The Health Consequences of Poverty : What We Know and What We Can Do

1. Introduction

   1. Explanation Of Poverty And Its Impact On Health

      Poverty is the economic condition of an individual or family in which they lack sufficient income to attain the minimum levels of food, healthcare, clothing, transportation, education, and other needs that are required to lead a decent standard of life. Poverty is a main cause of ill health and a barrier to accessing proper health care when required. Poor people cannot afford to purchase essential things that are needed for good health, including quality food and health care.

      More than 689 million people rely on less than $1.9 per day, and 250 million people are under the global poverty line.⁽¹⁾ Poverty significantly affects health in different directions. Poor people suffer from malnutrition, which makes children starve to death. Moreover, poverty is also linked with a higher risk of diseases and early death.

      The phenomenon of poverty is considered an intractable problem in all countries globally. However, the significant increase in the rate of poverty is a major problem in developing countries.

   2. Importance Of Addressing Poverty As A Public Health Issue

      It is essential to remain informed about the impact of poverty on health. Poverty is a global problem and a public health issue that needs to be addressed in some way or the other. Achieving the vision of optimal health for everyone is required and this can be done by a proficient care team and volunteers that support the poor people to practice proper means of sanitation and keep away from diseases, help people with low income get proper healthy food, and health care. Moreover, it is also essential to spread awareness about how poverty can impact public health and what measures can be followed to eradicate or reduce poverty and prevent people from suffering and dying due to different illnesses.

2. The Health Consequences of Poverty

   1. Increased Risk Of Chronic Diseases

      One of the major health consequences of poverty is that there is an increased risk of chronic diseases. Some of them are listed below.

      HIV/AIDS

      HIV/AIDS is a chronic disease that is common among poor people in developing countries. After the death of the first known case of the disease in Kinshasa in Africa in 1959, HIV/AIDS spread to various other countries in the world as a sexually transmitted disease pandemic.⁽²⁾ The virus attacks the affected person’s immune system. There is no standard curative treatment for HIV/AIDS.

      A much higher prevalence of death from the disease in developing countries has been seen compared to developed countries, and even higher deaths have been found in developed countries among poor people who have limited access to proper healthcare facilities.

      Neglected Tropical Diseases or NTDs Related To Poverty:

      NTDs or neglected tropical diseases are the diseases that mainly affect poor people in tropical and subtropical areas.^{(3, 4)} These are a group of twenty diseases, including Buruli ulcer, Dengue and chikungunya, Dracunculiasis, Chagas disease, Echinococcosis, Foodborne trematodes, Leprosy, Rabies, Leishmaniasis, Human African Trypanosomiasis, Lymphatic filariasis, Schistosomiasis, Scabies, Onchocerciasis, Mycetoma, Chromoblastomycosis, and other deep mycoses, Snakebite envenoming, Trachoma, Soil-transmitted helminthiases, Taenisis and cysticercosis, and Yaws.

      These diseases are mainly seen in developing countries among poor populations.

      Tuberculosis (TB) Among Poor People

      Tuberculosis (TB) is caused by Tubercle bacilli. It is a disease that is most prominent in poor people and developing or underdeveloped countries. Though many steps and efforts have been taken to eradicate this disease, it remains a threat to global health.

      Malaria Among Poor Countries:

      Malaria is another chronic disease that is a vector-borne parasitic disease transmitted by female anopheline mosquitoes.^{(5, 6)} Plasmodium (P) falciparum, P. oval, P. vivax, and P. malariae are the four kinds of malarial parasites that cause malaria in human beings.⁽⁷⁾

      Although the disease is eradicated in the U.S. and many European countries, it remains highly prevalent in the poor countries of Africa.⁽⁸⁾

   2. Negative Impact on Mental Health

      One of the major health consequences of poverty is that it greatly affects the mental health of individuals. Mental illness, chronic health problems, and substance abuse disorders are extremely prevalent among people with low income.⁽⁹⁾ Poor nutrition along with elevated levels of cortisol( stress hormone) are factors associated with poverty and that may have lasting effects on children along with adults. Children from poor background show impaired development of the nervous system that affects cognitive development, they also have an increased risk of behavioral challenges, adverse health behaviors, and mental health issues.

