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Poverty and health in the United States

By Barry S. Levy and Victor W. Sidel

We live in the richest nation on earth. Yet 15% of the US population (about 46 million people) live below the poverty line — about $23,000 for a family of four. Almost 25% of children live in poverty. The number of American households living on $2 or less grew by 130% between 1996 and 2011. Actual household median income decreased by more than 8% between 2007 and 2012. And the number of homeless children in preschools and schools recently rose 10% within one year.

If you are poor, you are more likely to develop many illnesses, more likely to become injured, more likely to become disabled, and more likely to die early. You are less likely to have access to high-quality medical care — or any medical care at all — and less likely to have access to preventive services.

If you are poor, you are less likely to have adequate knowledge about threats to your health and to the health of family members, and less likely to know how to navigate our complex health care system. You are less likely to receive medical care from providers who are sensitive to your needs, who understand your living conditions, and who comprehend your personal and cultural perspectives on health and illness.

If you are poor, you are more likely to live in communities with hazardous outdoor and indoor air pollution. Your children are more likely to have elevated lead levels and resultant problems, such as lower IQ scores and reading levels, attention deficits, and behavioral problems. You are more likely to be unemployed or underemployed, and when able to get a job, you’re more likely to work in an unhealthful or unsafe workplace with hazardous chemical or physical exposures.

If you are poor, you are less likely to be able to access healthy foods and are more likely to be obese — and develop illnesses associated with obesity. You are more likely to be addicted to cigarettes. You are more likely to be victims of domestic or community violence. As a young adult, you are more likely to join the military in the hope of getting out of poverty — despite the risk of physical or mental disability, or death.


Not only does poverty adversely affect health, but also poor health increases the probability that a person will be poor. In the absence of adequate safety nets, people who are chronically ill or disabled from an injury are likely to become poor or even poorer. Medical expenses have been the leading cause of personal bankruptcy in the United States, even among individuals who thought they had adequate health insurance.

Why are there so many poor people in the United States today? There are many reasons: the ongoing high unemployment rate, the shredding of the social safety net, the declining power of workers and labor unions, the rising influence of market forces on social values and allocation of resources, decreased spending on the infrastructure of society, and diversion of financial and human resources to military purposes and away from programs and services that support people.

Much needs to be done.

We, as a nation, need to assure conditions in which poor people can be healthy, by promoting equal access to affordable high-quality medical care and preventive services; by addressing the societal conditions that keep poor people poor, such as by assuring that jobs provide a living wage – rather than a wage that amounts to a poverty wage; by providing access to high quality education, appropriate job training, and employment opportunities; and by providing adequate housing.

We also need to address racism, sexism, ageism, and other forms of discrimination. We need to protect the rights of everyone in society, especially those who are most vulnerable. And we need to make sure that poor people have a say in the decisions that affect them and their families and communities.

We need to communicate data that describe poverty and put a human face on these data by giving voice to the stories of poor people. We need to engage the public in these issues.

We need to educate and train health professionals to be culturally competent to address the medical needs of poor people, and also socially and politically competent to address the social context that keeps poor people poor from one generation to the next.

As public health workers and other health professionals gather for professional conferences this fall, we have a chance to focus on addressing poverty and its health consequences and on how to effectively address these problems.

Barry S, Levy, M.D., M.P.H., and Victor W. Sidel, M.D., are co-editors of the following books published by Oxford University Press: the recently published second edition of Social Injustice and Public Health, and two editions each of War and Public Health and Terrorism and Public Health. They are both past presidents of the American Public Health Association. Dr. Levy is an Adjunct Professor of Public Health at Tufts University School of Medicine. Dr. Sidel is Distinguished University Professor of Social Medicine Emeritus at Montefiore Medical Center and Albert Einstein Medical College and an Adjunct Professor of Public Health at Weill Cornell Medical College. Read their previous blog posts.

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