Many of our finest researchers across the country have lectured to their students, written papers, and provided countless presentations on the association of poverty with poor health outcomes.
Per the “For the Sake of All” project, “Deaths due to limited economic and educational opportunity affect us all. In St. Louis, the estimated cost of this loss of life in one year is approximately $4.0 billion.” And it is not just the poverty-related mortality rates we’re talking about. It is also the type of life you are more likely to live when income inequality is an issue.
For example, girls who are repeatedly exposed to poverty growing up are more likely to beoverweight or obese as young women per a study published in the Journal of Epidemiology and Community Health.
As an “on the ground” type of provider who has practiced in community health centers in Illinois and Missouri in addition to an academic practice, the data from these studies simply provide validation to what I have seen and continue to see in my practice. Simply put, patients who lack economic resources have poorer outcomes.
Let’s take a case I encountered in about 2002. My patient was a 40 something year old African American mother of young girls. She was a hard working uninsured woman who after receiving a mammogram through one of the safety net facilities available to her at the time was told that her screening test was suspicious for cancer. I can only imagine the conversation this poor lady was having in her head. How am I going to pay for my care? Who will take care of my daughters if I am out sick? So you know what she decided to do?
Nothing. She decided to do nothing until about a year ago. This patient recently reconnected with me several weeks ago and updated me on her journey. Since our last encounter she unfortunately had become addicted to drugs and had neglected her health in other areas as well.
Her cancer had progressed to the point where mastectomy had been the only option. As a result of drug addiction and a lack of preventative care, she now battles other health conditions as well. What if economic barriers had not been an issue for this lady? Would her outcomes have been better?
In some ways, yes this patient’s care could have dramatically taken a different course with
adequate resources. However, we must remember that even with controlling for income, in some instances disparities still exist for people of color as compared to whites. But income inequality continues to contribute the greatest gaps in health outcomes between black and white patients.
And having insurance alone is not the answer. Many of my patients have “good” insurance yet they miss taking their daily hypertension meds because they did not have the money to pay the copay for their prescriptions. Not to mention the patients who have not gotten their shingles vaccine because their out of pocket portion is approximately $200.
So as you can see, having money in this country is one way to slightly improve your chances of having better health outcomes. But I do hope our future leaders, policy makers and practitioners will develop a solution to this shameful social ill of our nation as it relates to the “haves and the have nots.”
Your family doctor,
Denise Hooks-Anderson, M.D.
Assistant Professor
SLUCare Family Medicine
yourhealthmatters@stlamerican.com
