United Nations A/HRC/38/33/Add.

1
General Assembly Distr.: General
4 May 2018

Original: English

Human Rights Council

Thirty-eighth session
18 June–6 July 2018
Agenda item 3
Promotion and protection of all human rights, civil,
political, economic, social and cultural rights,
including the right to development

Report of the Special Rapporteur on extreme poverty and

human rights on his mission to the United States of America

Note by the Secretariat

The Secretariat has the honour to transmit to the Human Rights Council the report of
the Special Rapporteur on extreme poverty and human rights, Philip Alston, on his mission
to the United States of America from 1 to 15 December 2017. The purpose of the visit was
to evaluate, and report to the Human Rights Council on, the extent to which the
Government’s policies and programmes aimed at addressing extreme poverty are consistent
with its human rights obligations and to offer constructive recommendations to the
Government and other stakeholders.

GE.18-07152(E)


A/HRC/38/33/Add.1

Report of the Special Rapporteur on extreme poverty and

human rights on his mission to the United States of America*
Contents
Page
I. Introduction ................................................................................................................................... 3
II. Overview ....................................................................................................................................... 3
III. Human rights dimension ............................................................................................................... 5
IV. Who are “the poor”? ...................................................................................................................... 6
V. Current extent of poverty in the United States of America ........................................................... 6
VI. Problems with existing governmental policies .............................................................................. 7
A. Undermining of democracy .................................................................................................. 7
B. Shortcomings in basic social protection................................................................................ 8
C. Reliance on criminalization to conceal the underlying poverty problem .............................. 12
D. Persistent discrimination and poverty ................................................................................... 14
E. Confused and counterproductive drug policies ..................................................................... 17
F. Environmental pollution ....................................................................................................... 17
VII. Conclusions and recommendations ............................................................................................... 18

* Circulated in the language of submission and in Spanish only.

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I. Introduction
1. The Special Rapporteur on extreme poverty and human rights visited the United
States of America from 1 to 15 December 2017, in accordance with Human Rights Council
resolution 35/19. The purpose of the visit was to report to the Council on the extent to
which the Government’s policies and programmes relating to extreme poverty are
consistent with its human rights obligations and to offer constructive recommendations to
the Government and other stakeholders. The Special Rapporteur is grateful to the
Government for inviting him, for facilitating his visit and for continuing its cooperation
with the Council’s accountability mechanisms that apply to all States. 1
2. During his visit, the Special Rapporteur met with government officials at the federal,
state, county and city levels, members of Congress, representatives of civil society,
academics and people living in poverty. He also received more than 40 detailed written
submissions in advance of his visit.2 He visited California (Los Angeles and San
Francisco), Alabama (Lowndes County and Montgomery), Georgia (Atlanta), Puerto Rico
(San Juan, Guayama and Salinas), West Virginia (Charleston) and Washington, D.C. He is
deeply grateful to all those who organized community consultations for him in these
locations, and to the US Human Rights Network, which devoted a full day of its 2017
national convening in Atlanta to his country visit.
3. The strict word limit for this report makes it impossible to delve deeply into even the
key issues. Fortunately, there is already much excellent scholarship and many civil society
analyses of the challenges of poverty in the United States. 3 In the present report, the Special
Rapporteur aims to bring together some of those analyses, identify the key poverty-related
problems and explain the relevance of the international human rights obligations of the
United States in this context. As with all such country visits, the consideration of the report
by the Human Rights Council will enable other States to examine the extent to which the
United States is living up to its international obligations.

II. Overview
4. The United States is a land of stark contrasts. It is one of the world’s wealthiest
societies, a global leader in many areas, and a land of unsurpassed technological and other
forms of innovation. Its corporations are global trendsetters, its civil society is vibrant and
sophisticated and its higher education system leads the world. But its immense wealth and
expertise stand in shocking contrast with the conditions in which vast numbers of its
citizens live. About 40 million live in poverty, 18.5 million in extreme poverty, and 5.3
million live in Third World conditions of absolute poverty. 4 It has the highest youth poverty
rate in the Organization for Economic Cooperation and Development (OECD), and the
highest infant mortality rates among comparable OECD States. Its citizens live shorter and
sicker lives compared to those living in all other rich democracies, eradicable tropical
diseases are increasingly prevalent, and it has the world’s highest incarceration rate, one of

1 The Special Rapporteur is grateful for the superb research and analysis undertaken by Christiaan van
Veen, Anna Bulman, Ria Singh Sawhney and staff of the United Nations Office of the High
Commissioner for Human Rights.
2 Submissions available at www.ohchr.org/EN/Issues/Poverty/Pages/Callforinput.aspx.
3 See, for example: Kathryn J. Edin and H. Luke Shaefer, $2.00 a Day: Living on Almost Nothing in

America (New York, Mariner Books, 2016); Matthew Desmond, Evicted: Poverty and Profit in the
American City (New York, Crown Publishers, 2016); Sasha Abramsky, The American Way of Poverty:
How the Other Half Still Lives (New York, Nation Books, 2013); and Peter Edelman, Not a Crime to
Be Poor: The Criminalization of Poverty in America (The New Press, New York, 2017).
4 Jessica L. Semega, Kayla R. Fontenot and Melissa A. Kollar, Income and Poverty in the United States:

2016 — Current Population Reports (United States Census Bureau, September 2017), pp. 12 and 17.
Available at www.census.gov/content/dam/Census/library/publications/2017/demo/P60-259.pdf. See
also Angus Deaton, “The U.S. can no longer hide from its deep poverty problem”, New York Times,
24 January 2018.

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the lowest levels of voter registrations in among OECD countries and the highest obesity
levels in the developed world.
5. The United States has the highest rate of income inequality among Western
countries.5 The $1.5 trillion in tax cuts in December 2017 overwhelmingly benefited the
wealthy and worsened inequality. The consequences of neglecting poverty and promoting
inequality are clear. The United States has one of the highest poverty and inequality levels
among the OECD countries, and the Stanford Center on Inequality and Poverty ranks it
18th out of 21 wealthy countries in terms of labour markets, poverty rates, safety nets,
wealth inequality and economic mobility. But in 2018 the United States had over 25 per
cent of the world’s 2,208 billionaires. 6 There is thus a dramatic contrast between the
immense wealth of the few and the squalor and deprivation in which vast numbers of
Americans exist. For almost five decades the overall policy response has been neglectful at
best, but the policies pursued over the past year seem deliberately designed to remove basic
protections from the poorest, punish those who are not in employment and make even basic
health care into a privilege to be earned rather than a right of citizenship.
6. The visit of the Special Rapporteur coincided with the dramatic change of direction
in relevant United States policies. The new policies: (a) provide unprecedentedly high tax
breaks and financial windfalls to the very wealthy and the largest corporations; (b) pay for
these partly by reducing welfare benefits for the poor; (c) undertake a radical programme of
financial, environmental, health and safety deregulation that eliminates protections mainly
benefiting the middle classes and the poor; (d) seek to add over 20 million poor and middle
class persons to the ranks of those without health insurance; (e) restrict eligibility for many
welfare benefits while increasing the obstacles required to be overcome by those eligible;
(f) dramatically increase spending on defence, while rejecting requested improvements in
key veterans’ benefits; (g) do not provide adequate additional funding to address an opioid
crisis that is decimating parts of the country; and (h) make no effort to tackle the structural
racism that keeps a large percentage of non-Whites7 in poverty and near poverty.
7. In a 2017 report, the International Monetary Fund (IMF) captured the situation even
before the impact of these aggressively regressive redistributive policies had been felt,
stating that the United States economy “is delivering better living standards for only the
few”, and that “household incomes are stagnating for a large share of the population, job
opportunities are deteriorating, prospects for upward mobility are waning, and economic
gains are increasingly accruing to those that are already wealthy”.8
8. The share of the top 1 per cent of the population in the United States has grown
steadily in recent years. In 2016 they owned 38.6 per cent of total wealth. In relation to both
wealth and income the share of the bottom 90 per cent has fallen in most of the past 25
years.9 The tax reform will worsen this situation and ensure that the United States remains
the most unequal society in the developed world. The planned dramatic cuts in welfare will
essentially shred crucial dimensions of a safety net that is already full of holes. Since
economic and political power reinforce one another, the political system will be even more
vulnerable to capture by wealthy elites.
9. This situation bodes ill not only for the poor and middle class in America, but for
society as a whole, with high poverty levels “creating disparities in the education system,
hampering human capital formation and eating into future productivity”.10 There are also