      Recent studies have even shown a strong association between pediatric suicide and county-level poverty rates.⁽¹⁰⁾

   3. Increased Risk of Infectious Diseases

      People living in poverty or poor conditions can also raise the chance of developing various infectious diseases. Without proper and effective sanitation in their home, people, especially children are vulnerable to life-threatening intestinal infections, including diarrhea. Moreover, in small houses where there is insufficient ventilation, people also experience several types of respiratory diseases. People living in properly constructed homes are less likely to suffer from such infectious diseases. Clean and warm houses offer protection from various infectious agents and help improve people’s health by preventing various diseases like diarrhea, malaria, and tuberculosis.

   4. Poor Maternal And Child Health Outcomes

      People surviving in poverty are prone to various diseases and health issues. Poverty impacts maternal and child health a lot.

      Women and children usually suffer from a lack of protein and energy, which leads to various adverse health problems; and their conditions are often worsened by deficiencies in micronutrients like iron, iodine, zinc, and vitamin A.⁽¹¹⁾ Globally, among people of reproductive age, maternal mortality has been listed as the second leading cause of death. It has also been found that women face a 1 in 180 chance of dying from maternal causes.⁽¹²⁾

      Apart from this, low birth weight has also been a major cause of infant mortality.⁽¹³⁾ Children who survive low birth weights, but live in poor conditions, might suffer from growth retardation and various infections in their childhood, adolescence, and even adulthood.

      Poverty leads to insufficient food intake in children, which causes malnutrition. Some children under five years start suffering from malnutrition, which is evidenced by their stunted growth.

      Malnutrition is a leading cause of millions of deaths every year in low and middle-income countries, not only directly, but also as a result of multiple infections.^{(14, 15)}

3. Factors Contributing to Poverty and Health

   Various factors contribute to poverty and health. Let us take a look beyond this and know about some of those major factors.

   1. Socioeconomic Status and Income

      Socioeconomic status is a way to describe people based on their income, education, and occupation. It is usually described as high, medium, and low. People with a low socioeconomic status, generally have less access to social, financial, educational, and health resources when compared with those having a higher socioeconomic status.

      Income is strongly associated with all indicators of late-life health. Individuals with low socioeconomic status have, on average, poorer or reduced health and die younger when compared with people having more favorable socioeconomic status.

      Studies have shown that those with low educational levels tend to have a more rapid health decline in their old age.⁽¹⁶⁾ So, somehow, socioeconomic status has been associated with a reduced level of health.

   2. Access to Healthcare And Education

      People with limited finances or low income might have more difficulty obtaining health insurance or paying expensive medical bills. Moreover, limited access to healthy foods, education, and healthcare facilities, also affects the overall health and well-being of people with low income.

      Families with higher income and people with good education can more easily avail healthy foods, focus on their nutrition and exercise routine, and also pay for various health services. However, poverty, low wages, and lack of assets associated with less education can make people more vulnerable during tough times, which can lead to poor nutrition, stress, and health problems.

   3. Environmental factors

      People with low income usually live in low-income neighborhoods or environments that lack appropriate resources for attaining good health. More often these neighborhoods are economically marginalized and have more risk factors for poor health.

      People living in poverty usually live in slum areas or in environments that have less green space like parks and also less access to supermarkets and other places to find healthy and nutritious foods. Moreover, such environments are exposed to higher levels of toxins like water and air pollution, and industrial and hazardous wastes. All these factors are responsible for poor health conditions.

4. Addressing Poverty and Improving Health Outcomes

   Individuals who suffer from ill health conditions because of their poor standard of living or low income can be benefited by addressing their poverty and thus improving their health outcomes. Some of the ways to address poverty and improve health conditions are discussed below.

   1. Public Policy Interventions

      1. Minimum Wage Laws

         The minimum wage should be increased so that every people gets a chance to lead improved living conditions. Today’s federal minimum wage is $7.25 per hour, which makes it around $15, 000 annually for a full-time job.

         The ‘Raise the Wage Act” can gradually lift the federal minimum wage to around $15 per hour by 2025. These changes in the minimum wage would help to lift 3.7 million Americans out of poverty and would particularly benefit women, and people with disabilities, who are disproportionately represented in jobs with low wages.⁽¹⁷⁾

         So, poverty can be reduced by raising the minimum wage in the case of people with low minimum wage jobs.

