ASK DR. BAUGHAN June 12, 1998
POVERTY AND HEALTH
Medicine and health are fascinating and frustrating because they can challenge our assumptions about the way life ought to be. Health problems are assertive and persistent. If we try to ignore them, or if we do not understand them, they will continue to knock on the doors of our attention until we take care of them. A glaring example of this is the relationship between poverty and illness. The June 3, 1998 issue of the Journal of the American Medical Association has a lead article entitled, “Socioeconomic Factors, Health Behaviors, and Mortality,” by Paula Lantz, PhD, et al, and an editorial by R. Williams, MD, “Lower Socioeconomic Status and Increased Mortality.”
Lantz’s article reports on the results of a study of 3617 adults studied for 7.5 years. The people represented a cross-section of the U.S. population in age, race, and income levels. The researchers examined the relationship of multiple factors such as diet, exercise, smoking, alcohol intake, education and income to the risk of dying.
In this country, we would like everyone to be responsible for themselves. It is an annoying design flaw in Nature that some people have genetically induced disease. We have a stance as society that these people have a right to health care, but not to health insurance, which doesn’t make much sense. But when it comes to poor people, we have been even more ambivalent and judgmental. We know that people who live in poverty have more diseases and more risk of dying at any age compared to those with more money. Do they “bring it on themselves?” Poor people smoke more, drink more, are more likely to be sedentary and overweight. Can we then conclude that if they stopped doing those things, they have just as much chance at being healthy as anyone else? Poor people in general have less education. Does this result in poverty and ill health? So if they would just stay in school, they would be healthier? The answers this study found were, “Yes and No.”
Yes, if you smoke, abuse alcohol, don’t exercise, are overweight, or dropped out of school, you have a greater chance of dying than someone your age who does not have those risk factors. However, if you do not have any of these risk factors, but you are poor, you still have an increased risk of death. In fact, poverty was a stronger factor in health than all of the other risk factors. Doesn’t seem “fair,” does it?
Williams’ editorial reviews some of the literature that seeks to explain why poverty is so powerful. Is it biological, behavioral or psychological? Poor people in general have higher cholesterol levels, blood sugar levels and blood pressure. As mentioned, they exercise less, drink and smoke more. They have more depression, hopelessness and less social support. Poor children hear fewer positive statements from their parents than middle or upper class children. Children who hear more positive statements in early childhood have higher IQs than those who don’t, regardless of parents’ IQs.
There are many layers to this onion. The daunting challenges this information provides are several. (1) As an individual doctor with medicines, advice or surgery in my office or hospital, I can only chip at the iceberg of the health effects of poverty. The patient has a much better chance of getting better or staying alive if their economic status improves. This does not mean their health does not improve if they stop smoking, drinking and starting exercising and eating well. (2) As a society with an increasing percent of people, particularly women and children, living in poverty, we will continue to see health problems that do not get better just by medical care. Since we are not willing to turn patients away from emergency rooms with heart attacks and cancers if they cannot pay their medical bills, we as a society will continue to pay for their illness until we find out how to generate work and wealth in a way that results in better health for more people.