5 World Income Inequality Database, available at www.wider.unu.edu/project/wiid-world-income-

inequality-database.
6 See www.forbes.com/sites/forbespr/2018/03/06/forbes-32nd-annual-worlds-billionaires-
issue/#43e9e95a10e0.
7 In the present report, references to race or ethnicity include the following classifications used by the
United States Census Bureau: American Indian or Alaska Native, Asian, Black and White (see
www.census.gov/topics/population/race/about.html).
8 IMF, “United States: staff report for the 2017 Article IV Consultation”, para. 14.
9 Jesse Bricker and others, “Changes in U.S. family finances from 2013 to 2016: evidence from the
Survey of Consumer Finances”, Federal Reserve Bulletin (September 2017), vol. 103, No. 3, p. 10.
10 IMF, “United States: staff report”, para. 18.

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global consequences. The tax cuts will fuel a global race to the bottom, thus further
reducing the revenues needed by Governments to ensure basic social protection and meet
their human rights obligations. And the United States remains a model whose policies other
countries seek to emulate.
10. Defenders of the status quo point to the United States as the land of opportunity and
the place where the American dream can come true because the poorest can aspire to the
ranks of the richest. But today’s reality is very different. The United States now has one of
the lowest rates of intergenerational social mobility of any of the rich countries. 11 Zip
codes, which are usually reliable proxies for race and wealth, are tragically reliable
predictors of a child’s future employment and income prospects. High child and youth
poverty rates perpetuate the intergenerational transmission of poverty very effectively, and
ensure that the American dream is rapidly becoming the American illusion. The equality of
opportunity, which is so prized in theory, is in practice a myth, especially for minorities and
women, but also for many middle-class White workers.
11. New technologies now play a central role in either exacerbating or reducing poverty
levels in the United States. Some commentators are singularly optimistic in this regard and
highlight the many potential benefits of new technologies, including those based on
artificial intelligence, for poverty reduction efforts in fields as diverse as health care,
transportation, the environment, criminal justice, and economic inclusion. 12 Others
acknowledge the downsides, and especially the potential negative effects of automation and
robotization on future employment levels and job security. 13 But remarkably little attention
has been given to the specific impact of these new technologies on the lives of the poor in
American society today.14 Such inquiries have significance well beyond that pertaining to
the poor, since experience shows that those in poverty are often a testing ground for
practices and policies subsequently applied more broadly. In the present report, the Special
Rapporteur seeks to stimulate deeper reflection on the impact of new technologies on the
human rights of the poorest.

III. Human rights dimension

12. Successive administrations, including the current one, have determinedly rejected
the idea that economic and social rights are full-fledged human rights, despite their clear
recognition not only in key treaties that the United States has ratified, such as the
Convention on the Elimination of All Forms of Racial Discrimination, but also in the
Universal Declaration of Human Rights, which the United States has long insisted other
countries must respect. But denial does not eliminate responsibility, nor does it negate
obligations. International human rights law recognizes a right to education, a right to health
care, a right to social protection for those in need and a right to an adequate standard of
living. In practice, the United States is alone among developed countries in insisting that,
while human rights are of fundamental importance, they do not include rights that guard
against dying of hunger, dying from a lack of access to affordable health care or growing up
in a context of total deprivation. Since the United States has refused to accord domestic
recognition to the economic and social rights agreed by most other States in the

11 Raj Chetty and others, “The fading American dream: trends in absolute income mobility since 1940”,
National Bureau of Economic Research Working Paper 22910 (December 2016), p. 2. See also
Jonathan Davis and Bhashkar Mazumder, “The decline in intergenerational mobility after 1980”,
Opportunity & Inclusive Growth Institute working paper (29 March 2017), available at
www.minneapolisfed.org/institute/working-papers/17-21.pdf.
12 Executive Office of the President, National Science and Technology Council Committee on
Technology, “Preparing for the future of artificial intelligence” (October 2016), p. 1. See also
Elisabeth A. Mason, “A.I. and big data could power a new war on poverty”, New York Times, 1
January 2018.
13 Charles Varner, Marybeth Mattingly and David Grusky, “The facts behind the visions”, Pathways
(Spring 2017), p. 4.
14 Cathy O’Neil, “The ivory tower can’t keep ignoring tech”, New York Times, 14 November 2017.

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International Covenant on Economic, Social and Cultural Rights and other treaties, 15 except
for the recognition of some social rights, and especially the right to education, in state
constitutions, the primary focus of the present report is on those civil and political rights
reflected in the United States Bill of Rights and in the International Covenant on Civil and
Political Rights, which the United States has ratified.

IV. Who are “the poor”?

13. In thinking about poverty, it is striking how much weight is given to caricatured
narratives about the purported innate differences between rich and poor that are consistently
peddled by some politicians and media. The rich are industrious, entrepreneurial, patriotic
and the drivers of economic success. The poor are wasters, losers and scammers. As a
result, money spent on welfare is money down the drain. If the poor really want to make it
in the United States, they can easily do so: they really can achieve the American dream if
only they work hard enough. The reality, however, is very different. Many of the wealthiest
citizens do not pay taxes at the rates that others do, hoard much of their wealth offshore and
often make their profits purely from speculation rather than contributing to the overall
wealth of the American community.
14. In imagining the poor, racist stereotypes are usually not far beneath the surface. The
poor are overwhelmingly assumed to be people of colour, whether African Americans or
Hispanic “immigrants”. The reality is that there are 8 million more poor Whites than there
are poor Blacks.16 The face of poverty in America is not only Black or Hispanic, but also
White, Asian and many other backgrounds.
15. Similarly, large numbers of welfare recipients are assumed to be living high on “the
dole”. Some politicians and political appointees with whom the Special Rapporteur spoke
were completely sold on the narrative of such scammers sitting on comfortable sofas,
watching cable television or spending their days on their smartphones, all paid for by
welfare. The Special Rapporteur wonders how many of those politicians have ever visited
poor areas, let alone spoken to those who dwell there. There are anecdotes aplenty, but little
evidence. In every society, there are those who abuse the system, as much in the upper
income levels as in the lower. But in reality, the poor are overwhelmingly those born into
poverty, or those thrust there by circumstances largely beyond their control, such as
physical or mental disabilities, divorce, family breakdown, illness, old age, unliveable
wages or discrimination in the job market.

V. Current extent of poverty in the United States of America

16. There is considerable debate over the extent of poverty in the United States, but the
present report relies principally upon official government statistics, especially from the
United States Census Bureau. It defines and quantifies poverty in America based on
“poverty thresholds” or official poverty measures, updated each year. These thresholds
have been used since President Lyndon B. Johnson’s war on poverty in the 1960s and use a
set of dollar value thresholds that vary by family size and composition to determine who is
in poverty.17 Following much criticism of the official poverty measures, the Census Bureau
developed a supplemental poverty measure, which is preferred by many experts. 18
According to the official poverty measures, in 2016, 12.7 per cent of Americans were living
in poverty;19 according to the supplemental poverty measure, the figure was 14 per cent. 20

15
The United States is the only country in the world that has not ratified the Convention on the Rights
of the Child, which protects the economic and social rights of children.
16 Semega, Fontenot and Kollar, Income and Poverty, p. 12.
17 Ibid., p. 43.
18 Written submission by the Georgetown Center on Poverty and Inequality, 4 October 2017, p. 2.
19 Semega, Fontenot and Kollar, Income and Poverty, p. 12.
20 Liana Fox, “The supplemental poverty measure” (September 2017), p. 1. Available at
www.census.gov/content/dam/Census/library/publications/2017/demo/p60-261.pdf.

