Poverty is a strong predictor of mortality and a critical social determinant of health. The Department of Health and Human Services lists poverty as a key component of economic stability. Being poor literally shortens your life span. When considering race, gender, employment, neighborhood socioeconomic status, and household income, household income is the strongest predictor of mortality.
Those in the lowest socioeconomic bracket have a threefold higher mortality than those in the highest socioeconomic bracket. Poverty is also not equally distributed throughout society in terms of risk and health impact. Disparities in incidence and impact are particularly severe for children and racial minorities.
One in five children live in poverty as defined by the federal poverty level, and 41 percent live in low-income families. The stress associated with lower socioeconomic status creates biological and physical changes in the body, resulting in higher risks of disease and mortality. While detrimental in adulthood, these changes are devastating in childhood. Health in early life has lifelong effects on health status. The biological changes due to poverty in childhood limit developmental capacity. Poorer socioeconomic conditions during childhood cause an increased risk of cardiovascular disease in adulthood irrespective of adult socioeconomic status. In other words, your life expectancy not only depends on your current zip code but also the zip code where you were born.
Those in the lowest socioeconomic bracket have a threefold higher mortality than those in the highest socioeconomic bracket. Disparities in incidence and impact are particularly severe for children and racial minorities.
Childhood socioeconomic status becomes even more important for children with health problems, learning disabilities, or other diagnoses. Dr. Jen, a pediatrician who runs the Good Sam Health Center’s Developmental Clinic, remembers the experience that prompted her to initiate the developmental clinic, along with a multidisciplinary team, to provide family assistance and health care for children with developmental disorders. Her son was diagnosed with autism, prompting a personal journey to identify any resources that might assist him. “I had the ability to quit work,” she explains. “I could take him to speech therapy and occupational therapy.” She started volunteering at Good Sam and one day entered the exam room to find a mother sitting with her young son working on flashcards. That boy had also been diagnosed with autism, but his mother was on her own to assist him. As a single mother working full-time she did not have the time or financial resources to supply him with additional support.
“I saw this mom working with her kid the way I would be with mine,” Dr. Jen remembers. “Yet her resources were so much more limited than mine. It seemed so unfair that my child had a chance for a better outcome than her son.” The difference was not in their love for their children, work ethic, or dedication to providing the best they could, but rather a difference in socioeconomic status.
Poverty is also more prevalent among racial and ethnic minorities. Twenty-four percent of black Americans and 21 percent of Hispanic Americans live at or below the poverty line compared to 9 percent of white Americans. Health disparities mirror these statistics. Black Americans have a higher death rate than white Americans for eight of the ten leading causes of death, and black infants are more than two times more likely to die than white infants.
Segregation lies at the heart of health disparities as it shapes the socioeconomic conditions, education, and employment options at individual and community levels. Racism has a direct negative impact on health. A review of over one hundred studies found that experiencing racism was consistently associated with negative mental-health outcomes and health-related behaviors. Improving health outcomes depends on dismantling systems of oppression that allow racism and segregation to persist in the United States.
Racism has a direct negative impact on health. Improving health outcomes depends on dismantling systems of oppression that allow racism and segregation to persist in the United States.
The difficult reality is that systems that so devastatingly impact the lives of some, benefit the lives of others. Most people don’t want to see their neighbors suffer, and reading about the gross injustices within our wealthy nation is uncomfortable at best. Social determinants of health have largely been favorable to me as an upper-middle-class, well-educated white woman. The social constructs bringing privilege to me are working against the patients I see every day.
Growing up, all of my health care providers looked like me. I never questioned whether I could join that profession someday. As a teenager, people asked me where I was going to college rather than what I was doing after graduation. My public school had ample resources, and my home had books filled with characters I could relate to. Racism and classism have worked to my advantage.
This is an unsettling reality. Just as most people in poverty are not there as a direct result of their own actions, those on the upper rungs of social status did not choose comfort and longevity at the expense of others. Regardless, it does not absolve us from taking responsibility for this reality. As a society, we prefer situations that are win-win. We desire for the lives of others to be better, but not at the expense of our status and comfort.
The problem lies not in whether or not such solutions exist, but in our definition of “win.” As I look at my life and work in the face of devastating injustice, I have a choice to start with the question, What will make my neighbors healthy? I have to be willing to accept that the answer might not be comfortable.
In Bryan Stevenson’s Just Mercy: A Story of Justice and Redemption, he states that the opposite of poverty isn’t wealth, it is justice. The gross disparities in health status and life expectancy in this country are symptoms of a deep, unrelenting injustice.
Veronica Squires is chief administrative officer at The Good Samaritan Health Center in Atlanta, Georgia, where she leads fundraising strategy and development efforts. She previously served as director of corporate development for Boys and Girls Clubs of Metro Atlanta, and as the Georgia director of ministry partnerships for InterVarsity Christian Fellowship. She is a certified CCDA practitioner and serves on the advisory board for the Georgia Charitable Care Network.
Breanna Lathrop is chief operating officer and a family nurse practitioner for Good Samaritan Health Center. She earned her doctor of nursing practice from Georgia Southern University and a master of public health and a master of nursing from Emory University. She is passionate about eliminating health disparities through improving health care access and health outcomes among vulnerable populations, and has previously published on the social determinants of health.
This excerpt is taken from How Neighborhoods Make Us Sick: Restoring Health and Wellness to Our Communities and appears with permission from InterVarsity Press.