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Poverty and Health Outcomes

US poverty trends 1959-2014

As of 2017, 12.3% of Americans were considered in poverty, according to the official poverty measure. People who are in poverty have different health risks than those who are not considered in poverty, as well as different outcomes associated with those risks. People who are in poverty grapple with varying outcomes in physical health, mental health, and access to care. Examining divergences in health between those above and below the poverty line gives insight into conditions for those who live in poverty.

Poverty and physical health

Poverty affects health outcomes throughout a person’s entire life cycle.  The insidious component is that the negative result may not be expressed while the person is in an impoverished condition. Mothers who are in poverty during their pregnancies may experience more health risks during their delivery, more health risks to their newborn, and markedly more behavioral problems for their child later on.  If a child is in poverty, they will have worse health outcomes during their adulthood's. This is especially pronounced for certain ailments such as heart disease and diabetes.  This effect is present even if a person escapes poverty during adulthood, suggesting a lasting effect of the stress of poverty encountered during childhood or adolescence.  Likewise, if an adult lives within an area deemed poverty-dense, they will have worse health outcomes, on average, than their peers who live in neighborhoods with less poverty.  This result is observed after controlling for factors like age, race, and lifestyle choices.  This suggests that the unique stresses of life within an impoverished community contribute to poorer health outcomes, without any assumed detrimental behavior on the part of the resident.

Poverty and mental health

Receiving treatment has shown positive effects for those struggling with mental illness and poverty.

Poverty also has a complex relationship with mental health. Being in poverty may itself provoke a condition of elevated emotional stress, known as “poverty distress”.  Poverty is also a precursor or risk factor for mental illness, particularly mood disorders, such as depression and anxiety. Schizophrenia is also strongly associated with poverty, occurring most frequently in the poorest classes of people all over the world, especially in more unequal countries.  In a sort of reciprocating relationship, having mental illness is a major risk factor for being in poverty.  Having a mental illness may inhibit a person’s ability to work or deter employees from hiring them.

A hypothesis known as “drift hypothesis”, posits that for people with psychiatric disorders (primarily schizophrenia), they tend to fall further down the socio-economic ladder as their condition reduces their functionality.  This hypothesis is an effort to establish that people with profoundly limiting psychiatric symptoms are more likely to descend economically, not that the financially challenged are more likely to present severe psychiatric disorders. People experiencing less severe symptoms are less likely to be affected by “drift”.  

With those in poverty having greater likelihood of suffering from mental illness, the benefit of access to clinical psychotherapy treatments has been explored. Despite numerous barriers for access to care for low-income individuals, there is evidence that those who do receive care respond with significant improvements. This research supports policy measures for improved outreach and access-to-care measures designed to benefit those with low-incomes and mental health disorders.

Healthcare effects

Demonstrators rallying for healthcare reform

Between the periods of 1987 and 2005, the number of people without health insurance in the United States rose from just over 30 million, to 46.6 million. At that time, 8.5% of people belonging to households that made over $75,000 annually were uninsured. When looking at families earning $25,000 or less, that percentage rose to 24.4% uninsured. This figure exhibits how lack of access to care via health insurance disproportionately affects those in poverty.

Despite the cost of healthcare being an obstacle for those with relatively low incomes, research suggests that insurance coverage will not dramatically change outcomes related to physical health.  Access to Medicaid for low-income adults aided in diagnosis of metabolic disease, saw a reduction in diagnosis of mental health disorders, and reduced incurrence of “catastrophic medical costs” by patients dramatically. While these positive effects were observed, outcomes for heart disease, diabetes, and other physical health characteristics were not meaningfully improved.  It has been posited that one year, the duration of the study, is an insufficient length to fully observe the divergent health outcomes that would be characteristic of an experiment with a lengthier time-table.