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Talking
about Class and Health
News • 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.
News
Latest research and opinion on
class and health
- New! 25
million U.S. adults are underinsured The number of people who
have health coverage that does not adequately protect them from high
medical expenses has risen dramatically. A new
Commonwealth Fund study finds that as of 2007, there were an estimated
25 million underinsured adults in the U.S., 60 percent more than the
16 million underinsured in 2003. Most of this growth came from rising
uninsured rates among middle- and higher-income families, according
to the article, How Many Are Underinsured? Trends Among U.S. Adults.
 Poor,
minority and less educated get sick more, die younger A new report
issued by the Robert Wood Johnson Foundation reveals that " whether
or not a person gets sick in the first place often has little to do
with their health care," according to RWJF President Risa Lavizzo-Mourey. - Cash
transfers reduce disabilities A study examining whether the Supplemental
Security Income (SSI) program, (the federal cash transfer program
to poor elderly) affects old-age
disability finds that benefits are linked to lower disability rates.
Income support policy may be a significant new lever for improving
population health, especially that of lower-income persons.
Thanks to Hennepin County for assistance in compiling news items.
Contact Luanne Nyberg to
receive a daily email digest of research headlines.
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Class:
Questions & Answers
Equitable treatment
for patients regardless of economic class
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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Got a question? Share it on the Exchange members' discussion
forum.
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
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.
Offered
by: Universal Health Care Action Network - MN (UHCAN-MN) 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.
Minnesota Universal Health Care Coalition:
Promotes legislation for a universal, single-payer system in Minnesota
and America.
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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