A recent study from Columbia University found that of all the health factors they measured, poverty had the greatest negative impact on health. The other factors they looked at included smoking, obesity, lack of health insurance, and binge drinking, all of which had a less significant impact on health outcomes than living in poverty. Poverty, defined as living below 200% of the United Stated Federal Poverty Level, was determined to take away 8.2 years of health, meaning poor people have 8.2 fewer years in which they are healthy than someone above 200% of the FPL (This is a standard measure of health burden, used by the WHO.) We should also be explicit that when we talk about poverty we talk about race – over 50% of black and Latino young adults live in poverty, compared to less than 30% of white young adults.
To which I respond, well, YES, clearly. But you would never know these things from the way we talk about health. Think about how many public health programs are focused directly on the spectre of obesity. There’s PE programs and school activity policies, public education campaigns (usually involving TV ads) to tell people to spend less time watching TV, there’s calorie labeling requirements and scolding people to go to their farmer’s markets and taxes on soda or foods with trans fat. Some of those policies may have worth, but their goal of eliminating TEH FAT ZOMG and thereby solving the health crisis is clearly misdirected. Even worse are the articles and attitudes engendered by this focus on obesity as a health issue, like this recent article in the LA Times, because they imply that a systemic issue like the health care problem can be resolved by individuals changing their lifestyles, rather than by systemic change on a much broader level.
The effect of poverty on health has been clearly documented. People who live in poverty are more likely to have asthma and diabetes. They’re way more likely to be exposed to parasites like toxocariasis, cysticercosis, and toxoplasmosis, which can have significant physical and neurological effects including seizures and developmental delays. They’re five times more likely to be exposed to lead paint as children. They’re twice as likely to have untreated cavities, which can lead to heart disease or infection and even death. This all means that from the beginning, even from birth, people living in poverty are more likely to develop or acquire a disability or chronic health condition.
It would seem, then, that addressing poverty in order to prevent those negative health outcomes would be a public health priority. But it really isn’t – poverty programs are rarely described as health programs. When a politician starts talking about welfare, they’re talking about cash payments to help parents raise their kids, to preserve and support families. They don’t talk about how assisting a family out of poverty will make that whole family healthier, and less in need of health care. And addressing the negative health effects of poverty – safely removing all the lead paint, preventing slum housing conditions like cockroach infestations and mold that contribute to asthma, get them some access to dental care – would have an enormously beneficial effect on hundreds of thousands of individuals and on the health care system as a whole. However, addressing the systemic effects of poverty isn’t nearly as easy as shaming “the fatties” and slapping some calorie numbers on menus.
This is especially galling because there is so much overlap between the community of PWDs and people in poverty. A recent study found that almost half of working-age adults who experience poverty for at least a 12-month period have one or more disabilities. People with disabilities account for a larger share of those experiencing poverty than people in all other minority, ethnic and racial groups combined and are even a larger group than single parents. Families with more than one member with a disability are even more likely to be living in poverty. There are two things going on here. First, people who live in poverty are more likely to be or become PWDs, partly because of the health factors discussed above. But also, PWDs are more likely to live in poverty, partly because of the cost of health care.
All of this suggests that our conversations about health care need to include ideas about addressing poverty and that our work on poverty issues has special effects on health and disability. Hurrah for intersectionality!
5 thoughts on “Newsflash: Poverty is Bad for Your Health”
Wow, this post totally blew my mind. I can’t believe I never thought about poverty this way before. Can’t wait to bring it up the next time my right wing uncle brings up “the lazy poor.”
To pick a very specific thing–utility assistance alone would save thousands of lives annually and improve the health of I have no idea how many more. People are injured and sickened and die in cold weather when they try to heat their homes with space heaters or charcoal grills or wood fires. We all know this. What’s less publicized is the same thing happens every year in the summer without air conditioning to thousands more. Most of the people who die are older people and people with disabilities.
But for so many in USian society the higher priority is making sure that someone isn’t getting something for nothing. So we have programs that are supposed to provide help around the home for disabled people burdened with punitive, humiliating, and expensive fraud-prevention measures. The IRS puts more effort into investigating Earned Income Tax Credit fraud than corporate income tax fraud. This is required by law passed by Republican-dominated congresses and is not a coincidence. The Social Security Administration denies nearly every application for disability income the first time–it’s difficult and humiliating as a way of keeping people off the rolls even if they qualify for benefits. And we don’t help people live in homes that are healthy and won’t make them sick. We get upset when a child dies from an untreated cavity because dentists don’t want to take Medicaid/CHIP patients but the upset passes soon enough and the system that killed that child doesn’t change.
I’m bitter today. I’m disappointed in my country. I want to think we be better than this but so far it hasn’t happened.
Thank you for writing this! It’s a relief to hear it spelled out so clearly. I really appreciate the fact that you’re not just talking about poverty as though it is a personal, moral failing whose only real consequences are a tax drain on the wealthy — because sometimes I feel that this gets said (not here!) and I hate hearing it. I also think you’re right that the consequences of poverty are also about situations and physical environments, and that does go hand in hand with disabilities… why can’t we create universally accessible, healthy environments that don’t cost an arm and a leg to build or buy? (That might be a rhetorical question.)
This is a fantastic post! I wish everyone would read it! The fatphobia and obesity scare tactics going on in society right now are filling me with rage; and as you say, those things put the focus on issues of personal choice and ignore institutional problems. They also ignore a lot of issues that involve privacy and respect of people’s food choices. This post rightly frames the issue of societal health in a whole different way.
I’ve long suspected that clean drinking water, food security, and vaccination have done far more for human health than all the rest of modern medicine combined, and the fact that the difference in access to medicine between those in poverty vs. those who are not only amounts to 8.2 years of difference on average in a population with a life expectancy several decades beyond populations without access to the basics I mentioned would seem to support that notion.
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