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VI. Problems with existing governmental policies

17. There is no magic recipe for eliminating extreme poverty, and each level of
government must make its own good-faith decisions. At the end of the day, however,
particularly in a rich country like the United States, the persistence of extreme poverty is a
political choice made by those in power. With political will, it could readily be eliminated.
What is known, from long experience and in the light of the Government’s human rights
obligations, is that there are indispensable ingredients for a set of policies designed to
eliminate poverty. They include: democratic decision-making, full employment policies,
social protection for the vulnerable, a fair and effective justice system, gender and racial
equality, respect for human dignity, responsible fiscal policies and environmental justice.
As shown below, the United States falls well short on each of these measures.

A. Undermining of democracy

18. The cornerstone of American society is democracy, but it is being steadily

undermined, and with it the human right to political participation protected in article 25 of
the International Covenant on Civil and Political Rights. The principle of one person, one
vote applies in theory, but is increasingly far from the reality.
19. In a democracy, the task of government should be to facilitate political participation
by ensuring that all citizens can vote and that their votes will count equally. However, in
the United States there is overt disenfranchisement of more than 6 million felons and ex-
felons,21 which predominantly affects Black citizens since they are the ones whose conduct
is often specifically targeted for criminalization. In addition, nine states currently condition
the restoration of the right to vote after prison on the payment of outstanding fines and fees.
A typical outcome is that seen in Alabama, where a majority of all ex-felons cannot vote.22
20. Then there is covert disenfranchisement, which includes the dramatic
gerrymandering of electoral districts to privilege particular groups of voters, the imposition
of artificial and unnecessary voter identification requirements, the blatant manipulation of
polling station locations, the relocation of Departments of Motor Vehicles’ offices to make
it more difficult for certain groups to obtain identification, and the general ramping up of
obstacles to voting, especially for those without resources. The net result is that people
living in poverty, minorities and other disfavoured groups are being systematically deprived
of their right to vote.
21. It is thus unsurprising that the United States has one of the lowest turnout rates in
elections among developed countries, with only 55.7 per cent of the voting-age population
casting ballots in the 2016 presidential election. 23 Registered voters represent a much
smaller share of potential voters in the United States than in just about any other OECD
country. Only about 64 per cent of the United States voting-age population was registered
in 2016, compared with 91 per cent in Canada and the United Kingdom of Great Britain
and Northern Ireland, 96 per cent in Sweden and nearly 99 per cent in Japan. Low turnouts
are also explained by the perception that election outcomes will have no impact on the lives
of poor people. One politician remarked to the Special Rapporteur on how few campaign
appearances most politicians bother to make in overwhelmingly poor districts, which
reflects the broader absence of party representation for low-income and working-class
voters.24

21
The Sentencing Project, “6 million lost voters: state-level estimates of felony disenfranchisement,
2016”.
22 Marc Meredith and Michael Morse, “Discretionary disenfranchisement: the case of legal financial
obligations” (January 2017). Available at www.sas.upenn.edu/~marcmere/workingpapers/
DiscretionaryLFOs.pdf.
23 Pew Research Center, “U.S. trails most developed countries in voter turnout” (15 May 2017).
24 See also Karen Long Jusko, Who Speaks for the Poor? Electoral Geography, Party Entry, and
Representation (Cambridge University Press, 2017).

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22. The link between poverty and the absence of political rights is perfectly illustrated
by Puerto Rico. If it were a state, it would be the poorest in the Union. But it is not a state,
it is a mere “territory”. Puerto Ricans who live on the island have no representative with
full voting rights in Congress and cannot vote in presidential elections, although they can
vote in Presidential primaries. In a country that likes to see itself as the oldest democracy in
the world and a staunch defender of political rights on the international stage, more than 3
million people who live on the island have no real power in their own capital.
23. Puerto Rico has a fiscal deficit and a political rights deficit, and the two are not
easily disentangled. The Special Rapporteur met with the Executive Director of the
Financial Oversight and Management Board that was imposed by Congress in 2016 on
Puerto Rico as part of the Puerto Rico Oversight, Management, and Economic Stability
Act. There is little indication that social protection concerns feature in a meaningful way in
the Board’s analyses. At a time when even the IMF is insisting that social protection should
be explicitly factored into prescriptions for fiscal adjustment (i.e., austerity), the Board
should take account of human rights and social protection concerns as it contemplates far-
reaching decisions on welfare reform, minimum wage and labour market deregulation.
24. It is not for the Special Rapporteur to suggest any resolution to the hotly contested
issue of the constitutional status of Puerto Rico. Many interlocutors, however, made clear
the widespread feeling that Puerto Ricans consider their territory to be colonized and that
the United States Congress is happy to leave them in a limbo in which they have neither
meaningful Congressional representation nor the ability to govern themselves. In the light
of recent Supreme Court jurisprudence and Congress’s adoption of the Puerto Rico
Oversight, Management, and Economic Stability Act there seems to be good reason for the
Special Political and Decolonization Committee of the United Nations to conclude that the
island is no longer a self-governing territory.

B. Shortcomings in basic social protection

25. It is sometimes argued that President Johnson’s war on poverty has failed miserably
because, despite the “trillions of taxpayer dollars” spent on welfare programmes over the
past five decades, the official poverty rate has remained largely unchanged. 25 The proposed
solution then is to downsize the safety net by making it more “efficient”, “targeted” and
“evidence-based”, while underlining the need to move “from welfare to work”.26
26. These ideas underpin both Speaker Paul Ryan’s blueprint for welfare reform27 and
the budget proposed by President Donald Trump for the fiscal year 2019, which decries
“stubbornly high” enrolment in welfare programmes, and describes millions of Americans
as being “in a tragic state of dependency on a welfare system that does not reward work,
and in many cases, pays people not to work”.28
27. The available evidence, however, points in a very different direction. A 2014 White
House report concluded that the war on poverty had been highly successful. 29 Based on the
supplemental poverty measure, poverty rates in the United States fell from 26 per cent in
1967 to 16 per cent in 2012 — a decline of nearly 40 per cent. 30 The Census Bureau
calculates that programmes such as Social Security, refundable tax credits (earned income
tax credit), the Supplemental Nutrition Assistance Program, the Supplemental Security

25 See, for example, Task Force on Poverty, Opportunity, and Upward Mobility, A Better Way: Our
Vision for a Confident America (June, 2016).
26
Ibid.
27 David Morgan, “Speaker Ryan pledges to work with Trump on bold agenda”, Reuters, 9 November
2016.
28 Office of Management and Budget, Efficient, Effective, Accountable: An American Budget (2018),
p. 3.
29 Council of Economic Advisors, The War on Poverty 50 Years Later: A Progress Report (2014), p. 45.
30 Christopher T. Wimer and others, “Trends in poverty with an anchored supplemental poverty
measure”, Colombia Population Research Center working paper (2013).

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Income programme and housing subsidies collectively prevented about 44 million

Americans from falling into poverty in 2016.31
28. The following sections address shortcomings in both the existing social protection
system for the poorest Americans and in the assumptions underlying the administration’s
policy responses.

