Covering poverty and health

– by Patricia Thomas

(Note: Some of the examples in this tutorial are based in Georgia, where this site was created. That said, virtually all of the advice is based on county-level data that is applicable to and available in every U.S. state.)

Why should you cover poverty and health in your county:

1. Low-income women are less likely to have adequate prenatal care and more likely to give birth to premature or low birth weight infants, who often require additional, costly medical care as they develop. In Georgia, African-American babies are twice as likely as white infants to die before they are old enough to talk.
2. Children from low-income families often miss out on preventive immunizations and check-ups that detect developmental or sensory impairments. Treatable health problems ranging from head lice to advancing deafness undermine individual achievement and the school system as a whole. Unaddressed health problems can contribute to lower test scores, inflate demand for special education services, and boost drop-out and teen pregnancy rates.
3. Low-income and minority teens have higher pregnancy rates than higher-income, white teens, and teen pregnancies are increasing among Georgia's growing Hispanic population. Teen mothers are more likely to drop out of school, less likely to be employed, more likely to require public assistance, and at greater risk for persistent poverty.
4. Poor neighborhoods have more fast-food outlets than supermarkets. Not surprisingly, people in these settings are more likely to consume calorie-rich, nutrient-poor foods than they are to follow dietary guidelines promoted by public health authorities. Easy access to a cheap, unhealthful diet sets the stage for obesity, hypertension, diabetes and other chronic problems that reduce productivity, increase dependence and shorten lifespan.
5. The working poor are less likely to have employer-provided health insurance than higher-paid workers. Uninsured workers are less likely to undergo periodic physical exams, and as a result risk factors and early signs of cardiovascular disease, cancer, diabetes and other chronic conditions may be overlooked until disease worsens and treatment becomes costlier and cure less likely.
6. Even minority patients who are fully insured and can pay for care are harmed by bias-driven disparities in medical care. In Unequal Treatment, the Institute of Medicine reported that insured black people who suffer a heart attack are less likely to receive many treatments that white people receive. This partly explains why, in all age groups, cardiovascular disease death rates for African Americans are nearly one-third higher than for any other group.
7. Regular mammograms and Pap smears are standard procedures for insured women, and follow-up is routine when abnormal results are found. Poor women are less likely to be screened for breast or cervical cancer, and when a diagnosis is made they often lack access to tumor genotyping, costly new drugs and other interventions available to women with private health coverage.
8. Mental health problems such as depression and substance abuse take an enormous toll on productivity, parenting, and other vital aspects of daily life - yet the availability of free or low-cost services is declining in many communities. Psychiatric units in many hospitals have been shut down, turning emergency rooms and jails into holding pens for people whose mental illnesses could be effectively treated in an appropriate setting.
9. Dental benefits are rare for the working poor, even those with some form of employer-based health insurance. Nor is oral health care provided by Medicaid or Medicare. Preventive care, such as tooth cleaning and filling of dental caries, is rarely available to low-income children or adults. For many people in poverty, tooth extraction is the only dental service they have ever received. Being gap-toothed can significantly lower lifetime earnings, because free dentures are rarely available and job options are limited by appearance.
10. When communities compete for a new manufacturing plant or government installation, local leaders know that the winner is often the one with the better- educated workforce. Because employers anticipate that they will shoulder many medical costs for a new workforce, having a healthier pool of potential hires can also be a competitive advantage.
11. The number of Georgia residents over 65 is increasing at nearly twice the national rate, transforming us from a "younger than average" state to one with a disproportionate share of older folks. This will significantly impact family caregivers, demand for personal care services, need for assisted living and nursing home beds, physician and hospital services, ambulance services and even highway safety.
12. Even though Medicare covers many medical and hospital services, being over 65 does not sever the lifelong tie between poverty and poor health. According to a report compiled by the University of Georgia's Institute of Gerontology, older Georgians are at elevated risk for health problems because 38% of them live below or within 200% of the poverty level and 25% are minorities.