Are You Sick, or are You Just Poor? A Peer Into the Interconnectedness of Health and Poverty

Author: Rachel Downey

Upon arriving in Athens on July 6th, one of the program coordinators, Tom, took myself and my fellow classmates on a short tour of the immediate area of the city, called Plaka. On our way through town, a frantic, greasy-haired woman scurried past us on the street, with her breasts hanging free and a young child to her nipple. She was distressed, and even began speaking to passerby in Greek, but we couldn’t understand. I didn’t think too much of it, because the #FreeTheNipple movement has made it’s impact in the states, but I also realize that we are in a different culture on the other side of the world.

Shortly after this encounter, Tom informs us of what is going on. These women panhandle, at these children’s expense, exploited for their innocence by their own mothers and handed off to beggars on the street. This experience got me thinking about the lengths people will go, simply in order to live a comfortable life. In 2014, 14.8% of the U.S. population was living below the poverty line, that is, making less than $24,008 a year for a family of four (Bernstein, 2018). The statistics in Greece are not much different. In 2016, 13.6% of Greeks lived below the poverty line, rounding out to just under 1.5 million (Chrysopoulos, 2017).

Regardless of geographical location, poverty affects people of all ages, and manifests itself amongst various levels. A journal article composed by Deepti Gupta (2017), focuses on the effects of poverty, unemployment, and recession on youth’s mental health. The youths are a pivotal population to study, because they have the highest chance to emerge out of poverty between the ages of 18 and 22. Emergence is much less likely to happen after one reaches post-college age, or doesn’t graduate high school. Poverty can impact an individual’s mental and physical health within various contexts. At an individual level, poverty can cause anxiety, depression, and low self esteem. Physically, it can cause immense amounts of stress, which can lead to high blood pressure, circulatory problems, and an increased risk for sclerosis multiplex. It has even been known to manifest as an immune system suppressant, causing an increased risk for infections as well as a multitude of other physiological issues.

 At the family level, poverty, recession, or unemployment can lead to shame (from the providers of the family for not fulfilling their duty), neglect, and harsher parenting practices, while marital distress can lead to negative social and emotional outcomes for children. It has been said that financial strain, particularly in the case of providing for a family, is thought to be a better predictor of psychiatric morbidity than both poverty and unemployment. In the case of parents, this frequently manifests as chronic stress and feelings of hopelessness (Deepti, 2017).

At the community level, living in poverty can mean poor educational facilities and resources, violent or dangerous neighborhoods, behavioral problems at school such as difficulty making friends, aggression, conduct disorder, and overall increased levels of frustration due to lack of resources and feelings of helplessness. Growing up in an unsafe neighborhood can lead to a number of different psychological difficulties for children. Increased exposure to violence or gang related behaviors has been known to predict violent behavior in the future, and puts youth at a greater risk for injury, death, or ending up in the juvenile justice system (Deepti, 2017).

One’s own perception of their quality of life or poverty level can also impact their health. Anderson (1968), proposes what he calls the Anderson Model to describe three telling factors of health service use. These three factors include: predisposing characteristics, enabling resources, and need. Predisposing characteristics includes sociodemographic factors such as one’s age, sex, race/ethnicity, or marital status. Enabling factors can be seen at both an individual level and community level, and these include income, health insurance, and the availability of health resources and facilities. Lastly, need refers to one’s perceived need for medical evaluation and/or health services. In simpler terms, people living in poverty are less likely to take advantage of health service facilities due to lack of income, inadequate or nonexistent health insurance, and overall scarcity of resources. Stigma also plays a role in access to healthcare, for the need to rely on welfare or government assistance can have a negative perception in society.

What does this mean for people struggling to make ends meet who are struggling with chronic illnesses? A study (Ezzy, 1999) titled “Poverty, Disease Progression, and Employment Among People Living with HIV/AIDS in Australia” may help shed some light on the effects of having a chronic illness and dealing with poverty. Although the Australian Health and Welfare system provides reasonable assistance with the costs of medical bills, it can be assumed that the results of this study could be amplified to mirror the healthcare systems in the U.S. (or lack thereof). Ultimately, the study found that living with a chronic illness such as HIV/AIDS has the potential to propell someone into poverty, since their health progressively declines as the disease progresses, and psychosocial factors such as anxiety, depression, and withdrawal can cause them to leave the workforce. Likewise, infectious diseases have been a leading killer of the poor since the beginning of society. The poor cannot afford the same treatments the wealthy can, therefore risk of infection is higher and treatment is less likely (Ngonghala, 2014).

Additionally, a study conducted by Bernstein (2018) found that individuals that met the income levels up to three thresholds higher than the federal poverty threshold had higher annual survival rates than those living in poverty, or even near poverty. Since the official federal poverty threshold is set so low, Bernstein considered people “near” poverty in the study as well and found that they had lower life expectancies than their more well-off counterparts. “Near poverty” is generally considered as a family income of 101%- 134% of the federal poverty level, whereas “poverty” is considered to be a family income of 0%-100% of the federal poverty level (Kim, 2015).

Overall, there are striking ties between income disparities, unemployment, and health qualities of the poor. Poverty has been shown to impact people of all ages, at various levels, and the effects can be mental, emotional, and in extreme cases, physical. In order to prevent poverty from affecting the health of the poor disproportionately, there should be an improved healthcare system implemented in the United States, providing better assistance to the poor, and making healthcare more accessible. Hopefully with the help of the scientific community, infectious diseases will become more easily combatable, and vaccines will be more accessible and accepted in the public eye.

Resources:

Bernstein, Shayna Fae. (2018). “Poverty dynamics, poverty thresholds, and mortality: and age-stage Markovian model” PloS ONE. 13 (5). P. 1-12.

Chrysopoulos, Phillip. (2017). “Almos 1.5 million Greeks live in extreme poverty” Greek Reporter:

http://greece.greekreporter.com/2017/05/02/almost-1-5-million-greeks-live-in-extreme-poverty/. 

Ezzy, Douglas. (1999). “Poverty, disease progression, and employment among people living with HIV/AIDS in Australia” AIDS Care. 4 (11). P. 405-414.

Gupta, Deepti. (2017). “Unemployment, poverty, and recession impact on youth’s mental health”. Indian Journal of Health and Well-being. 8 (8). P. 911-914.

Kim, Jim. (2015). “Poverty, health insurance status, and health service utilization among the elderly” Journal of Poverty. (19). P. 424-444.

Ngonghala, Calistus N. (2014). “Poverty, disease, and the ecology of complex systems” PloS Biol. 12 (4). P. 1-7.