An illusory emphasis on employment

29. Proposals to slash the meagre welfare arrangements that currently exist are now
sought to be justified primarily on the basis that the poor need to leave welfare and go to
work. The assumption, especially in a thriving economy, is that there are a great many jobs
out there waiting to be filled by individuals with low educational qualifications, often with
disabilities of one kind or another, sometimes burdened with a criminal record (often
poverty related), without meaningful access to health care, and with no training or effective
assistance to obtain employment. It also assumes that the jobs they could get will make
them independent of state assistance.
30. In reality, the job market for such people is extraordinarily limited, and even more
so for those without basic forms of social protection and support. The case of Walmart, the
largest employer in the United States, is instructive. Many of its workers cannot survive on
a full-time wage in the absence of food stamps. This fits in a broader trend: the share of
households that, while having earnings, also receive nutrition assistance rose from 19.6 per
cent in 1989 to 31.8 per cent in 2015. 32 Up to $6 billion annually goes from the
Supplemental Nutrition Assistance Program and other public assistance programmes to
support workers in firms like Walmart, providing a huge indirect subsidy to the relevant
corporations.33 Walmart lobbied heavily for tax reform, 34 from which it will save billions,
and then announced it would spend an additional $700 million in increasing employee
wages and benefits for its workers.35 But the resulting rise in the debt of the United States,
due in part to the tax reform, 36 has then been used to justify a proposed 30 per cent cut in
Supplemental Nutrition Assistance Program funding over a decade.37
31. In terms of job availability, the reality is very different from that portrayed by the
welfare-to-work proponents. Despite the strong economy, there has been a long-term
decline in employment rates; by 2017, only 89 per cent of males aged 25 to 54 were
employed. 38 While “supply” factors such as growing rates of disability, increasing
geographic immobility and higher incarceration rates are relevant, a 2016 White House
report concluded that reductions in labour supply were far less important than reductions in
labour demand in accounting for the long-run trend.39 In the future, new technologies, such
as self-driving cars, 3D printers and robot-staffed factories and warehouses, may lead to a
continuing decline in demand for low-skilled labour. Leading poverty experts have
concluded that, because of this rising joblessness, the poverty population in the United
States “is becoming a more deprived and destitute class, one that’s disconnected from the
economy and unable to meet basic needs”.40

31 Fox, “The Supplemental Poverty Measure”, p. 10.

32 See www.ers.usda.gov/data-products/chart-gallery/gallery/chart-detail/?chartId=82672.
33 Clare O’Connor, “Report: Walmart workers cost taxpayers $6.2 billion in public assistance”, Forbes,
15 April 2014.
34 Center for Responsive Politics, reporting on lobbying activity on tax issues in 2017. Available at
www.opensecrets.org/lobby/issuesum.php?id=TAX&year=2017.
35 Michael Corkery, “Walmart’s bumpy day: from wage increase to store closings”, New York Times, 11
January 2018.
36 “Growing the deficit: the Senate passes a tax bill”, Economist, 2 December 2017.
37 Julie Hirschfeld Davis, “White House proposes $4.4 trillion budget that adds $7 trillion to deficits,”
New York Times, 12 February 2018.
38 Varner, Mattingly and Grusky, “The facts”, p. 4.
39 Council of Economic Advisers, “The long-term decline in prime-age male labor force participation”
(2016).
40 Varner, Mattingly and Grusky, “The facts”, p. 4.

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32. Earlier experiments with welfare reform, particularly the Clinton-era replacement of
Aid to Families with Dependent Children with the Temporary Assistance for Needy
Families programme, should caution present-day proponents of “welfare to work”. The
impact of the 1996 welfare reform on poor, single mothers has been especially dramatic.
Many took low-wage jobs after the reform and “the increase in their earnings was often
cancelled out by their loss of welfare benefits, leaving their overall income relatively
unchanged”.41 The situation of single mothers who could not find work deteriorated.42 As a
result, there was a 748 (!) per cent increase in the number of children of single-mother
families experiencing annual $2-a-day poverty between 1995 and 2012.43

Use of fraud as a smokescreen

33. Calls for welfare reform take place against a constant drumbeat of allegations of
widespread fraud in the system. Government officials warned the Special Rapporteur that
individuals are constantly coming up with new schemes to live high on the welfare hog, and
that individual states are gaming the welfare system to cheat the federal Government. The
contrast with tax reform is instructive. In the tax context, immense faith is placed in the
goodwill and altruism of the corporate beneficiaries, while with welfare reform the opposite
assumptions apply. The reality, of course, is that there are good and bad corporate actors
and there are good and bad welfare claimants. But while funding for the Internal Revenue
Service to audit wealthy taxpayers has been reduced, efforts to identify welfare fraud are
being greatly intensified. 44 Revelations of widespread tax avoidance by companies and
high-wealth individuals draw no rebuke, only acquiescence and the maintenance of the
loopholes and other arrangements designed to facilitate such arrangements. But revelations
of food stamps being used for purposes other than staying alive draw howls of outrage from
government officials and their media supporters.
34. Yet, despite repeated requests to officials for statistics on welfare fraud, the Special
Rapporteur has received little convincing evidence. The Government collects data on
“improper payments” made by federal departments and agencies, but this is a much broader
concept than fraud. A 2016 Government Accountability Office report showed an error rate
in 2015 of 3.66 per cent for the Supplemental Nutrition Assistance Program and 4.01 per
cent for public housing and rental assistance. By contrast, the error rate for travel pay by the
Department of Defense was 8 per cent.45
35. The percentage of Supplemental Nutrition Assistance Program benefit dollars issued
to ineligible households or to eligible households in excessive amounts was as low as 2.96
per cent in 2014. 46 According to the Center on Budget and Policy Priorities, the
overwhelming majority of those errors result from mistakes by different parties, rather than
from dishonesty or fraud by recipients. 47 Almost 60 per cent of the dollar value of
overpayments by states resulted from mistakes by the government, rather than recipients. 48
In 2015, 55 per cent of 723,111 investigations found no fraud. 49

41 Robert A. Moffitt and Stephanie Garlow, “Did welfare reform increase employment and reduce
poverty?” Pathways (Winter, 2018), p. 19.
42 Ibid.
43 H. Luke Shaefer and Kathryn Edin, “Welfare reform and the families it left behind”, Pathways
(Winter, 2018), p. 24.
44 Arthur Delaney, “Rich fraud, poor fraud: the GOP’s double standard on tax mistakes”, Huffington
Post, 14 December 2017.
45 United States Government Accountability Office, report to Congressional committees on improper
payments (June 2016), appendix III.
46 See https://fns-prod.azureedge.net/sites/default/files/snap/2014-rates.pdf. See also Center on Budget
and Policy Priorities, “SNAP: combating fraud and improving program integrity without weakening
success”, 9 June 2016, p. 10. Available at www.cbpp.org/sites/default/files/atoms/files/6-9-16fa-
testimony.pdf.
47 Center on Budget and Policy Priorities, “SNAP: combating fraud”, p. 11.
48 Ibid.
49 See https://fns-prod.azureedge.net/sites/default/files/snap/2015-State-Activity-Report.pdf.

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36. Fraud rhetoric is commonly used against persons with disabilities, large numbers of
whom allegedly receive disability allowances when they could actually be working full
time. When the Special Rapporteur probed into the reasons for the very high rates of
persons with disabilities in West Virginia receiving benefits, government officials
explained that most recipients had attained low levels of education, worked in demanding
manual labour jobs and were often exposed to risks that employers were not required to
guard against.

