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In poverty and in health

Posted by: Julia Eisman on Oct 16, 2008

In honor of yesterday's blog action day on poverty, wethought this a good opportunity to discuss how poverty is inextricably linkedto inadequate access to health care services and overall poor health. Living inpoverty means living without readily available affordable fresh foods and nutritiousmeals. It means living in more dangerous, polluted neighborhoods thatdiscourage spending time outdoors. It often means living with alcohol andsubstance abuse, which wreak havoc on the health of individuals and communities. Living in poverty often means livingwithout regular access to a doctor. Taken as a whole, these conditions are arecipe for chronic illnesses and even premature death. 

Those at the lower end of the economic spectrum aredisproportionately represented in the ranks of the uninsured - and getdisproportionately less access to quality medical care.  While it is illegal for emergency rooms toaltogether deny care to critically ill individuals, insured or not, it doesn'tmean that everyone will get the same level of care, says onephysician in the Washington Post:

"I used to get angry every time the emergency room admitted an uninsured patient," he said. "I would try to spend less time with them -- 20 minutes instead of 30 -- and try to get them out of the hospital quickly and hope they would not come to my clinic."      

The article goes on to say:

It's not uncommon for patients with no insurance or poor insurance to receive different treatment. A 2006 study of 25 primary care private practices in the Washington area showed that in nearly one in four encounters, physicians reported adjusting their clinical management based on a patient's insurance status; nearly 90 percent of physicians admitted to making such adjustments. For patients with no insurance, alterations occurred 43 percent of the time; and for the privately insured, just 19 percent. 

As the rich get richer and the poor get poorer, it's notonly the income gap that's widening, buta health gap. It's deplorable that emergency rooms offer the primary sourcefor medical treatment for those without health coverage, and it may at times besubstandard care at that.

But wait. Don't low-income people get Medicaid?Well, some do. If happen to be in certain groups, like kids, pregnant women, orpeople with severe disabilities. But for most adults, being poor means goingwithout health insurance-unless you're lucky enough to live in a (relatively)generous state like Pennsylvania or Vermont. But good luck if you move to Alabama or Texas, where an incomeof 30% of the poverty level makes youtoo rich to get Medicaid if you're a parent (and ifyou don't have kids, you can't get Medicaid even if you're broke).

The lack of access to quality affordable health care to allAmericans, especially to the sickest and poorest, is abhorrent - particularlytaking into account the social, environmental, and behavioral factors that leadto poor health to begin with. Providing all Americans with high-quality,affordable health coverage would be one step to eliminating the growing health disparitybetween the haves and the have-nots.