Urban Injustice: How Ghettos Happen — Book Review

Introduction

Urban Injustice: How Ghettos Happen was written by M.D. David Hilfiker, who, as a young idealist, moved to the inner city of Washington, D.C. His original goal was to provide the poor with a "hand up," but he soon discovered that most inner-city poor were as hardworking, dedicated, and sincere as his colleagues from medical school.

Written in an energetic style that combines personal experience with social science research on poverty, the book dismantles the old myth that the poor are typically to blame for their own condition. Hilfiker deconstructs this myth through narrative, analogy, and hard empirical data. As a sympathetic white doctor who spent more than two decades living among the poor and practicing what he calls "poverty medicine," he initially approached his patients with the belief that his guidance and encouragement alone could turn their lives around.

Urban Injustice represents Hilfiker's frank examination of why that belief proved insufficient, and offers his answer to the question of why African-American poverty remains so stubborn and structural. The book includes a thorough chapter on welfare history — including the 1960s "war on poverty" — and closes with practical public policy proposals that Hilfiker argues could constitute a real victory against poverty, if the United States can overcome the political obstacles embedded in the issue.

About the Author

M.D. David Hilfiker is a physician and writer who has devoted his life to social justice through both professions. In 1983, after seven years as a rural physician in northeastern Minnesota, he moved to Washington, D.C., to practice medicine at Christ House — a 34-bed medical recovery shelter for homeless men — where his family also lived alongside him.

In 1990, he co-founded Joseph's House, a residential community and care home for formerly homeless men dying of AIDS, where he spent three years. He served as both Medical Director and Finance Director at Joseph's House until September 2002, after which he left active medical practice to pursue social justice advocacy through writing and public speaking.

Hilfiker also spent three weeks in Iraq in December 2002, and has since written and lectured against the military intervention in that country. His previous books are Healing the Wounds and Not All of Us Are Saints.

Hilfiker, who worked for nearly 20 years with homeless and HIV-positive men in Washington, D.C., opens his analysis by observing:

Analysis of the Book

"When most Americans think about poverty, or see the poor on television, or read about them in the newspapers, the images are of poor black men hanging around the street corner, poor black teenagers selling drugs, poor black single mothers living on welfare, poor black inner-city schools failing their children."

While the author is well acquainted with the medical and psychosocial dimensions of poverty, he admits to having been puzzled by several larger questions: Why has poverty clustered so strongly in particular geographic areas? How does the cycle continue from one generation to the next? How did government assistance programs actually work in practice?

To find answers, he conducted an extensive survey of the sociological, economic, and public policy literature — the kind of resource, he notes, he wished he had encountered in medical school. Hilfiker is particularly attentive to the origins of poverty in African-American inner-city neighborhoods and the historical forces that created and entrenched them.

Conclusion

As both a writer and a doctor, David Hilfiker committed his life to people in need, writing about the urban poor with whom he spent over two decades. In clear and accessible language, he explains how the myth of the "undeserving poor" has diverted valuable government resources, how most assistance programs helped some people but were never sufficiently organized or funded to allow people to escape the trap of urban poverty, and how the facts consistently contradict easy moral judgments.