Social protection for children

37. Appropriate cognitive and socio-emotional stimulation, adequate nutrition and
health care, and stable and secure environments early in life are all essential ingredients in
maximizing children’s potential and achieving optimal life outcomes. Empirical evidence
suggests strong correlations between early childhood poverty and adverse life outcomes,
particularly those related to achievement skills and cognitive development.
38. From this perspective, the shockingly high number of children living in poverty in
the United States demands urgent attention. In 2016, 18 per cent of children (13.3 million)
were living in poverty, and children comprised 32.6 per cent of all people in poverty. 50
About 20 per cent of children live in relative income poverty, compared to the OECD
average of 13 per cent.51 Contrary to stereotypical assumptions, 31 per cent of poor children
are White, 24 per cent are Black, 36 per cent are Hispanic and 1 per cent are indigenous. 52
This is consistent with the fact that the United States ranks 25th out of 29 industrialized
nations in investing in early childhood education. 53
39. Poor children are also significantly affected by the country’s crises regarding
affordable and adequate housing. On a given night in 2017, about 21 per cent (or 114,829)
of homeless individuals were children. 54 But this official figure may be a severe
underestimate, since homeless children temporarily staying with friends, family or in
motels are excluded from the point-in-time count. 55 According to the Department of
Education, the number of homeless students identified as experiencing homelessness at
some point during the 2015/16 school year was 1,304,803.56
40. The infant mortality rate, at 5.8 deaths per 1,000 live births, is almost 50 per cent
higher than the OECD average of 3.9.57 On a positive note, the United States has increased
health insurance coverage for children through the expansion of Medicaid and the
Children’s Health Insurance Program, bringing child health insurance rates to a historic
high of 95 per cent.58 These achievements are, however, under threat, as discussed below.
41. In addition, the Supplemental Nutrition Assistance Program kept 3.8 million
children out of poverty in 2015,59 and in 2016, the earned income tax credit and the child
tax credit lifted a further 4.7 million children out of poverty. 60 By contrast, the reach and

50 Semega, Fontenot and Kollar, Income and Poverty, p. 14.

51 OECD, “How does United States compare on child well-being?” (November 2017).
52 Heather Koball and Yang Jiang, “Basic facts about low-income children: children under 18 years,
2016” (National Center for Children in Poverty, January 2018).
53 Robert Wood Johnston Foundation, “Can early childhood interventions improve health and well-
being?” (March 2016).
54 United States, Department of Housing and Urban Development, The 2017 Annual Homeless
Assessment Report (AHAR) to Congress, Part 1: Point-in-time estimates of Homelessness, p. 8.
55 Madeline Daniels, “Housing Department’s count of homeless children and youth problematic”, 19
November 2015. Available from https://campaignforchildren.org/news/press-release/housing-
departth-problematic/.
56
National Center for Homeless Education, Federal Data Summary: School Years 2013–14 to 2015–16,
p. iii.
57 OECD, “How does United States compare”.
58 Joan Alker and Alisa Chester, “Children’s health coverage rate now at historic high of 95 percent”
(Georgetown University Health Policy Institute, October 2016).
59 Center on Budget and Policy Priorities, “Policy basics: the Supplemental Nutrition Assistance
Program (SNAP)” (February 2018).
60 Center on Budget and Policy Priorities, “Policy basics: the child tax credit” (October 2017).

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impact of the Temporary Assistance for Needy Families programme has been very limited.
In 2016, only 23 per cent of families in poverty received cash assistance from that
programme, and the figure is less than 10 per cent in a growing number of states. 61

Adult dental care

42. The Affordable Care Act greatly expanded the availability of dental care to children,
but not for adults. Some 49 million Americans live in federally designated “dental
professional shortage areas” and Medicare (the programme for the aged and those with
disabilities) does not cover routine dental care. 62 The only access to dental care for the
uninsured is through the emergency room, where excruciating pain can lead to an
extraction. Even for those with coverage, access is not guaranteed, as only a minority of
dentists see Medicaid patients.63 Poor oral hygiene and disfiguring dental profiles lead to
unemployability in many jobs, being shunned in the community and being left unable to
function effectively. Yet there is no universal programme to address those issues, which
fundamentally affect the human dignity and ultimately the civil rights of the persons
concerned.

C. Reliance on criminalization to conceal the underlying poverty problem

Criminalization of the homeless

43. The official point-in-time estimates of homelessness in 2017 show a nationwide
figure of 553,742, including 76,501 in New York, 55,188 in Los Angeles and 6,858 in San
Francisco. 64 There is ample evidence that these figures significantly underestimate the
actual scale of the problem.
44. In many cities, homeless persons are effectively criminalized for the situation in
which they find themselves. Sleeping rough, sitting in public places, panhandling, public
urination and myriad other offences have been devised to attack the “blight” of
homelessness. The criminalization of homeless individuals in cities that provide almost
zero public toilets seems particularly callous. In June 2017, it was reported that the
approximately 1,800 homeless individuals on Skid Row in Los Angeles had access to only
nine public toilets.65 Los Angeles failed to meet even the minimum standards the United
Nations High Commissioner for Refugees sets for refugee camps in the Syrian Arab
Republic and other emergency situations. 66
45. Ever more demanding and intrusive regulations lead to infraction notices for the
homeless, which rapidly turn into misdemeanours, leading to warrants, incarceration,
unpayable fines and the stigma of a criminal conviction that in turn virtually prevents
subsequent employment and access to most housing. Yet the authorities in cities such as
Los Angeles and San Francisco often encourage this vicious circle. On Skid Row in Los
Angeles, 14,000 homeless persons were arrested in 2016 alone, an increase of 31 per cent
over 2011, while overall arrests in the city decreased by 15 per cent. 67 Citizens and local
authorities, rather than treating homeless persons as affronts to their sensibilities and
neighbourhoods, should see in their presence a tragic indictment of community and
government policies. Homelessness on this scale is far from inevitable and reflects political
choices to see the solution as law enforcement rather than adequate and accessible low-cost

61 Center on Budget and Policy Priorities, “TANF reaching few poor families” (December 2017).
62 Mary Otto, Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America (New
York, The New Press, 2017), p. vii.
63
Ibid., pp. 37, 120 and 171.
64 United States, Department of Housing and Urban Development, The 2017 Annual Homeless
Assessment Report.
65 Alastair Gee, “At night on Skid Row, nearly 2,000 homeless people share just nine toilets”, The
Guardian, 30 June 2017.
66 See https://emergency.unhcr.org/entry/33015/emergency-sanitation-standard.
67 Gale Holland and Christine Zhang, “Huge increase in arrests of homeless in L.A. – but mostly for
minor offenses”, Los Angeles Times, 4 February 2018.

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housing, medical treatment, psychological counselling and job training. 68 The Right to Rest
Act introduced in California, Colorado and Oregon is an example of the type of legislative
approach needed to shift from the criminal justice response to a human rights-centred
response to homelessness.
46. As the Special Rapporteur explained in more detail in his 15 December 2017
statement,69 coordinated entry systems to match housing supply for the homeless to demand
have been introduced in Los Angeles, San Francisco and elsewhere. These are premised
partly on the idea that homelessness is a data problem and that new information
technologies are key to solving it.70 But despite the good intentions behind them, including
the reduction of duplication and fragmentation in service delivery, coordinated entry
systems simply replicate many problems associated with existing policy responses. They
contribute to the process of criminalization by requiring the homeless to take part in an
intrusive survey that makes many feel they “are giving up their human right to privacy in
return for their human right to housing”.71 Many participants fear that police forces have
access to data collected from the homeless; it could be concluded from conversations
between the Special Rapporteur and officials and experts that this fear may well be
justified. The introduction of coordinated entry systems has also been criticized for being
costly and diverting resources and attention away from the key problem, which is the lack
of available housing for those in need.72 New information technology-based solutions, such
as coordinated entry systems, might bring improved reliability and objectivity, but the
vulnerability scores they produce have been challenged for their randomness.73

Treatment of the poor in the criminal justice system

47. In many cities and counties, the criminal justice system is effectively a system for
keeping the poor in poverty while generating revenue to fund not only the justice system
but many other programmes. The use of the legal system to raise revenue, not to promote
justice, as was documented so powerfully in a 2015 report on Ferguson, Missouri by the
Department of Justice,74 is pervasive around the country.
48. So-called fines and fees are piled up so that low level infractions become immensely
burdensome, a process that affects only the poorest members of society, who pay the vast
majority of such penalties. Driving licences are also commonly suspended for a wide range
of non-driving related offences, such as a failure to pay fines. 75 This is a perfect way to
ensure that the poor, living in communities that have steadfastly refused to invest in serious
public transport systems, are unable to earn a living that might have helped to pay the
outstanding debt. Two paths are open: penury, or driving illegally, thus risking even more
serious and counterproductive criminalization.
49. Another practice that affects the poor almost exclusively is that of setting large bail
bonds for a defendant who seeks to go free pending trial. Some 11 million people are
admitted to local jails annually, and on any given day more than 730,000 people are being
held, of whom almost two thirds are awaiting trial, and thus presumed to be innocent. Yet
judges have increasingly set large bail amounts, which means that wealthy defendants can

