March 15, 2007


Comment: Inequality, demonstrated here by two crawdads, can cause serious public health problems.

This is the second post in a series about poverty, inequality, and public health.If this is your first visit, please scroll down to yesterday's post.

This series was inspired by a recent scholarly article in The American Journal of Preventative Medicine by Steven H. Woolf (MD, MPH), Robert E. Johnson (Ph.D.), and J. Jack Geiger (MD, MS) titled "The Rising Prevalence of Severe Poverty in America: A Growing Threat to Public Health."

Yesterday's post looked at growing severe poverty from an economic and social standpoint, while today's will deal with health consequences, many of which are obvious and serious:

The public health implications of increasing poverty are profound, given how strongly social class is linked with premature mortality, disease, and mental illness. The poor have greater exposure to risk factors, such as those caused by homelessness, substandard housing, and environmental pollutants. They experience greater rates of smoking, physical inactivity, and obesity, in part because impoverished neighborhoods are not conducive to healthy lifestyles (e.g., having built environments for walking and supermarkets that offer healthy food choices); these communities are also targets for the promotion of cigarettes, alcoholic beverages, and fast foods.

(Note: footnotes were removed from quoted passages for easier reading.)

Poor people who work generally don't have jobs that offer insurance and can't afford to buy it themselves. This may cause people to do without care or postpone seeking it until the situation worsens. Further, the cost of uncompensated care shifts costs to other health care consumers.

Education is another factor related to poverty that can lead to adverse health consequences. The authors note that the inadequate education that usually goes along with poverty makes it harder for people to have the information to make good health decisions and to get the kinds of jobs that provide access to health care.

Not surprisingly, the effects of severe poverty are hardest on children:

Children are especially vulnerable to harm from severe poverty because of its influences on perinatal outcomes, growth, nutrition, parenting, safety, development, emotional health, access to health care, adolescent pregnancy, cognition, and educational success. Children exposed to severe poverty are at greater risk of experiencing unemployment, learning disabilities, mental illness, physical disease, substance abuse, and crime as adults. They are also more likely to remain in poverty as adults,104 thereby perpetuating the cycle for their children. According to one report, only 6% of children who grow up in the lowest quintile of income attain the highest income quintile as adults (compared to 42% of those who grow up in the highest income quintile).

The authors conclude that government policies in recent years has been

to promote vibrant commerce as a vehicle for job creation and to reduce outlays for social services to finance tax cuts and other incentives to “grow the economy.” The findings reported here suggest that this policy has improved incomes for only a small proportion of the population—primarily the most affluent class—while poverty rates at the other end of the spectrum have increased. Millions of Americans, over-represented by children and minorities, have entered conditions of extreme poverty. After 2000, Americans subsisting under these conditions grew as a class more than any other segment of the population. Potential solutions to poverty are formidable and politically difficult, but the first step is to recognize the problem, which to date has received little exposure, and its implications for public health and society. Policymakers should consider our data in judging whether policies enacted in recent years have helped or hindered the public.

El Cabrero's unauthorized translation: we're on the wrong road and we need to change directions.

BIG NEWS! Caliente damn! DSL has arrived at Goat Rope Farm! This means big changes for this blog, including more than one post per day as things arise, video clips, and maybe even podcasting (once I figure out what, exactly, podcasting is)...unless I get lost in youtubeland.



hipparchia said...

yeah! i just got DSL too. it's slowed my blogging a lot. now i can surf the internet, instead of just getting my toes wet. who's got time for blogging?

El Cabrero said...

Who's got time for anything? I just wanna play on the computer. Youtube is cool...