Social Determinants of Health

The Link Between Economic Well-Being and Health

There is no doubt that underserved populations in the United States face significant health disparities—preventable differences in the burden of disease, injury, violence and overall health. Some factors, such as language barriers, can be easily overcome—adding an interpreter or translation service inside the health center is a relatively simple solution. But other factors of lifestyle, environment and access are more deeply ingrained in the fabric of our society, leaving underserved communities at a significant disadvantage when it comes to health. The reasons for these disparities become abundantly clear when you examine the close link between financial status and health.

In a recent article on the link between income and health, Dave Chokshi, NYC Chief Health Population Officer, points out that low-income populations have been a driver for healthcare reform for over a century, with evidence dating back to the cholera outbreaks in the 1800s. But he also notes that as the income inequality gap continues to widen, there is growing cause for concern.

The Urban Institute reports that poor adults are almost five times as likely to report being in fair or poor health and are more than three times as likely to have activity limitations due to chronic illness. What’s more, low-income American adults also have higher rates of heart disease, diabetes, stroke, and other chronic disorders than wealthier Americans.

When you consider the financial implications that are inextricably tied to healthy living in the United States today, it’s not difficult to see why these disparities occur. Here are just a few of the factors:

The Cost of Healthcare

People with low incomes are more likely to be uninsured or underinsured, and they face greater financial barriers to affording deductibles, copayments, and other expenses. While the Affordable Care Act made some headway in making healthcare more accessible, the Kaiser Family Foundation reports that, for many low income individuals, it did not go far enough in resolving the inequalities. In fact, at the end of 2017, 22.8% of Americans with annual incomes of less than $36,000 remained uninsured.‍

The Cost of Medication

As generic prescription prices soar adherence rates are left stagnant. And with underserved populations at a greater risk for chronic illnesses such as diabetes and hypertension, poor adherence can mean poorer outcomes.

The Cost of a Healthy Lifestyle

Healthy foods are typically more expensive and less convenient than less nutritious, processed, high-calorie foods and fast foods, making good nutrition a difficult choice for low-income families. Access to gyms, fitness equipment or even outdoor recreational space is often non-existent, or unaffordable, creating another barrier to healthy living.

Living Conditions

Poor housing conditions can be tied to a wide variety of health concerns. Evidence shows that poor ventilation, pest infestations and water leaks can be linked to respiratory conditions such as asthma. In fact, about 40% of diagnosed childhood asthma is attributed to exposure at home. Lead poisoning, elevated radon levels, poor lighting and lack of safety devices are among other contributing factors.

Lack of Education

A 2015 study by researchers at the University of Colorado, University of North Carolina and New York University concluded that “Mortality attributable to low education is comparable in magnitude to mortality attributable to individuals being current rather than former smokers.”

The links between education and healthcare are complex and multifold—and are still being explored. They range from availability of income and resources, to social and psychological discrepancies, to health literacy. Those with lower education levels have less access to jobs that provide health insurance, paid leave and retirement, which can all positively impact an invidual’s health. They carry the daily burden of ongoing economic hardship which can lead to social and emotional stress. And they often lack the knowledge and understanding of how to self-advocate, communicate with their providers and make healthy choices.  In fact, people with a high school education or less are more likely to have risk factors for disease—to smoke, to smoke while pregnant, to be physically inactive, to be obese, or to have children who are obese.

Next Steps

As the income inequality gap continues to widen, it is imperative that providers take into account an individual’s financial constraints when evaluating their health and healthcare plan. Strong patient engagement is critical in overcoming the hurdles faced in creating better outcomes for low-income individuals. By activating and empowering these patients, healthcare providers can start to reduce the impact of the many factors that create disparities in health. Smart patient engagement strategies can be leveraged to improve medication adherence, fill gaps in care, increase preventive screenings, improve health literacy and open direct lines of communication.  

For more information on how CareMessage is helping organizations improve patient engagement to reduce healthcare inequality for underserved populations, use the form below to connect with the CareMessage team.

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