      2. Affordable Housing Programs

         One in every four renter households in the U.S. is extremely low income, and about 50% of the renters are moderately or severely cost-burdened, which means that they pay more than a third to half of their total income on rent and essentials.⁽¹⁸⁾

         Investing in permanent housing programs like Housing First should be supported to offer a path for people experiencing homelessness to obtain stable housing. Apart from this, policymakers must also increase renter protections. All these can help people with low income have stable housing and improvised health.

      3. Access To Healthcare

         Providing easy and affordable access to healthcare for every people can help in improving health conditions, especially those who live below the poverty line and suffer in silence.

         The Affordable Care Act( ACA) has expanded access to various high-level, affordable health coverage for millions of Americans, particularly those with pre-existing conditions.⁽¹⁹⁾

         Though many American are enrolled in coverage through the ACA marketplaces, 12 states continue to refuse to expand their Medicaid programs to cover adults that make 138 % of the federal poverty guideline, placing a heavy burden on families that are already suffering. Expanding Medicaid would mean a lot for people with too low incomes.

         Increasing access to Medicaid, Medicare, and other Public health insurance benefits could be an effective way to reduce poverty and improve health. These public health insurances help pull families out of poverty by offering them proper access to affordable health coverage.

   2. Community-based Initiatives

5. 1. Food Security Programs

      Various community-based initiatives, especially food security programs can help in addressing poverty and improving health outcomes quite effectively. There exists food security when everyone, at all times, has economic and physical access to sufficient safe, healthy, and nutritious food to meet their daily dietary requirements for a healthy and active life. So, for food security, sufficient food is necessary.

      However, food insecurity has become a significant public health concern. In 2018, around 11.2 million children lived in food-insecure households.⁽²⁰⁾

      To eradicate poverty and improve the health conditions of individuals living with low income, policies, laws, and action plans should be made that would help everyone enjoy the right to have food on their table every day. Various agencies are working in reducing poverty and providing proper food and social security to people.

      Some major food security programs that work to address food insecurity and its negative outcomes are the Supplemental Nutrition Assistance Program (SNAP), National School Lunch Program, School Breakfast Program, Child and Adult Care Food Program (CACFP), Special Supplemental Nutrition Program or Women, Infants, and Children( WIC), and Afterschool Nutrition Programs.

   2. Educational Programs

      Education is a luxury that many people take for granted. However, some people, especially poverty-ridden families usually have to sacrifice it. Millions of children globally do not get a chance to go to school or attain basic education, and the major cause of this is poverty. However, poverty can be reduced or even ended with proper education that could be affordable to all. With education, parents would learn more ways to care for their families and health, lead healthier lives, and have better lives.

      There must be more and more free schools for children and even adults who cannot afford fees to study in big schools or colleges. Equal Opportunity Schools (EOS) ensures that every student receives the opportunity to be placed in rewarding classes and gain essential education.

      Apart from this, various scholarship programs should also be made available to meritorious students so that they can attend university and pursue their higher studies which would help them get decent jobs for themselves and help them come out of poverty.

      The Education Trust and various other agencies and programs should work more effectively to provide educational justice for all students, particularly low-income students.

      With all these effective and affordable educational programs, poverty can be reduced and people could get chances to live in better health and social conditions.

   3. Mental Health Services

      Children and adults living in poverty face a lot of barriers that could not only harm their physical health but also affect their mental health. Such people have a reduced level of access to various mental health services that could impact their overall well-being. Moreover, lack of insurance and quantity of affordable mental health services can prevent children and families from accessing the required mental health services.

      However, with affordable mental health services, many people living in poverty and suffering from stress or mental health issues can be benefited. This, in turn, can help in trying hard to get a decent education and jobs and come out of poverty.

6. Conclusion

   Poverty can cause a lot of health consequences, including various mental health problems, chronic illnesses like HIV/AIDS, tuberculosis, and malaria, and also result in various infectious diseases like diarrhea and respiratory diseases.

   By addressing poverty through various means like affordable housing programs, healthcare facilities, and educational programs, we can eradicate some of the chronic and infectious health issues and have a better society with healthy and fitter people. So, to improve health outcomes and bring out a healthier society globally, it is highly essential to reduce or eradicate poverty and give every individual an equal opportunity to avail of healthcare services, education, and stable housing.

   It is not only the work of an individual, but a joined work of individuals, communities and policymakers to take proper necessary actions to address poverty and help low-income people come out of their ill health condition and build a better environment for themselves and their families. This way, we will have a better, healthier, and more developed world.

References: