By Joy Bang
According to the World Health Organization, income is one of the ten social determinants of health. Poverty and low-income status correlate with a number of adverse health effects, including heart disease, diabetes, stroke, and other chronic diseases. The dramatic increase in income inequality in recent decades has exacerbated the health disparity across the economic spectrum throughout the whole world. To address and alleviate these issues, it is important to understand how income influences the health of individuals — whether through behavioral, environmental, or clinical factors.
From a behavioral standpoint, poverty prevents individuals from adopting a healthy lifestyle. Studies show strong evidence that suggest the correlation between unhealthy diet and income. People with limited income are unable to purchase enough fresh food like fruits and vegetables, which are required for a nutritious, balanced diet. Instead, they face a more immediate concern of satiating their hunger, and, as a result, many end up choosing food that is filling instead of food that has high nutritional value. According to Dr. Dariush Mozaffarian, Professor of Nutrition at Tufts University, “almost twice as many people at low incomes have poor diets compared to people at the highest income level.” These unhealthy diets, in turn, lead to higher rates of obesity and chronic illnesses.
Other types of behavioral risk factors, such as smoking, substance use, and low physical activity, also lead to poorer health in the low-income population. These factors are closely intertwined with the structural challenges posed by the environment in which low-income people live. According to the Centers for Disease Control and Prevention, “People living in poverty smoke cigarettes for a duration of nearly twice as many years as people with a family income of three times the poverty rate.” Likewise, substance use among the low-income population is more prevalent than the higher-income counterparts. This apparent disparity in the smoking and substance use rate can be attributed to many environmental factors, such as a higher density of tobacco retailers, familial neglect, and the lack of education in poorer neighborhoods. Neighborhoods like these are also more likely to have a built environment that is not optimal for physical activity, with less open space and fewer parks and sidewalks. Adults living in these neighborhoods likely do not meet the recommended levels of physical activity, and they are thus more vulnerable to the various health effects brought about by insufficient bodily movement.
Receiving medical care can be a luxury and an added burden for low-income individuals. For one, low-income workers are more likely to be employed by institutions that do not offer health benefits: only about one-third of low-income workers acquire their health insurance through their employers, as compared to 60% of their higher-income counterparts. Even after the Affordable Care Act in 2010, over 27 million Americans, most of whom are low-income people, remain uninsured. These people without health insurance are far less likely to have a regular source of medical care and are more likely to forgo medical care due to cost concerns.
Poor health induces even more economic burden to the low-income population and acts as a negative feedback loop, making these people stuck in a health-poverty trap. It is important to note, however, that low-income status does not have to mean poor health or poor healthcare experience. Interventions through effective policy-making, such as expanding insurance coverage, access, and coordination of social and medical services, can help reduce the persisting gap of health disparity.