While it may be true that “money doesn’t buy happiness,” money may buy life—or at least a few extra years of it. In the United States, economic standing—and the money, power, and privilege that goes with it—is a direct determinant of health outcomes for a person. This is calculated by measures of life expectancy and risk of disease and morbidity—both of which are inversely related to social and economic status.
It is common to measure health outcomes by subgroups within populations, such as by race, gender, and income. These measurements show differences amongst specific population groups in the incidence, prevalence, mortality, and burden of a disease—otherwise defined as a health disparity. Importantly, the relationship between a social-identity group and disease is not causal. In other words, a woman’s black-ness is not causing her to have higher risk of infant mortality. A woman’s gender does not cause her higher likelihood of obesity. On the contrary, the members of these varied groups face different realities than others. The surplus of research in this topic says that differences in health outcomes conclusively stem from social factors—not genetically or biologically predetermined factors. On the other hand, the vast majority of research has been done on white men, and the differences in treatment and overall life experience is varied amongst different demographics. For this reason, our understanding of what exact differences do exist amongst demographics is limited. Nonetheless, based on what we do know, one of these social factors is socioeconomic status: how much money, power, and privilege one has in society. Socioeconomic status is a summary of the resources a group or individual is able to access. Research shows that someone with low socioeconomic status is likely to suffer from higher rates of low birth weight babies, cardiovascular disease, hypertension, arthritis, diabetes, cancer, and a shorter life expectancy overall than someone with a higher socioeconomic status.
I believe there are certain things money should be able to buy. Money affords access to certain amenities and a quality of life that is above other members of society. This is good; this incentivizes people to work hard, to get educated, and to improve their productivity and human capital. However, as long as money is in the story, a hierarchy of some form is bound to manifest. Someone will always be richer and someone will always be poorer. Poverty is often discussed as one of the worst conditions one could live in. This is for good reason: poverty often leads to a quality of life that—in many ways—is considered inhumane by society. I believe the answer to the poverty problem is not to eliminate poverty; it is to make poverty livable. If poverty is relative, which I believe it is, then any form of economic development will not solve the poverty problem. Here is an example of why I think poverty is relative: if a family of four in the United States has an annual household income of $24,400, it is below the poverty. I will call this family the Murry family. The Murry family is in the richest 17% of the world, and has an income six times as high as the global average. Yet, the members of the Murry family have one of the lowest standards of living in the country—and this relative lack of wealth will harm them in roughly equal magnitude as if they were actually in the poorest in the world. The Murry’s will still likely suffer poorer health and die younger than their richer equivalents. In some ways, they may even be worse off. The fact that they are privileged enough to be among a rich country’s poorest means that junk food is made available to them. Cheap, high calorie food that gives the calories needed to survive is something that the poor in poorer countries cannot typically access. This may be better for the health of the poor among the poorest countries. This relative poverty aspect is why I think that simply increasing wealth for a country cannot solve the problem; statistical poverty is not as important as the conditional outcome. This is why I believe that in order to combat poverty, the state of poverty must become more dignified and more habitable.
One of the primary ways to make this happen is to improve the health of low-income individuals through eliminating health disparities. In this way, even if someone is in the economic bottom of a society, it may be uncomfortable, but at least basic health needs will be met. Martin Luther King famously said, “of all the forms on inequality, injustice in health care is the most shocking and inhumane.” I agree. I believe citizens have a moral obligation to provide for the basic health needs for the poorest citizens of a country—especially when that country can afford it. It can still be uncomfortable. Houses may be small, budgets may be tight, neighborhoods may not be pretty, but the poor will not be dying and getting sick at faster rates than the rich. If I haven’t succeeded in establishing a moral case for eliminating health disparities, I turn to economics. Improving health is found to be effective in developing the economy. Health, it turns out, is an important input to human capital that has high economic returns. Therefore not only the poor will benefit, but everyone will have a boost in their income.
