epidemiologist, compared American Community Survey data from consecutive five-year periods — 2005 to 2009 and 2010 to 2014 — and found that the number of people living in poverty grew from 11 percent to 13 percent statewide and increased significantly in 31 of 72 Wisconsin counties, including Dane.

Jones moved to Madison from Los Angeles last July and has been involved in Applied Population Lab projects on health insurance coverage and migration in addition to the poverty report.

She has a master's and doctorate degrees in public health, and she said she ended up at her current job because of the lab's work in health geography, "looking at how the places we go and the places we spend time affect health."

Poverty is one of the major influences on public health, and Jones' analysis indicates how prevalent an issue it is.

What surprised you from the numbers you found?

I think that it's counterintuitive to find that poverty is going up when the economy is expanding. We weren't the first group to uncover that; that's been going on for a couple years. But it is a little surprising. This is a really robust measure, looking at these five-year rolling averages, so it's a really strong indicator that poverty really is going up. And that's a little puzzling in the face of a growing economy.

We didn't look at explanations for that but other people have, and I think what's happening is that people at the low end of the economic spectrum are not benefiting from recovery. They're really being left behind. So inequality is increasing in the face of an expanding economy.

Is that common for other economic recoveries we've had, that it seems to benefit the well-to-do first?

This did sort of happen after the recession in the '80s. We saw a huge rise in inequality. But some economists who have looked at inequality, comparing now to what happened in the '80s, say inequality is worse. Others disagree. They say that this time is not as bad. So it's a little bit up for debate.

But we have seen that after a recession, those who are well-positioned to benefit from recovery benefit. And those who don't have any cash can't get back into the housing market. The really low-skilled, they don't benefit. They can't take advantage of new opportunities.

You point in the report to child poverty increasing quickly in Wisconsin, from 14.6 percent between 2005 and 2009 to 18.5 percent in 2010 to 2014. How much of a concern do you think that should be for policymakers?

I think that the number of kids living in poverty is a really important, critical public health issue. That kind of early exposure leads to a lifetime of disability. It's those kinds of stressors like housing insecurity, not being sure if there's going to be food for dinner, living in a crummy neighborhood with violence, those stressors can impair normal brain development.

And that leads to behavioral outcomes. It can affect school performance. It affects skill development, which leads, of course, to job opportunity problems. In addition, there are more direct health effects, too. Living in poverty is a major risk factor for obesity, diabetes, hypertension, premature death even. So it's really costly to have this really high rate of child poverty. It's also sort of embarrassing. If you compare the child poverty rates in the U.S. to other developed nations, it's really shameful.

Are there elements of poverty that don't get talked about enough?

I have a health background, so to me that's the most important concern, that poverty is probably the most important risk factor for chronic disease. And chronic disease, I think it's something like eight of the top 10 causes of death. It is the No. 1 public health problem. Heart disease, diabetes, stroke, hypertension, chronic pulmonary disease — poverty is a major risk factor for all of those.

The mechanisms of that are becoming better understood, and I think one of the things that goes on is that people who live in poverty, their choice set is really constrained. They can't afford healthy food. They don't have time to exercise. They don't feel like they can see a doctor on a routine basis and treat a treatable condition. So those kinds of constraints for someone who's living in poverty really lead to negative health outcomes that are costing our health care system a fortune. It is a huge economic issue as well as a public health, social justice issue.

Shouldn't a dollars-and-cents impact bring it into a greater level of discussion?

Maybe it is because it's complicated to think about. It's a few steps removed. Also, I find that people have a hard time thinking about really long timelines. It's easy to think about things that happen on a really short timeline. But when we're talking about chronic disease, it's 40, 50 years down the road when these kids are going to have problems. But they're going to have problems. I'm here to certify that these kids will be sick when they're grown-ups.

The data show racial gaps in poverty. Is the trend getting worse in Wisconsin?

Some people who've been following what's going on in Wisconsin are not surprised by this, but, being relatively new to Wisconsin, I was a little bit shocked when I saw the actual numbers. Wisconsin not only is 49th out of the 50 states in terms of the size of the gap between blacks and whites on poverty rates, but is getting worse faster than the nation and most other states. So not only are we doing almost the worst in the country, we're also getting worse over time. It is shocking.

Are there factors you can point to in the data to say how that happens?

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We're talking about the intersection of poverty and race. And I just mentioned that I think the reason poverty is growing in spite of a growing economy is that the lower end of the economic spectrum is not benefiting, doesn't have opportunities to benefit from a growing economy. And in the state of Wisconsin, unfortunately, there is almost perfect overlap between economic and racial disparities. There are almost no upper-class blacks in the state, whereas in other places you do see more of a variety of income, wage levels among families of color. So what I'm saying is that I think what we're seeing in terms of this growing gap really reflects that there are very few blacks who are in position to benefit from a growing economy in this state.

The Race to Equity report has already highlighted this to some extent, and there are some initiatives that are trying to address this. But I think that we really need to think about the opportunities that blacks have to get out of poverty and take advantage of some of the economic benefits. You can't benefit from a recovering housing market if you can't get a loan. Those are things that need to be addressed by policy.

How do you define social epidemiology?

Epidemiology is the study of diseases and population. Social epidemiology is the study of social factors that cause disease, like poverty, housing inequality, wage opportunity, racial disparities including structural factors like who has access to mortgages and so forth, as well as discrimination directly. So all the social factors that lead to chronic disease, which, when you look at the numbers, are the most influential factors in chronic disease outcomes. There are other things like, how many times have you seen a doctor? What kind of insurance do you have? Those are important, but the social factors are a much bigger piece of the pie.

An Applied Population Lab study looked into effects on health insurance rates after the implementation of the Affordable Care Act. What were the big takeaways there?

In 2014, most of the provisions of the Affordable Care Act took effect and we saw a really historic uptick in the number of Americans with health insurance coverage, including in Wisconsin. We saw really big gains even among lower-income individuals in the number of people who have insurance. 

We'll expect to see more and more people who are covered by insurance as a result of some of the changes in the ACA. And in particular, we saw increasing insurance among what might be called the lower working class people and in kids. Those people having access to preventive medicine is going to be an important determinant of not only their disease outcomes but their poverty status. Because poverty really is about the cost of living, and when you have insurance those costs go down a little bit for most people. Then you're able to redirect some of that money toward something else. And if you're healthy you can work and you can earn more money. That will have positive effects, we expect.

What kind of data stood out from the lab's work on migration?

Wisconsin has, and has had for a while, a little bit of a migration problem. We're experiencing brain drain, especially in rural areas. Young people are leaving rural communities and going to big population centers like Chicago. We invest a lot in educating our kids, and then they grow up, they don't see a lot of opportunity in Wisconsin and they're leaving.

So population growth is stagnant. We're not growing, which is a challenge from an economic perspective. We need young people to enter the workforce to support aging populations. And we're also experiencing some level of brain drain in terms of young, skilled people leaving.

That sounds like an ominous sign if Wisconsin can't change that.

Wisconsin would be really smart to create opportunities for smart young people to stay in the state or even attract people from other places. From an economic perspective, it would be a healthier economy if those people were hanging around or being attracted here. That's about opportunities to work and earn a good living and also get a great education. The strength of the university is an important factor in that.

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Todd D. Milewski covers Wisconsin Badgers men's hockey and the UW Athletic Department for the Wisconsin State Journal.