In my work as a primary care physician in a Baltimore homeless clinic and hospital, most of my office visits ended by asking my patients if I could do anything else for them. Sometimes I forget to address a concern a patient brought up at the beginning, or they save a difficult question about erectile dysfunction or depression for the very end of the visit. The response I tended to hear most often, though, was this: “Not unless you can get me a job.”

Much to my regret, I was unable to prescribe “One job—at least five days a week at a wage that pays the bills” for my patients. While the residents of the post-industrial region were not exactly rural, they were the sort of people who have been discussed, quoted, pandered to, or sneered at during this election cycle—poor, underskilled, often with a history of hard labor in an industry that was gutted in the last several decades.

If we are to find a solution to the problem that Donald Trump has exposed—the cultural and economic evisceration of the working class, particularly the white working class—we cannot simply ask how to magically prescribe jobs. We have to ask how public goods and virtuous behavior come to be. And that must always bring us back to community, and to whether our cities and towns are organized in ways that make us good neighbors.

Conservative discourse has of late found itself unable to describe how virtue is formed, even as it presupposes that virtue and the institutions that form it are necessary for any meaningful political order. We can bluster on about the role of faith, family, virtue, self-discipline, and community in maintaining economic and social flourishing, but then we actually give very little regard to such institutions when we talk as though people would abandon them all for $185 a month and some food stamps.

We recognize rightly that, as moral agents, humans are to be held accountable for their actions. But at their worst, both liberals and conservatives treat virtue and economic self-sufficiency as a closed system—either supposing that people will just behave virtuously when you subsidize them hard enough or that personal character only grows under threat of deprivation. Neither account actually describes how the state interacts with all of the intermediary institutions that shape the decisions we can make or how we make them. Economic agency is exercised through the employers who offer jobs. When those institutions disappear, the virtues they supported can go with them. Likewise, neither a check nor a job can substitute for an intact family.

Furthermore, looking realistically at the forces which make bad decisions easier or harder is hardly the same as granting people victimhood. GOP leader Reince Preibus didn’t put a needle in anyone’s arm, but the maker of Oxycontin spent over $200 million to deceptively promote their product. The suggestion by some conservatives that people simply move out of declining areas won’t help anyone whose doctor’s exercise of agency led them to addiction—unless, of course, they are hauling themselves to a state where one can get treatment on demand. If we’re going to talk about accountability, we must not reserve our judgment only for the people who are too poor to paper over their mistakes.

Even if we can agree that the current welfare regime doesn’t encourage virtue, we have to give a constructive account of one that will. We have to describe a way back more comprehensive than “quit whining and find a job.” Talking about personal character and cultural decay as black boxes from which spring forth either virtue or victimhood is a lazy habit of thought that has no place in conservative discourse; discipline is always imposed by someone or something, and while deprivation is often a means of discipline, it is hardly the most useful or most prescient one. Relationships discipline as well as support, and good behavior often comes from good neighbors.

Thus I appreciated Rod Dreher’s extensive dialogue with Kevin Williamson’s recent, rather incendiary take on the white working class in National Review. Dreher invokes his father’s work as a public health officer to create, sustain, or extend public goods for the sake of his community. A public servant, he “helped bring running water and sewerage to the houses of poor people who had never had it,” helped start his town’s volunteer fire department, gave free rabies shots to the parish’s dogs. The instinct to keep the state from meddling as much as possible is a perfectly reasonable and often quite wise one, but if it becomes an allergy to building the infrastructure within which justice and mercy are practiced then it has actually become a detriment to creating a beneficent culture.

Dreher’s follow-up post about concentrated poverty contains a significant part of the solution. If distant conservative exhortations to virtuous living as a means of economic self-sufficiency, or the liberal tactic of manually extracting people from poor areas into rich ones, have failed to work, it is not because our pleas for discipline fall on deaf ears. Rather, it is (in part) because such extraction decreases the concentration of good neighbors, explicitly favoring a geographical arrangement that segregates the best and the brightest into places where they can maximize their wealth and time. If we actually want to deal with the cultural malaise that has fueled the messianic politics that threatens our republic, then we will have to reverse the trends that create more distance between the disciplined and the undisciplined. That will probably require a greater supply of good neighbors than we currently have on offer.

This endeavor of creating a less toxic culture through less marked segregation will take a lot of work. For the rich and powerful, it will involve taking on risks and making sacrifices (you know, the same things that we ask the poor to do in order to be more self-sufficient). If we reject the simplistic notion that the state deserves the ultimate power so that it can guarantee as many positive human outcomes as possible, we had best be willing to exercise the stewardship and discipline of our power to prevent any voids that the state might be asked to fill.

A pundit castigating my patient to “rent a U-Haul” (as Kevin Williamson would do), is about as useful as me scribbling “get a job” on a prescription pad. Yet each of us has the power to do other things that will put us more in touch with the poor—who might be able to help us with some of our moral failings, by the way—and thus rebuild the culture instead of merely condemning it. If we are going to invoke the value of virtue and refuse to accept anyone’s learned helplessness, then we must also count the cost of inculcating self-discipline and refuse to throw our own hands up when compassion and justice require difficult choices from us.

Matthew Loftus teaches health workers and practices family medicine in South Sudan with his family (MatthewandMaggie.org). Before that, he lived with his family for six years in the Sandtown-Winchester neighborhood in Baltimore. New Urbs is supported by a grant from the Richard H. Driehaus Foundation.