Ehrenreich notes how girls who must work for hours cleaning houses often select a bag of Doritos over a sandwich for lunch, presumably because the Doritos are cheaper and taste good. Of course, for the workers at the lowest end of the pay scale, Doritos or the free burger Ehrenreich gets as a waitress for lunch is an undreamed-of luxury. Lunch might instead be some store-brand hot dog or hamburger rolls. Public food assistance is distinctly unhelpful -- like the bag of food containing candy and Hamburger Helper but no hamburger, Ehrenreich dryly observes, to 'help' it out. Ehrenreich, although health-conscious, often finds herself eating fast food like Wendy's, simply because of a lack of time and cooking space and the fact that the food is filling and cheap. The poor are often criticized for eating fattening food, not cooking, and not getting enough regular exercise. Ehrenreich's struggle to stay healthy is a potent illustration of why this is the case: she is forced to live in efficiencies with almost no access to cooking implements that are located in dangerous areas with little access to places to move around. Simply getting to work is a challenge.

The psychological toll of low-wage work is also devastating: worker's opinions are not sought by management. Even when cleaning, something the workers presumably do in their own homes, they are instructed how to clean according to the company format. Although sometimes they are forced to be entirely autonomous, such as when Ehrenreich must manage the care of an entire ward of severely incapacitated patients, although she has no medical training, their commitment to their job is never honored or recognized. The only exception can be found in some of Wal-Mart's forcibly cheerful corporate slogans, which are transparently designed to convince workers not to unionize.

Community health issues and application

Basic aspects of the healthcare system are clearly broken. Workers need to have greater access to community health centers and also information about how to obtain benefits for themselves...

Food stamps and charity-based food services are seldom used by the workers in Ehrenreich's book, because workers are too confused about how to get them or cannot take time off of work to explore their support options from public assistance. The example of Holly also indicates that the culture of America might encourage workers not to seek help because of the value placed upon independence, hard work, and pride. But Ehrenreich stresses that these individuals are working hard: they often are trapped in an exhausting spiral of poor housing, poor education, and poor opportunities and cannot improve their circumstances.
Having adequate access to easy-to-prepare food in reasonably clean and safe accommodations, having access to community centers where individuals can safely exercise and commiserate about their shared experiences, and perhaps 'network' better access to jobs and transportation would clearly be a positive step in the right direction. However, Ehrenreich's book makes it clear that there is no single solution. Without a higher level of wages, better housing, and health benefits, the 'small steps' sometimes touted as the solution to the crisis of ill health and poverty -- such as green markets and playgrounds to exercise -- will not solve the problem.

Conclusion

Education is perhaps the most fundamental aspect of Ehrenreich's manifesto. Without education, workers cannot make connections, unionize, and improve their lots in life. And educating the next generation about health literacy is also critical: the link between health, safety, and the ability to better one's self is clearly delineated in Nickel and dimed. Someone who is constantly struggling with bad teeth, a bad diet, living in a bad area and the other stressors of poverty hardly has the strength to pull him or herself up by the bootstraps, as the working poor are often counseled to do in America.

Reference

Ehrenreich, Barbara. (2002). Nickel and dimed: On (not getting by in America). New York: Holt.