I know Thanksgiving is approaching when I see the line at our hospital’s food pantry stretching down the hall and into the next building, an annual sign that holiday turkey distribution has begun. Our office conference room fills with donated toys waiting to be distributed to children in our clinic. This is the time of year when people across the country who have the resources to do so, reach into their pockets and share with their neighbors. Charitable donations to food banks and local organizations increase as people respond to the heart-wrenching thought of children missing Thanksgiving dinner and having no gifts to open during the holidays. It is a trend year after year: giving to food pantries and organizations serving people living in poverty is higher in November and December compared to other months. The rest of the year, non-profits struggle to meet the ongoing needs of communities facing economic hardships.

Life is hard if you’re poor, especially if you have children to care for, and most especially if you’re a single parent. It means living on thin ice, which broke recently for one family I follow, a single mother with three children, ages 2, 5, and 8 years. The mother had, after a long effort, found a minimum-wage job and an apartment she could afford. But she couldn’t find affordable childcare, and so she had to leave her job and apply for welfare. However, a delay in processing her application meant she couldn’t pay her rent, so she was evicted, and now the family is homeless. We shouldn’t be surprised. New data show that the number of homeless children (half of whom are under six years old) has increased from 1.6 to 2.5 million in the past four years. What’s going on?

This is the human face of the ever-growing polarization of wealth, increasingly recognized as the major social dynamic in the United States over the past half-century.  Even with maximal support from public assistance programs, full-time work at the minimum wage will not support a family that has to pay market rates for rent and childcare. And things are getting worse. The Federal Reserve recently reported that income for the bottom 90% of the U.S. population fell between 2010 and 2013, with those near the bottom dropping the most, while incomes in the top decile increased.

As pointed out in a recent Op-Ed in the New York Times, this trend is the direct result of government policy. Income inequality in the U.S. is no worse than other wealthy nations before tax and spending policies are taken into account; but lower tax rates and less spending on social welfare make the U.S. the worst developed nation in which to be poor. And this trend is increasing: during the Eisenhower administration, the richest Americans faced a top marginal tax rate of 91%; by 2009, that rate stood at 20%. Our government does less than any other wealthy nation to support its low- and middle-income population, be it in education (from preschool to higher education), working conditions, disability, or retirement.

Public assistance programs, such as the Supplemental Nutrition Assistance Program (SNAP) and the Special Supplemental Nutrition Assistance Program for Women Infants and Children (WIC), provide essential support to families each month, but these programs are designed to supplement the resources of poor families and by themselves cannot provide an adequate diet. Organizations that are structured to provide emergency assistance, such as food pantries, are often looked to as a way to solve chronic, systemic injustices – but they are no substitute for government policy when it comes to lifting people out of poverty.

The low-income families we serve work hard to try to make ends meet. Most seem grateful for those resources which they can access, whether it’s SNAP benefits or our hospital’s food pantry. But they would rather work jobs that pay enough for them to support their families and not have to access those resources at all. What would it take?  A living wage, for starters.  It was reported recently in the New York Times that in Denmark, a Burger King employee has enough money to pay rent, go out with friends, and still save money. Those should be goals within reach for everyone who works full-time. A living wage is possible here too, and is readily achievable through the democratic process, as has been shown in Seattle and San Francisco. Even in this past election, all four state-wide ballot initiatives mandating an increase in the minimum wage passed – and all were in “red states”.  Affordable housing is essential, and universal preschool education and quality childcare are the underpinnings crucial to parents for successfully staying in the workforce and children having a chance to succeed in the future workforce. Virtually every other rich country provides its people with this infrastructure for human development, yet the United States – the richest country in the history of the world – does not.

Yes, I am grateful for the donations made each year during the holiday season.  I want my patients to have a nice holiday meal, a warm coat, a present.  But charity will never end poverty; government action can. If all of us who give generously during the holiday season, raised our voices to demand that our government change course, there would cease to be a need for campaigns to feed hungry children. Ending poverty is within our reach; we just have to find the citizen groundswell and harness the political will to do it.