There is now ample documentary evidence to show that poverty—and the physical, intellectual, and emotional deprivations that go with it—can be a direct cause of mental retardation.
The poor of all races are affected and—in absolute numbers—there are more whites than Negroes who suffer from it. I am, however, particularly interested in this subject because the Negro poor are victimized by this alarming situation more than others, since, in relative numbers, there are far more poor Negroes than poor whites. Too many children, and all too frequently, Negro children, thus pay a heavy price for the injustices of our society.
We know today that only a few among all those who are mentally retarded suffer from an obvious organic defect with genetic cause. Genetic defects affect all levels of society in the same way, whether those afflicted are rich or poor, white or Negro. But it is quite different when damage to the brain is due not to a genetic cause but to disease before or after birth, or else to accident, infection, or poisoning. The poor, whether they are white or Negro, are more often its victims. And the mentally retarded who do not show any organic brain damage—those who are only functionally retarded—come predominantly from the poorer sections of our society. Functional retardation is very rare among those with high incomes and among well educated segments of the community. But it is very common—it can be detected in as many as 15 percent of all children—in deprived rural areas and in the chaos of the inner cities. This is now so well accepted that we have given the name of “socio-environmental retardation” to this kind of functional retardation prevalent among the deprived. More than half of all mentally retarded people fall into this last category.
What in fact are the environmental factors in the life of the poor that stunt their intellectual development?
To begin with, we are now convinced that intelligence itself is largely controlled by the kind of diet a child receives. Evidence was presented at a recent International conference that malnutrition in the first three years of life may permanently impair intelligence and it has been estimated that more than half of the 90 million babies born each year may run a risk of permanent retardation resulting from malnutrition. Moreover, experiments with several kinds of laboratory animals suggest that malnutrition at certain critical times during development of the brain—for the human species this would be about the time of birth—can cause long-term damage to brain structure and to the bodily functions it controls.
So, malnutrition among pregnant women as well as newborn children can be an important cause of mental retardation and is its major cause, on a worldwide basis.
In our own country, the Department of Agriculture found that in two Mississippi Delta counties 60 percent of children receive less than two thirds of the minimum dietary allowance recommended by the National Research Council. Among the underprivileged children of our society in general, still other factors are at work, probably more often than simple malnutrition. There is a whole catalog of them—ranging from all those circumstances that threaten physical development to insidious but powerful psychological factors.
The children of poverty—those who inherit the circumstances rather than the genes that predispose to mental retardation—have to fight against heavy odds from the very moment they are conceived.
Their mothers—often undernourished themselves—are still victims of toxemia of pregnancy, as well as of infections and physical hardships that the more affluent do not encounter. Thirty percent of the women who live in poverty, either in rural areas or else in towns of over 100,000 people, never get medical supervision during their pregnancies. Among the 500,000 indigent women giving birth each year, 100,000 need special medical help for complications. Most of them never get it. For one thing they give birth to premature children three times more often than middle class mothers, and it is well known that three quarters of all premature children, weighing less than three pounds at birth, develop physical and mental defects.
Knowledge of family planning, as well as realization of the importance of medical attention during pregnancy, is still widely lacking among the poor. Moreover, they don't know how to use, or else, for many reasons, cannot avail themselves of the resources that provide such knowledge and services. So illegitimate births, as well as families which are too large, not only for the parents' income, but also for their emotional and physical resources, occur all too frequently.
Brain damage resulting from continuous low-level exposure to lead, to which the children of the poor are commonly exposed because of the cheap, lead-containing paints frequently used in the slums, occurs almost exclusively among the deprived. One study showed that as many as 5 per cent of the children in slum areas had dangerous levels of lead in their bloodstreams.
In addition, infectious diseases are far more common among the poor: tuberculosis, for example, is 3 to 5 times more prevalent among them than among middle income or affluent groups. Crowded living conditions increase the incidence of several chronic and latent infections that have been suspected as a direct cause of mental defects in unborn babies when their mothers are exposed to such conditions during pregnancy. Childhood infections, some of which—such as measles—can cause brain damage, are more widely spread because too many children remain unvaccinated.
It has been reported, for example, that in New York, in 1961, 21 per cent of children from families whose incomes were three thousand dollars or less, have not received smallpox vaccinations; only 4 percent of children from families with incomes of nine thousand dollars and over remained unvaccinated. The corresponding figures for diptheria-tetanus vaccination are 19 per cent and 2 per cent. “The situation is even worse in the small, minor income groups. In one of these groups (the second-lowest income) 31 percent of all students did not receive smallpox vaccinations, and 2.8 per cent had no diptheria-tetanus shots.”
So there are still children who have suffered brain damage, after catching whooping cough, although vaccination has been available for this disease for several decades!
Even accidents are more likely to happen to poor children, usually because they are inadequately supervised: in this country, one million children each year suffer head injuries—about 8 out of each 1000 children between the ages of 4 to 18 every year. Such injuries alone account for 10 percent of the institutionalized population.
All these physical and environmental causes of mental retardation—most of them preventable—account for more cases of brain damage in the total population than all the genetic causes lumped together.
And I have mentioned so far only grossly obvious, physically injurious factors.
Let us now consider some others, social and psychological factors that are themselves by-products of the misery of the few and the prejudice of the many.
In poor households, many children are badly cared for and so are deprived of intellectual, sensorial and emotional stimulation.
There are many “unavailable mothers”—not only working mothers, but also those who are unable to supply the needs of their children because of difficulties of their own: they are emotionally unavailable. Among them are those who cannot arouse themselves sufficiently from their passivity or lethargy to show affection for their children. Others are deeply depressed or mentally ill and reject their children for any of a multitude of reasons.
As a result of this there is often no proper family structure, the home becomes disrupted and damaging to the child's character. Parents do not seek help and very often distrust the social institutions that can provide it.
Under such conditions, every individual has to use all his meager energies just to keep body and soul together. He has to fight all the time just to survive. Parents have neither the means nor the ability to provide their children with stimulating conversation, with books, music, travel, or the other intellectual and cultural advantages bestowed almost automatically on most children of the middle and upper income groups.
When a lack of motivation and opportunity for learning in early years are added to other adverse conditions such as poor diet, bad health habits and inadequate sanitation, lack of pre-natal and post-natal care, emotional disorders, and crowded living conditions—it should come as no surprise that the result is often stunted intellectual development.
Children from families like these come to school for the first time without either the experience or the skills necessary for learning. They are backward in language and have no ability for the abstract thought necessary for reading, writing, and arithmetic. Their failure to learn becomes complicated by emotional disorders like frustration and anxiety.
And then, too just being poor is a frightful stigma in this country—where accomplishment is largely measured by economic success.
Anyone who has watched poor children and their families in countries where poverty is the usual condition of humanity—in Africa, South America and Asia—is aware that poverty by itself does not necessarily preclude warmth and communication within the family. But in countries where poverty is found side by side with affluence, a new condition exists. It has been aptly described by Oscar Lewis as the “culture of poverty,” that appears in all large, poor communities isolated in the midst of general prosperity. It involves an attitude of lethargy and indifference, or sometimes strange forms of escapism and rebellion, that represent both a reaction to the stigma imposed by the affluent world and a defense against the poor opinion the underprivileged have of themselves. In Lewis' words, “the individual who grows up in this slum culture has a strong feeling of fatalism, helplessness, dependence and inferiority.”
In the competitive and puritanical white society that prevails in this country, social and economic success have often become equated with goodness and, as a result, the unsuccessful and the economically weak have been regarded as inferior and bad. This belief was frankly and brutally expressed by a New Jersey farmer, who referred to the migrant workers on his land as “nothing . . . they never were nothing, they never will be nothing and you and me and God almighty ain't going to change them.”
The tragedy is that the American dream, the myth of equal opportunity for all in this country, is so deeply ingrained, that even the unsuccessful often believe in it, and have therefore a painfully poor opinion of themselves.
So the world of the “culture of poverty” is a world that rejects our targets of success and social status, ethics, and social values not for intellectual reasons, but out of despair. Nevertheless, it is a world with its own rules, taboos, pride, and scale of values. This is a world we have to learn to understand with intelligence and compassion, with which we have to learn to communicate, and which we must convince, despite its skepticism and its suspicion, that our goals are worthwhile. We have to prevent its spread, because it breaks the human spirit and so becomes the breeding ground of retardation.
We, the Negroes, have suffered discrimination, abuse and neglect for generations and we still live, by and large, a life isolated from the mainstream of society. Crowded into urban slums, pressured from all sides, poorly educated, and poorly equipped to compete, we are further demoralized by the indifference of the affluent society around us. So the poorer among us acquire the psychological characteristics of the slum culture. A chronically impoverished and humiliated population cannot respond to opportunity—the better opportunity recently offered by new legislation—as if poverty was a temporary accidental setback. The harm already done is too deep. It has long ago penetrated to the very souls of its victims.
By the time they reach school, poor Negro children already often possess built-in physical and psychological handicaps and in school, they are likely to face new obstacles which, although less obvious, may be just as harmful. What these obstacles are is best illustrated by an experiment of fundamental importance, recently carried out in California by Robert Rosenthal and Lenore Jacobson. To study the effect of teachers' attitudes on the performance of their pupils they chose a school with mixed Caucasian and Mexican children, picked out 20 percent of the children at random, and then told the teachers casually that these children were expected as a result of psychological tests to be “spurters”—that is, to make considerable progress during the next school year. Although these particular children did not receive special tutorial attention, and the curriculum of the school remained unchanged, their IQ—when tested a year later—had gone up remarkably. Those children whose IQ was the lowest to start with, made relatively the most progress. The children not designated originally as “spurters,” on the other hand, showed much less progress. This was observed for many teachers, over several grades, as well as in classes designed specially for bright, average, and slow learners. Even more interesting, when the teachers were asked to evaluate their pupils' progress, they described the progress of “bright” children in very positive terms, like “outgoing, curious, sociable, interested, etc.” But when they described progress made by an undesignated child, particularly one originally labelled “slow-learner,” their evaluation had negative connotations.
What are the implications of this? Mainly that when a child is expected by his teacher to be slow, he conforms to expectations. When the teacher expects the child to be bright—even when he never tells him so and does not change his method of teaching—the child feels it and blooms. The California teachers were busily and, quite unconsciously engaged in fulfilling their own prophecies, communicating to the children, in quite subtle and unintended ways, expectations which, in fact, did influence the child's performance. Moreover, their evaluations expressed resentment towards pupils who made unexpected progress.
It cannot be doubted that similar insidious—even unconscious—prejudice is widespread. In a society where the poor are generally considered inferior beings, where the Negro's potential for intellectual development is still largely doubted, what expectations a middle-class teacher may have for her deprived Negro pupils can be easily guessed and—maybe—their effect can be measured by the thousands of drop-outs, misfits and little rebels that our present school systems produce every year.
Considering all the injurious factors that oppress the poor and particularly poor Negroes, I submit that when we come across a disproportionate number of poor Negro children dropping out of school or sitting in classes for slow-learners or the retarded, there is no need to look for anything intrinsically wrong with the Negro people or “the Negro family.”
The Negro has been studied, inspected, analyzed and dissected ad infinitum. Thank you for so much attention. I am not against approaching the problem scientifically, nor do I want to discourage a substantial number of white scholars from an interesting academic exercise. But, in view of the conclusions reached by the President's Commission on Civil Disorders on the amount of white racism in this country, may I suggest that instead of more studies of the riots of black people, the anatomy of Watts, or the pathology of the Negro family, we should maybe start investigating the anatomy of Cicero, a city that can welcome Al Capone and reject Ralph Bunche; or the pathology of a Congress that widely applauds the President for saving the redwood trees, but sits on its hands when he talks of saving the lives of black people. Such new subjects of research could also provide some employment for Negroes, for who is better qualified than a former domestic to study white folks? I have always been told by white ladies how much they liked their Negro maids and how much they confide in them. Also who would know better the character of Congress than a former bellhop?
That much maligned Negro family has shown remarkable endurance. After being systematically broken during centuries of slavery, the mere number of Negroes in this country after 300 years of oppression, deprivation and discrimination, testifies to a remarkable talent for survival.
As one further instance of strength within the Negro family, let me point out that Negro families tend to react far more sympathetically to the presence of a retarded child than do white families. A Michigan State University study shows that “in middle class white families the consequences of having a child labeled retarded usually results in social isolation for the child, whereas, lower class Negro families seem to treat retarded children very much as they do other youngsters.”
May I also point out that the higher rates of illegitimate births occurring among deprived Negroes is not evidence of the higher virtues of the white middle class woman. It is due to the high cost of illegal, and the unavailability of, legal abortion; a 12 year study of therapeutic abortion in New York City from 1951 to 1962, reported that only 79 Puerto Ricans and 263 non-whites had obtained legal hospital abortions. By comparison, legal, therapeutic abortions were performed on 4,361 white women. On the other hand, it has been estimated that of all the maternal deaths caused by abortions performed by quacks and criminal abortionists in New York County, 50 percent were Negroes, 44 percent Puerto Ricans, and only 6 percent women from other groups. When Negro women find themselves bearing an unwanted child, not only are they more likely to carry their pregnancy to term, but they are also much more likely to keep their baby. They know that adoption for Negro babies is almost impossible, and abandoning the child would mean, for him, childhood in an institution or an orphanage. We need go no further than this to understand the greater proportion of unmarried mothers among Negro women.