68 See, for example, Gary Blasi and Phillip Mangano, “Stop punishing and start helping L.A.’s
homeless”, Los Angeles Times, 30 June 2015.
69 See paras. 54–61. Available at www.ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx?
NewsID=22533&LangID=E.
70 See, for example, City of Los Angeles, Comprehensive Homeless Strategy (2016), p. 49.
71 Statement made during a civil society consultation, San Francisco, 6 December 2017.
72 A recent publication estimated that in Los Angeles alone the coordinated entry system had cost about
$11 million since its introduction, including only the cost of technical resources, software and extra
personnel, not the cost of providing actual housing or services. (Virginia Eubanks, Automating
Inequality (New York, St. Martin’s Press, 2018), p. 113.
73 Ibid., chap. 3.
74 See www.justice.gov/sites/default/files/opa/press-releases/attachments/2015/03/04/
ferguson_police_department_report.pdf.
75 See, for example, Lawyers’ Committee for Civil Rights of the San Francisco Bay Area and others,
“Not just a Ferguson problem: how traffic courts drive inequality in California” (2015).

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secure their freedom while poor defendants are likely to stay in jail, with severe
consequences such as loss of jobs, disruption of childcare, inability to pay rent and deeper
destitution.
50. A major movement to eliminate bail bonds is gathering steam across the United
States, and needs to be embraced by anyone concerned about the utterly disproportionate
negative impact of the justice system upon the poor. The purpose of the reform is to link
pretrial detention to risk rather than wealth. A growing number of jurisdictions are adopting
risk assessment tools to assist in pretrial release and custody decisions. This is a positive
development, but the widespread use of risk assessment tools also raises human rights
concerns.
51. The fear is that highly political questions about the level of risk that society
considers acceptable are hidden behind the veneer of technical design choices, that obscure
algorithms disproportionally identify poor defendants as “high risk” by replicating the
biased assumptions of previous human decision makers, 76 and that private contractors who
develop risk assessment tools will refuse to divulge their content on the grounds that the
information is proprietary, which leads to serious due process concerns affecting the civil
rights of the poor in the criminal justice system.77
52. Solutions to major social challenges in the United States are increasingly seen to lie
with privatization, especially in the criminal justice system. Bail bond corporations, which
exist in only one other country in the world, precisely because they distort justice,
encourage excessive and often unnecessary levels of bail, and lobby for the maintenance of
a system that by definition penalizes the middle class and the poor.78
53. In some states, minor offences are routinely punished by placing the offender on
probation, overseen by a for-profit corporation, entirely at the expense of the usually poor
offender. Those who cannot pay are subject to additional fees, supervision and testing. 79
Similarly, in 26 states judges issue arrest warrants for alleged debtors at the request of
private debt collectors, thus violating the law and human rights standards. The practice
affects primarily the poor by subjecting them to court appearances, arrest warrants that
appear on background checks, and jail time, which interfere with their wages, their jobs,
their ability to find housing and more. 80

D. Persistent discrimination and poverty

Race
54. The United States remains a chronically segregated society. Blacks are 2.5 times
more likely than Whites to be living in poverty, their infant mortality rate is 2.3 times that
of Whites, their unemployment rate is more than double that for Whites, they typically earn
only 82.5 cents for every dollar earned by a White counterpart, their household earnings are
on average well under two thirds of those of their White equivalents, and their incarceration
rates are 6.4 times higher than those of Whites. 81 These shameful statistics can only be

76 Written submission to the Special Rapporteur from Edward W. Felten and Bendert Zevenbergen,
Princeton University.
77 AI Now, “AI Now 2017 report”.
78 See, for example, www.hrw.org/report/2018/02/20/set-fail/impact-offender-funded-private-probation-
poor.
79 Human Rights Watch, “Set up to Fail”: The Impact of Offender-Funded Private Probation on the
Poor (2018).
80 American Civil Liberties Union, “First-ever national report on widespread court practices that coerce
payments from people in debt without due process”, February 2018. See also American Civil
Liberties Union, A Pound of Flesh: The Criminalization of Private Debt (2018).
81 Economic Policy Institute, “50 years after the Kerner Commission” (26 February 2018). See also Fred
Harris and Alan Curtis (eds.), Healing Our Divided Society (Temple University Press, 2018).

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explained by long-standing structural discrimination on the basis of race, reflecting the

enduring legacy of slavery.82
55. Ironically, politicians and mainstream media portrayals distort this situation in order
to suggest that poverty in America is overwhelmingly Black, thereby triggering a range of
racist responses and encouraging Whites to see poverty as a question of race. Too often the
loaded and inaccurate message that parts of the media want to convey is “lazy Blacks
sponge off hard-working Whites”.

Gender
56. Women often experience the burdens of poverty in particularly harsh ways. Poor
pregnant women who seek Medicaid prenatal care are subjected to interrogations of a
highly sensitive and personal nature, effectively surrendering their privacy rights. 83 Low-
income women who would like to exercise their constitutional, privacy-derived right to
access abortion services face legal and practical obstacles, such as mandatory waiting
periods and long driving distances to clinics. This lack of access to abortion services traps
many women in cycles of poverty.84 When a child is born to a woman living in poverty, that
woman is more likely to be investigated by the child welfare system and have her child
taken away from her.85 Poverty is frequently treated as a form of “child neglect” and thus as
cause to remove a child from the home,86 a risk exacerbated by the fact that some states do
not provide legal aid in child welfare proceedings. 87
57. Racial discrimination makes matters even worse for many poor women. Black
women with cervical cancer — a disease that can easily be prevented or cured — have
lower survival rates than White women, due to later diagnosis and treatment differences, 88
owing to a lack of health insurance and regular access to health care. The United States has
the highest maternal mortality ratio among wealthy countries, and black women are three to
four times more likely to die than White women. In one city, the rate for Blacks was 12
times higher than that for Whites.89
58. In rural areas, women face significantly higher poverty rates, as well as related child
poverty.90 In economically depressed areas of the Midwest, rural Appalachia and the deep
south unemployment is high and essential services, such as childcare, health care and
grocery stores, are unavailable or difficult to access. 91 A lack of adequate public transport
means that families are unable to access decent supermarkets and instead rely
predominantly on expensive and poorly stocked local stores. In general, poor women and

82 Center for American Progress, “Systematic inequality: how America’s structural racism helped create
the black-white wealth gap” (2018). See also Tommie Shelby, Dark Ghettos: Injustice, Dissent and
Reform (Belknap Press, 2016).
83 Khiara M. Bridges, The Poverty of Privacy Rights (Stanford University Press, 2017).
84 Diana Greene Foster and others, “Socioeconomic outcomes of women who receive and women who
are denied wanted abortions in the United States”, American Journal of Public Health, vol. 108, No. 3
(March 2018), p. 407.
85 Written submissions to the Special Rapporteur from National Advocates for Pregnant Women and the
Center for Reproductive Rights.
86 Maren K. Dale, “Addressing the underlying issue of poverty in child-neglect cases” (10 April 2014).
Available at www.americanbar.org/aba.html.
87 Written submission to the Special Rapporteur from National Advocates for Pregnant Women.
88 Wonsuk Yoo and others, “Recent trends in racial and regional disparities in cervical cancer incidence
and mortality in United States”, PLOS ONE, vol. 12, No. 2 (February 2017).
89 New York City Department of Health and Mental Hygiene, Pregnancy-Associated Mortality: New
York City, 2006–2010. Available from www1.nyc.gov/assets/doh/downloads/pdf/ms/pregnancy-
associated-mortality-report.pdf.
90 See, for example, Southern Rural Black Women’s Initiative for Economic and Social Justice,
Unequal Lives: The State of Black Women and Families in the Rural South, p. 6.
91 Lisa R. Pruitt and Janet L. Wallace, “Judging parents, judging place: poverty, rurality and termination
of parental rights”, Missouri Law Review, vol. 77 (2011), p. 117.

