Talking about Class and Health
Questions & Answers • Tools

Overview: A person’s economic class affects their health, in both obvious and hidden ways. In the United States, not having enough money to pay for health insurance is a clear health risk. Individuals without health insurance are less likely to have routine physical examinations. They are less likely to know they have high blood pressure, diabetes, high cholesterol or many other serious health problems.

Health disparities are rooted in wealth disparities, but there’s more to health than a high income. Countries with a big gap between the haves and the have-nots show poorer health statistics overall than countries in which most people have similar incomes, even if they are modest.

Money isn’t often talked about in a doctor’s office, but it should be. A patient who can’t afford his medicine probably won’t buy it, and probably won’t mention that fact. Asking patients if treatments are affordable is tricky, but necessary.

Class: Questions & Answers
Equitable treatment for patients regardless of economic class

• How do we know that being poor is bad for your health?
• Is income the only way that economic class affects health?
• I think perhaps my patient can't afford the treatment I've recommended. How do I ask him?

Q. How do we know that being poor is bad for your health?

A. If you are too poor to afford health insurance, and you do not have access to free care, you are more likely to be unhealthy, according to recent research. The uninsured miss needed medical care, including screenings for early signs of cancer and other illnesses.

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Q. Is income the only way that economic class affects health?

A. No, definitely not. For example, researchers using data collected in the Black Women’s Health Study, a prospective follow-up study of 59,000 black women, found that median housing value was inversely associated with hypertension, but was independent of income level or of individual risk factors such as weight and physical inactivity. In other words, simply living in a poor neighborhood increases the likelihood of hypertension for black women.

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Q. I think perhaps my patient can’t afford the treatment I’ve recommended. How do I ask him?

A. It may be best to be indirect; people are often ashamed about being unable to afford health care. But don’t avoid the subject. Most patients would welcome a chance to save money on health care, if offered diplomatically. You could start with a question about whether the patient might prefer a generic brand rather than the name brand of the treatment prescribed.

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Tools:
Key publications, websites and organizations on class and health

National Resources

Low Income, Social Growth, and Good Health: A History of Twelve Countries, by James C. Riley, University of California Press. This book studies 12 countries that have broken through the limits that low incomes so often impose on human survival: China, Costa Rica, Cuba, Jamaica, Japan, Korea, Mexico, Oman, Panama, the former Soviet Union, Sri Lanka, and Venezuela. People had longer and healthier lives in these countries because of 'social growth' that enabled even poor communities to organize programs of schooling, public health, and health care.

Reaching for a Healthier Life: Facts on Socioeconomic Status and Health in the U.S. A recent report from The John D. and Catherine T. MacArthur Foundation Research Network on Socioeconomic Status and Health reveals the relationship between poor socioeconomic status and poor health in the U.S. The authors also discuss race as an additional factor linked to health status and offer policy suggestions to reduce premature death and eliminate health disparities.

Resource Guide to Serving Refugees with Disabilities Produced by the U.S. Committee for Refugees and Immigrants Assisting Refugees with Disabilities Program, the guide includes information about housing, assistive technology, medical resources, citizenship, and benefits for refugees with disabilities

Income, Poverty, and Health Insurance Coverage in the United States: Based on 2005 census figures.

Consequences of Uninsurance: Six annual reports from the Institute of Medicine on health insurance and access to care in America. Titles include:

• Insuring America’s Health: Principles and Recommendations
• Health Insurance is a Family Matter
• Coverage Matters: Insurance and Health Care
• Care Without Coverage: Too Little, Too Late
• A Shared Destiny
• Hidden Cost, Value Lost

Association of Clinicians for the Underserved: Nonprofit, transdisciplinary group to improve the health of America's underserved populations and enhance the development and support of the health care clinicians serving these populations.

Profiles of the Uninsured: Stories from the Commonwealth Fund that illustrate the many costs and consequences of living without coverage.

Minnesota Connections

Child& Teen Check-Ups Program: Low income children and teens in Minnesota can be vaccinated and screened for preventable and more serious illnessesthrough this program administered by the Department of Human Services.

Universal Health Care Action Network - MN (UHCAN-MN): Providers offer low-cost, mobile screenings for cholesterol, diabetes, blood pressure, pulse. Volunteer docs and nurses do extremely low-cost testing counseling and referral. Tests offered include total cholesterol, lipid panel, liver function. For more information, call 612-384-0973, or contact joel@uhcan-mn.org. Volunteers include Joel Albers, Pharm.D., Mike Cavlan R.N., Ann Ness R.N, Dori Ulman, Jennifer Umola and Diane O’Donnell.

Bridge to Benefits: An online program that helps families find out about and apply for Food Support, school meal programs, health care programs, energy assistance, child care assistance and the Earned Income Tax Credit. Produced by the Minnesota Children’s Defense Fund.

Children’s Defense Fund Minnesota: Promotes the Children’s Health Security Act, which would ensure that all children have access to affordable, quality health care coverage and eliminate current access and cost barriers.

Women and Health Insurance in Minnesota, Office on the Economic Status of Women April 2007. Health insurance rates in the state by gender, as well as rates of public and private coverage.

Advancing Community Health Worker Practice and Utilization: The Focus on Financing (PDF: 4.36MB/89 pages); Funding CHW Programs and Services in Minnesota: Looking to the Future (PDF: 1.58MB/28 pages); Community Health Worker National Workforce Study (1.08MB/285 pages) — all are available for download at the Minnesota Department of Health website.

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