Despite the realities of existence in the slums of our cities and in the dilapidated shacks of rural poor, many a “deprived” child is remarkably healthy and well equipped to cope with life. It may not be a reality we would wish on him, but it is his reality, and in relation to it, he often functions with an intelligence and a ready exercise of native wit that would leave the child of the white middle class, temporarily put in similar circumstances, hopelessly out-classed.
Insofar as the slum child is adapted to cope with a brutal world and has learned to survive in it, he is well adapted socially and is capable of intelligent behavior.
It is revealing that most of the deprived people who are labeled as retarded at some time in their lives, are usually recognized as such in the school situation. They are not “retarded” either before or after their school years, since they do not then fit the definition of retardation, which includes both a low intelligence quotient and a failure to adapt to social environment. School is the social environment they fail to adapt to. We are at last beginning to recognize that this is so because the attitudes and behavior required by the school, as well as the methods used for measuring what we call intelligence, are charged with cultural concepts foreign to the world of the deprived. Conventional aptitude and achievement tests, largely based on middle class standards, concepts and experience, can be expected to, and we now know do, fail to measure accurately the potential aptitudes of slum children.
In simple terms, it is stupid to give a question on cable cars to a New York child (who will fail to understand it) and to one from San Francisco (who obviously knows the answer), and then conclude that the child from San Francisco is more intelligent. One researcher working with the children of the Negro poor found they usually gave an incorrect answer to the question “what is wrong?” when shown a picture of a house with broken windows. In the experience of these children broken windows are normal and it would have been unintelligent of them to have answered otherwise. In the course of testing a group of Negro children at the University of Pittsburgh, researchers asked them to color a picture of a banana. Every one of them colored it brown. None of them had ever seen a fresh banana, but they all knew the color of the bananas they had seen.
Testing materials based on a white middle class environment complete with trees, flowers, pets, parks, toys, and comfortable surroundings, are simply incomprehensible to deprived youngsters; yet the same children may be able to operate anything that moves and fix anything that breaks. That which a child has not touched, tasted, seen, heard, learned, or experienced, he simply does not know, whatever his intellectual potential.
It is important to bear in mind that the elusive quality we call intelligence is intimately related to the amount and quality of verbal ability and schooling. The slum child has little preschool exposure to informed talk, and the schooling he gets has little relevance to his world.
Extensive informal channels of learning, however, exist within the slums, and new tests could be devised that would reveal the truth about the intelligence and aptitudes of the slum child.
I wish you could have, as I often do, the experience of visiting a barber's shop in Harlem on a Saturday afternoon. There the barber shop is a real social institution; few people are interested only in having a hair cut. In one corner a group debates philosophical questions, in another international affairs, a few play checkers; when I come in they all start telling me how to solve the race problem. One feels proud of the great natural wit and the intelligence of these men, and at the same time saddened and depressed by all this human potential that society has obviously failed to utilize. Because if you read the thoughts and the intentions behind the rustic vocabulary and the faulty grammar, you recognize the richness of the substance in their minds and of the feelings in their hearts. As an acquaintance of mine said about the importance of speaking correctly, “It is better to say ‘I's rich' than ‘I am poor!' ”
The alarming thought that a large number of Negro children might be labeled as mentally retarded because of inappropriate intelligence testing methods is supported by a finding of a Michigan State University study; it showed that employability among Negro mentally retarded youngsters was much higher than among white mentally retarded youths. More than 70 percent of the Negroes were in the top employability group as compared to only 36 percent of white youngsters. It was calmly pointed out that the difference might be due to standardized intelligence tests which were acknowledged to be less accurate for Negro children than they were for middle class white children. “Due to such inaccuracy” the study reported, “some of the Negroes in the study should not have been classified as mentally retarded.”
I suppose one could take refuge in the position that “our mentally retarded are better than your mentally retarded” but, there being little merit in this kind of comfort, I would rather say that poor Negro children have enough handicaps already without being falsely labeled as retarded. Employability, and the fact that such individuals disappear into society—into their society—after they leave the school system, is the real proof, that they were—even if deficient in the school system—functionally adaptable to the society they came from and to which they returned as adults.