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their children are more likely to be obese and suffer serious health issues and non-
communicable diseases that hinder them for the rest of their lives. 92
59. Female immigrants, who often suffer racial discrimination from employers and find
it more difficult to get jobs, experience higher poverty rates and have much less access to
social protection benefits than other women. 93 Undocumented women live a kind of half-
life, in which they experience exploitation, abuse and wage theft, and are refused access to
utilities such as water, but are unable to seek assistance or protection for fear of
deportation.94 While their undocumented status raises difficult legal and policy questions,
their shadow existence as mothers of United States citizens and as domestic, sex or other
workers undermines their ability to live a life in dignity. Even many permanent residents
who have lived in the United States for less than five years are excluded from coverage
under the Affordable Care Act 95 and assistance such as the Supplemental Nutrition
Assistance Program, the Temporary Assistance for Needy Families programme and housing
benefits.96
60. Lack of Internet connectivity in rural impoverished communities negatively affects
access to social protection benefits, other government services and even employment. 97 In
West Virginia, where an estimated 30 per cent of the population lack access to high speed
broadband (compared to 10 per cent nationally) and 48 per cent of rural West Virginians
lack such access (compared to 39 per cent of the rural population nationally), 98 the
government has no serious plans to improve access.

Indigenous peoples
61. The Special Rapporteur heard testimonies from Chiefs and representatives of
federally recognized and non-recognized tribes on widespread extreme poverty in their
communities. Indigenous peoples, as a group, suffer disproportionately from
multidimensional poverty and social exclusion. The 2016 poverty rate among American
Indian and Alaska Native peoples was 26.2 per cent, the highest among all ethnic groups. 99
Indigenous peoples also have the highest unemployment rate of any ethnic group: 12 per
cent in 2016, compared to the national average of 5.8 per cent. 100 One in four indigenous
young people aged 16 to 24 are neither enrolled in school nor working. 101
62. Disparities between indigenous and non-indigenous health status have long been
recognized but not effectively addressed. American Indians and Alaska Natives face almost
a 50 per cent higher death rate than do non-Hispanic White people, due to illnesses such as
heart disease, cancer, chronic liver disease and diabetes.102 Poverty, unemployment, social

92 See, for example, Southern Rural Black Women’s Initiative for Economic and Social Justice,
Unequal Lives.
93 See www.migrationpolicy.org/article/immigrant-women-united-states#Poverty.
94 Written submission to the Special Rapporteur from the Miami Workers Center and others on the
feminization of poverty in Miami; Azadeh Shahshahani and Kathryn Madison, “No papers? You can’t
have water: a critique of localities’ denial of utilities to undocumented immigrants”, Emory
International Law Review, vol. 31, No. 4 (2017).
95 Samantha Artiga and Anthony Damico, Health Coverage and Care for Immigrants, issue brief (The
Henry J. Kaiser Family Foundation, 2017).
96 See, for example, the submission from the Miami Workers Center and others, and Shahshahani and
Madison, “No papers?”.
97 See, for example, the written submission to the Special Rapporteur from Access Now. Broadband
access is also seriously lacking in the South (Southern Rural Black Women’s Initiative for Economic
and Social Justice, Unequal Lives, p. 16).
98 West Virginia Center on Budget and Policy and American Friends Service Committee, 2016 State of
Working West Virginia: Why is West Virginia so Poor?, p. 55.
99 United States Census Bureau, “American Indian and Alaska Native Heritage — Month: November
2017”. Available at www.census.gov/content/dam/Census/newsroom/facts-for-features/2017/cb17-
ff20.pdf.
100 The Aspen Institute, 2017 State of Native Youth Report: Our Identities as Civic Power, p. 33.
101 Ibid., p. 37.
102 David Espey and others, “Leading causes of death and all-cause mortality in American Indians and
Alaska Natives”, American Journal of Public Health (June 2014), vol. 104, No. S3.

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exclusion and loss of cultural identity also have significant mental health ramifications and
often lead to a higher prevalence of substance abuse, domestic violence and alarmingly
high suicide rates in indigenous communities, particularly among young people. Suicide is
the second leading cause of death among American Indians and Alaska Natives aged
between 10 and 34.103
63. In entering a “trust relationship” with the recognized tribes, the Government
assumed duties to provide for economic and social programmes to ensure the welfare of the
relevant indigenous groups.104 But their very high poverty rates attest to the Government’s
failure in this respect. Chronic underfunding of the relevant federal government
departments is a significant part of the problem. 105 The situation has also been compounded
by paternalistic attitudes, 106 which run directly counter to the approach reflected in
international human rights law and standards, particularly the United Nations Declaration
on the Rights of Indigenous Peoples, which the Government endorsed in 2010.
64. The situation of non-federally recognized tribes is even more desperate, for they are
not eligible to benefit from federally funded programmes. While 567 tribes are federally
recognized, some 400 are not.107 The latter exist in a context in which their way of life is
not legally sanctioned, they are disempowered and their culture is threatened. Failure to
collect disaggregated data for those tribes also hinders the development of evidence-based
policies to address their situation.

E. Confused and counterproductive drug policies

65. The opioid crisis has devastated many communities, and the addiction to pain-
control opioids often leads to heroin, methamphetamine and other substance abuse. Instead
of responding with increased funding and improved access to vital care and support, the
federal Government and many state governments have instead mounted concerted
campaigns to reduce and restrict access to health care by the poorer members of the
population.108
66. In terms of welfare, the main responses have been punitive. States increasingly seek
to impose drug tests on recipients of welfare benefits, with programmes that lead to
expulsion from the programme for repeat offenders. Others have introduced severe
punishments for pregnant women who abuse drugs. Medical professionals recognize that
such policies are counterproductive, highly intrusive and misplaced. The urge to punish
rather than assist the poor often also has racial undertones, as in the contrast between the
huge sentences handed down to those using drugs such as crack cocaine (predominantly
Black) and those using opioids (overwhelmingly White).

F. Environmental pollution

67. Poor rural communities throughout the United States are often located close to
polluting industries that pose an imminent and persistent threat to their human right to

103 Centers for Disease Control and Prevention, Leading Causes of Death Reports, 1981–2016.
104 See www.acf.hhs.gov/ana/resource/american-indians-and-alaska-natives-the-trust-responsibility.
105 See, for example, United States Government Accountability Office, Progress on Many High-Risk
Areas, While Substantial Efforts Needed on Others, report to congressional committees (February
2017). Available at https://www.gao.gov/assets/690/682765.pdf.
106 See A/HRC/21/47/Add.1, para. 15.
107 United States Government Accountability Office, Federal Funding for Non-Federally Recognized
Tribes (April 2012). Available at www.gao.gov/assets/600/590102.pdf.
108 See, for example, Debra E. Houry, Tamara M. Haegerich and Alana Vivolo-Kantor, “Opportunities for
prevention and intervention of opioid overdose in the emergency department”, Annals of Emergency
Medicine (2018).

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health. 109 At the same time, poor communities benefit very little from these industries,
which they effectively subsidize because of the low tax rates offered by local governments
to the relevant corporations.
68. Poor communities suffer especially from the effects of exposure to coal ash, which
is the toxic remains of coal burned in power plants. It contains chemicals that cause cancer,
developmental disorders and reproductive problems, 110 and is reportedly dumped in about
1,400 sites around the United States — 70 per cent of which are situated in low-income
communities. 111 In Puerto Rico, the Special Rapporteur visited Guayama, where poor
communities live close to a plant owned by Applied Energy Systems (AES) that produces
coal ash. Community members noted severe negative impacts on their health and economic
activities; neither federal nor local authorities had taken action. In March 2018 the
Environmental Protection Agency proposed a new rule that would significantly undermine
existing inadequate protections against coal ash disposal.
69. In Alabama and West Virginia, a high proportion of the population is not served by
public sewerage and water supply services. Contrary to the assumption in most developed
countries that such services should be extended by the government systematically and
eventually comprehensively to all areas, neither state was able to provide figures as to the
magnitude of the challenge or details of any planned government response.

VII. Conclusions and recommendations

70. The following analysis focuses primarily on the federal level. It is nonetheless
ironic that those who fight hardest to uphold state rights also fight hard to deny city
and county rights. If the rhetoric about encouraging laboratories of innovation is to be
meaningful, the freedom to innovate cannot be restricted to state politicians alone.

1. Decriminalize being poor

71. Punishing and imprisoning the poor is the distinctively American response to
poverty in the twenty-first century. Workers who cannot pay their debts, those who
cannot afford private probation services, minorities targeted for traffic infractions,
the homeless, the mentally ill, fathers who cannot pay child support and many others
are all locked up. Mass incarceration is used to make social problems temporarily
invisible and to create the mirage of something having been done.
72. It is difficult to imagine a more self-defeating strategy. Federal, state, county
and city governments incur vast costs in running jails and prisons. Sometimes these
costs are “recovered” from the prisoners, thus fuelling the latter’s cycle of poverty
and desperation. The criminal records attached to the poor through imprisonment
make it even harder for them to find jobs, housing, stability and self-sufficiency.
Families are destroyed, children are left parentless and the burden on governments
mounts. But because little is done to address the underlying causes of the original
problem, it continues to fester. Even when imprisonment is not the preferred option,
the standard response to those facing economic hardship is to adopt policies explicitly
designed to make access to health care, sick leave and welfare and child benefits more
difficult to access and the receipt of benefits more stigmatizing.
73. A cheaper and more humane option is to provide proper social protection and
facilitate the return to the workforce of those who are able. In the United States, it is
poverty that needs to be arrested, not the poor simply for being poor.

109 Bill Chameides, “A look at environmental justice in the United States today,” Huffington Post Blog,
20 January 2014. Available at www.huffingtonpost.com/bill-chameides/a-look-at-environmental-
j_b_4633223.html.
110 Earthjustice, “Fighting for protections from coal ash”. Available at
https://earthjustice.org/our_work/cases/2012/legal-fight-for-long-overdue-coal-ash-protections.
111 Oliver Milman, “A civil rights ‘emergency’: justice, clean air and water in the age of Trump”, The
Guardian, 20 November 2017.

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2. Acknowledge the plight of the middle class

74. Only 36 per cent of Republican voters consider that the federal Government
should do more to help poor people, and 33 per cent believe that it already does too
much.112 The paradox is that the proposed slashing of social protection benefits will
affect the middle classes every bit as much as the poor. Almost a quarter of full-time
workers, and three quarters of part-time workers, receive no paid sick leave. Absence
from work due to illness thus poses a risk of economic disaster. About 44 per cent of
adults either could not cover an emergency expense costing $400 or would need to sell
something or borrow money to do it. Over a quarter of all adults are classified as
having no access or inadequate access to banking facilities. 113 The impacts of
automation, artificial intelligence and the increasing fluidity of work arrangements
mean that employer-provided social protection will likely disappear for the middle
classes in the years ahead. If this coincides with dramatic cutbacks in government
benefits, the middle classes will suffer an ever more precarious economic existence,
with major negative implications for the economy as a whole, for levels of popular
discontent and for political stability.

3. Acknowledge the damaging consequences of extreme inequality

75. The United States already leads the developed world in income and wealth
inequality, and it is now moving full steam ahead to make itself even more unequal.
But this is a race that no one else would want to win, since almost all other nations,
and all the major international institutions, such as OECD, the World Bank and IMF,
have recognized that extreme inequalities are economically inefficient and socially
damaging. The trajectory of the United States since 1980 is shocking. In both Europe
and the United States, the richest 1 per cent earned around 10 per cent of national
income in 1980. By 2017 that had risen slightly in Europe to 12 per cent, but massively
in the United States, to 20 per cent. Since 1980 annual income earnings for the top 1
per cent in the United States have risen 205 per cent, while for the top 0.001 per cent
the figure is 636 per cent. By comparison, the average annual wage of the bottom 50
per cent has stagnated since 1980.114
76. The problem is that “inequality” lacks salience with the general public, who
have long been encouraged to admire the conspicuous, and often obscene,
consumption of billionaires and celebrities. What extreme inequality actually signifies
is the transfer of economic and political power to a handful of elites who inevitably use
it to further their own self-interest, as demonstrated by the situation in various
countries around the world. While the poor suffer, so too do the middle class, and so
does the economy as a whole. High inequality undermines sustained economic growth.
It manifests itself in poor education levels, inadequate health care and the absence of
social protection for the middle class and the poor, which in turn limits their economic
opportunities and inhibits overall growth.
77. Extreme inequality often leads to the capture of the powers of the State by a
small group of economic elites. The combined wealth of the United States Cabinet is
around $4.3 billion. As noted by Forbes: “America’s first billionaire president has
remained devoted to the goal of placing his wealthy friends in his Cabinet, a top
campaign promise.” 115 And many regulatory agencies are now staffed by “political
appointees with deep industry ties and potential conflicts”.116 Extreme inequality thus

112 Pew Research Center, “Majorities say Government does too little for older people, the poor and the
middle class” (2018). Available at http://assets.pewresearch.org/wp-content/uploads/sites/5/2018/01/
30104502/01-30-18-groups-release.pdf.
113 Board of Governors of the Federal Reserve System, Report on the Economic Well-Being of U.S.
Households in 2016 (May 2017).
114 Facundo Alvaredo and others, coordinators, World Inequality Report 2018, (World Inequality Lab).
115 Chase Peterson-Withorn, “The $4.3 billion Cabinet: see what each top Trump advisor is worth,”
Forbes, 5 July 2017.
116 D. Ivory and R. Faturechi, “The deep industry ties of Trump’s deregulation teams”, New York Times,
11 July 2017.

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poses a threat not just to economic efficiency but to the well-being of American
democracy.

4. Recognize a right to health care

78. Health care is, in fact, a human right. The civil and political rights of the
middle class and the poor are fundamentally undermined if they are unable to
function effectively, which includes working, because of a lack of the access to health
care that every human being needs. The Affordable Care Act was a good start,
although it was limited and flawed from the outset. Undermining it by stealth is not
just inhumane and a violation of human rights, but an economically and socially
destructive policy aimed at the poor and the middle class.

5. Get real about taxes

79. At the state level, the demonizing of taxation means that legislatures effectively
refuse to levy taxes even when there is a desperate need. Instead they impose fees and
fines through the back door, some of which fund the justice system and others of
which go to fund the pet projects of legislators. This sleight-of-hand technique is a
winner, in the sense that the politically powerful rich get to pay low taxes, while the
politically marginalized poor bear the burden but can do nothing about it. There is a
real need for the realization to sink in among the majority of the American population
that taxes are not only in their interest, but also perfectly reconcilable with a growth
agenda. A much-cited IMF paper concluded that redistribution could be good for
growth, stating: “The combined direct and indirect effects of redistribution —
including the growth effects of the resulting lower inequality — are on average pro-
growth.”117

117 Jonathan Ostry, Andrew Berg and Charalambos G. Tsangarides, Redistribution, Inequality, and
Growth, IMF Staff Discussion Note (IMF, 2014), p. 4.

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