In order to make the poor healthier, researchers must identify the pathways in which being poor leads to worse health. In fact, any policy that works to improve the health of the poor and close the health gaps must consider the following intervention points. Although there are limits to current knowledge on this, a plentitude of research points to these three mechanisms linking poverty to health outcomes: health care, built environment, and health behavior. I will give both anecdotal and research-based evidence of how these pathways occur.
Health care is an issue politicians often focus on, even though it may not be the largest contributor to health outcomes. Public health studies estimate barriers to quality health care accounts for about 10% of premature deaths, overall. Although this may seem small compared to the 50% accounted for by behavior, it is still a crucial pathway with a significant effect. Health care is a resource that is unequally distributed among socioeconomic levels, concentrated in the rich and diluted in the poor. It has been shown that low-income people are more likely to be uninsured, receive poor health care, and seek health care less often than their high-income counterparts. Often, when they do seek health care, it is in the emergency department. A second factor is the rising costs of hospital visits and prescription drugs. A third factor is that a lopsided shortage of primary care has been identified—states in the U.S. with large income inequality have fewer primary care physicians per capita than others. Health care quality and access are important intervention points for closing the health outcome gap between rich and poor.
Built environment describes the physical and cultural space in which we live, work, and play. It describes the physical layout of a place, designed by humans. Income and monetary resources available to a person naturally affect where that person lives. The physical space in which we live affects our health, and is related to the other pathways. Therefore poor people and rich people are exposed to very different conditions within their own neighborhoods. Poorer neighborhoods are more commonly located near highways, toxic waste sites, and industrial areas and as a result—poor families showed six times higher blood-lead levels compared to rich families, on average. Additionally, urban zoning policies can affect health: urban renewal and the restructuring of cities that came with it tore down many social structures. It is proven that social connection is important to improving health, and poor families are concentrated in urban areas where this zoning issue occurred. The cities in which they live are often not conducive to social and community interaction. These are just a few examples of how the built environment affects health, and how poor citizens are often exposed to harmful built environments. This is a very acute point for policy intervention because built environment is something humans manipulate. Theoretically, environments could be manipulated to be conducive to good health.
Behavior is a pathway favorite for public health experts. Top studies cite behavior to account for 50% of premature deaths. While behavior is very broad, and all people must make health behavior choices, there are discrepancies in the choices poor and rich people face. Among the behavioral habits affecting health, diet, exercise, and smoking are major ones. Diet and exercise, for example, result from personal behavior choice. Yet, a poor family with extremely constrained income will choose to eat differently than a rich family with more flexibility in consumption choices. In many cases, a poor person must choose to eat the food with the most calories per dollar in order to survive. In the United States, this means high-calorie, unhealthy food—fast food, donuts, chips. Also, even if a poor person chooses to prioritize healthy food, food deserts common in poor neighborhoods, may restrict them from doing so. Similar arguments apply to exercise choices. Poor neighborhoods are more likely to be plagued by crime, which hinders a low-income individual’s desire to walk or ride bikes outdoors. The risk of being victim of a crime is a factor poor people often have to consider in their behavior choices that rich people do not.
While this list is extremely abbreviated, I provide a sampling of the examples in which people of low-income face different circumstances than high-income people, and suggest how these circumstances are a pathway to health outcomes. In order to reduce socioeconomic health disparities, future policy must consider each pathway connecting wealth to health outcomes. They must identify these pathways and use them as critical points for intervention.
The United States government spends the most on health care out of any developed country in the world—and it has the worst health status. If the United States wants to be a global example like it has in the past, it must improve the conditions of the poorest members of the country. I believe poverty is not a problem that politicians can throw money at. Raising levels of wealth will not solve the true issue, because there will always be relative differences in wealth. Rather, I believe living in a state of statistical poverty should not lead to increased chance of disease, and shorter life expectancy. I think that although incomes are different, even the poorest members of the world should be able to live healthy lives. Not only do I think it is what should be done, I think the country has an obligation to provide adequate health opportunity to its citizens. The United States has been spending its money on health care investments that are not producing results for all members of society equally. The U.S. needs to reallocate these funds to eliminate the injustice in health care that exists among the country’s rich and poor.