Let us now consider the condition of Negroes who are so retarded that their deficiencies require special care beyond the slow-learner classes.
Among the severely retarded, Negroes are underrepresented in institutions because all institutions have long waiting lists, and getting to the top of the list requires a spokesman,—which the Negro seldom has. On the other hand, among the mildly retarded, who may be institutionalized because of mild delinquent behavior, the Negro is overrepresented. A white middle class child, equally retarded and having committed the same offense, often remains with his family; while the Negro child, not having the same social protections, is apt to end up in an institution. Again the system works against him.
And does the proportion of Negroes in relation to whites in such community programs as day-care centers, sheltered workshops, etc., reflect the proportion of Negroes in need of them in the community? Possibly it does in some places, but in most places it does not. Negroes remain largely unreached by those offering the services they most urgently need. And those needs are desperate because the Negro's ability cope economically with a retarded child at home is usually less than that of his white counterpart.
That Negroes are isolated from the services they need is not only—as often thought—due to their lack of awareness, or to their timidity and reluctance in asking for such services. A survey conducted by the President's Committee on Mental Retardation revealed that—essentially because local communities are required to provide matching funds in order to receive federal funds—95 percent of all institutions for the mentally retarded are built in middle or high income areas, often a long way from the inner cities that need them most. This geographic separation of services from the people who need them is of course basic to the problem of retardation among all the rural poor.
What can be done to prevent a tragic and costly waste of human potential?
In the order of their efficacy per cost, I will mention a number of preventive programs, either already in existence or else in the planning stage, that should be greatly expanded or established promptly so as to reach all of the poor:
Easily accessible community-centered birth control clinics whose staffs should not only be highly trained in the technicalities of birth control but who should have respect for human dignity, privacy and freedom of conscience, are an important—maybe the most important—element in the prevention of mental retardation.
There is a crying need for maternal and infant care centers in the heart of areas inhabited by “high risk mothers.” President Johnson's proposed Child Health Act of 1968 would assure medical supervision during pregnancy and delivery for indigent mothers and pediatric care for their children during their first year of life. Such centers could prevent most of the complications of pregnancy and delivery, and make it easier to treat those abnormalities that can be diagnosed early. Such centers would also improve the child rearing practices of indigent or ignorant mothers.
A Head Start-type program is needed to be combined with a comprehensive health care program, begun at an earlier age than at present, and sustained throughout the elementary school years; this would compensate for cultural deprivation in the home. It would also prevent the unjust classing of thousands of deprived youngsters as mentally retarded. Remedial education and health care, geared specifically to the needs of deprived children, is the only real way to break the vicious cycle of the culture of poverty.
Whether IQ tests measure intelligence or not, it remains true that they do measure the capacity to operate within the present culture of most people in this country, where a certain capacity for abstract thought, communication through verbal expression with a certain accent, and writing using a certain vocabulary, are necessary. It is therefore imperative for all children to learn such skills equally well and early in life, to make sure that they will be able first to cope with the demands of school and later to compete in the search for employment.
These three programs are measures that can save the next generation.
Since so much retardation is due to preventable disease or accident, health care for all must also have a high priority, in any program for the prevention of retardation.
Although the Negroes' bad health is largely due to poverty, increasing the number of Negro doctors, psychiatrists and health workers is probably the best way to correct its many deficiencies.
This is so because in most cities, the amount of health care available for Negroes is directly related to the number of Negro physicians. Every white doctor has 779 potential patients. In the Negro community, there is only 1 doctor for each 3745. At the time of the Watts riot in 1965, there were an overwhelming 4,200 persons for every physician in the Watts area. In Boston, the new Columbia Point Housing Project area, serving over 5,000 people, was not able, to start with, to attract a single doctor or dentist, Negro or white.
Largely owing to the lack of physicians in Negro communities, one third of all non-whites visits to physicians were to hospital-clinics rather than to private doctors. Clinics in low income areas operate under overcrowded conditions and therefore on very impersonal terms. Many Negroes are suspicious of “charity medicine,” which they feel quite correctly, as being operated less to serve the poor than the academic interest of medical practitioners. The result is that a disproportionate number of Negroes are suffering, even dying, from diseases the rest of the country conquered as long ago as the 1940's. By comparative standards, the relative health of the Negro continues to deteriorate all the time. Non-white maternal mortality, for example, was twice the white rate before World War II. Since then, it has grown to over four times the white rate, the latter having decreased in the interval.
Negro technicians, nurses, but above all physicians of all specialties, are needed. They will be the most effective, speedy and willing messengers of modern medical service, to the Negro population. The American Association on Mental Deficiency, concerned as it must be with the alarming and shocking existence in this country of retardation due to socio-economic factors, should act on the pressing necessity of increasing the participation of Negroes in all phases and aspects of its activities for the retarded.
But don't forget that we can never eliminate the threat of retardation due to environmental deprivation unless the whole fabric that produces the “culture of poverty” is destroyed. Woven into it are overt and insidious discrimination, inferior education, poor nutrition and health care, substandard housing, unemployment, and underemployment. You are in a position to know how these can break the spirit of millions of human beings and make them feel faceless and nameless. Your responsibility therefore is also to work at changing that destructive environment.
Since the death of Martin Luther King, I have received thousands of telegrams, letters and calls from white people expressing their sympathy, grief, embarrassment and sorrow. Unless this grief and sympathy can be changed into tangible action, Martin Luther King will have died in vain. But you can do something tangible now, and need not miss your chance to show your humanity. This meeting will have been worthwhile only if it ends with strong resolutions followed by action on the part of each of you and of your organization. Your agencies and institutions should be looked at in terms of the composition of their board membership, their staffs and their services. The best teaching is by example, not by exhortation alone. Moreover, for too long, your profession, like mine, has been more interested in methodology and technique than in its social impact. If the poor and the families of the mentally deficient are really going to believe the sincerity of our concern for them, we shall have to see that organizations like this one are on their side. The leaders in the movement to eradicate chronic injustice and poverty in this country, should be those people who have benefited the most from the American system. White Americans should stop riding on the moral coattails of the Negro; no longer should the burden of purifying America fall upon the victim; no longer should the patient be expected to be his own surgeon. I therefore insist that the most urgent need of America, in the striving for civil and economic justice for all, is for a tangible, visible commitment on the part of decent, responsible, white people. The responsibility of taking an outspoken, visible leadership in such a movement rests with the “elite” of our citizenry and of our institutions. Only this can justify their claim to high moral standing.
A Greek philosopher was once asked: “When shall we achieve justice in Athens?” To which he replied: “We shall achieve justice in Athens when those who are not wronged are more indignant than those who are.” And so it must be in America.
“. . . All do not develop in the same manner, or at the same pace . . . laws alone cannot overcome the heritage of centuries—of broken families and stunted children, and poverty and degradation and pain . . . We must first . . . demolish the . . . barriers of race and religion, social class and ignorance . . . call upon common qualities of conscience and of indignation, a shared determination to wipe away the unnecessary sufferings of our fellow human beings . . .”—Excerpts from Senator Robert F. Kennedy's address at the University of Capetown June 6, 1966
EDITOR'S NOTE: The Whitney M. Young article was based on a presentation at the national AAMD conference in 1968 and published later in volume 7 of Mental Retardation. At the end of the decade of the 1960s the Civil Rights Movement had statutorily established equal rights and access but the day-to-day reality of the nation was a “de facto” segregation based on race, poverty, and privilege. Young was a social worker and civil rights activist in the 1950s, and prior to assuming the Executive Director of the Urban League, the Dean of the School of Social Work at Atlanta University. Under his leadership and vision, the Urban League moved from an organization focused on social welfare to a force for social justice. When “Poverty, intelligence and life in the inner city” was published, IDD was largely framed by the field in terms of the challenges of service and care, while notions of civil or even human rights were only just beginning to establish a toehold. In my earlier commentary I referred to Young's article as “prescient.” In this paper, the issue of bias and overrepresentation of IDD among African Americans is the ostensible focus. But the themes addressed by Young go well beyond notions of cultural bias and engage questions about risk that is embedded in social, cultural, and economic inequities. These themes were not necessarily new in 1969 but they remain as relevant now as then. Over this past half century, the IDD field has visited and re-visited this intersection of race and poverty. And you will note their relevance throughout the goals generated across the 10 working groups of the National Goals meeting. While I implied in my commentary that Young's appeal to the “elite of our citizenry” for solutions was something of a relic from another era, his call for the direct engagement of the disability field in the broader debate on income inequality still rings true.