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Definition: Poverty is an important social determinant of health disparities across the lifespan. Poverty also influences other life challenges such as pecuniary instability, food insecurity, housing instability, educational inequality, and limited career mobility. According to the World Bank, more than 700 million people worldwide live in global poverty, surviving on less than USD 2.15 a day. Poverty may also be viewed as a state of deprivation that limits access to resources that address basic needs (i.e., food, water, shelter, clothing, health), limiting an individual’s opportunity to participate optimally in society. A large body of research has identified a positive relationship between poverty and chronic health concerns such as heart disease, diabetes, high cholesterol, kidney problems, liver problems, cancer, and hypertension. This entry examines health disparities associated with economic status, discrimination, racism, stress, age, race/ethnicity, gender, gender identity, and nationality from a social justice perspective.
- health disparities
- allostasis
- chronic stress
- chronic health concerns
- poverty
- discrimination
The National Institute on Minority Health and Health Disparities [1] defines health disparities as the occurrence of diseases at greater levels among marginalized groups compared to a reference group. Reference groups may include race/ethnicity, gender, gender expression, socioeconomic status, nationality, religion, ableism, and age. It is important to note that health disparities reflect the preventable differences in the morbidity and mortality rates experienced by disadvantaged groups [1]. These preventable differences suggest the opportunity for a reduction in the health burden for these groups. Poverty and race/ethnicity are two important social determinants of health disparities since both are known to influence other life outcomes such as food insecurity, economic insecurity, housing instability, educational inequality, and overall well-being. This discourse utilizes a nuanced life course perspective to examine chronic health conditions influenced by environmental stressors such as poverty, racism, and discrimination, centering health and well-being as basic needs and human rights issues.
The World Bank [2] purported that more than 700 million people worldwide live in global poverty, surviving on less than USD 2.15 a day. While every country determines its poverty line, the international poverty line of USD 2.15 serves as a standard for countries to measure extreme poverty (USD 1.90/day). Poverty may also be viewed as a state of deprivation that limits access to resources that address basic needs (i.e., food, water, shelter, clothing, healthcare, education), reflecting an “environmental press”. Consequently, individuals having the necessary resources to meet their basic needs reflect a “goodness of fit”, and for this entry, such individuals function as a reference group.
Globally, children represent nearly half of the individuals struggling to survive on less than USD 2.15 a day [3]. Around the world, roughly 1 billion children are “multidimensionally poor”, indicating they lack basic necessities such as nutritious food, clean drinking water, and basic services such as transportation, housing, communication, and health systems [3]. Children experiencing environmental adversity (e.g., living in impoverished neighborhoods) have been found to experience high rates of chronic stress and chronic physical health concerns, potentially impacting future trajectories [4][5][6]. Knowledge of the factors influencing the early development of chronic health conditions provides opportunities for early interventions that could reduce adverse health and social outcomes for the global society.
McEwen and Stellar coined the term “allostatic load” to explain the poorer health outcomes experienced by marginalized groups as a result of the chronic stress resulting from experiences with racism and discrimination [7]. Extant research has identified racism and discrimination as factors in the development of chronic health concerns such as cardiovascular disease (CVD, diabetes, high cholesterol, hypertension, and cancer [4][5][7][8]). Globally, the highest rates of poverty and chronic health conditions appear to be associated with racial and ethnic groups [5][7][8]. Geronimous et al. [5] reported that the stress-influenced health burden experienced by Black/AA persons was equivalent to the wear and tear of a White person 10 years older. Geronimous proffered the term “weathering” to explain the cumulative effect of repeated exposure to social and economic adversity. Section 1.3 provides a more detailed discussion of the relationship between poverty, stress, allostasis, and chronic health concerns.
While individual countries may utilize different monetary amounts to identify poverty, the health burden for those in poverty is comparable at the individual level. Poverty exacerbates risks for marginalized groups to experience discrimination based on a number of intersecting identities, particularly as it relates to healthcare [9][10]. Healthcare inequities are deeply embedded in the healthcare system, presenting as inequality in the diagnosis, management, and treatment of the health conditions experienced by marginalized groups [11]. In some developing and industrialized nations, access to quality medical care remains a problem due to practitioner attitudes, beliefs, and behaviors [12][13]. Although poverty functions as an important social determinant of health disparities, racialized groups, historically, have been the recipients of inequitable healthcare treatment, independent of income status [5][8][10][11] This entry examines the health outcomes that occur when environmental challenges exceed an individual’s ability to cope.
This entry is adapted from the peer-reviewed paper 10.3390/encyclopedia5010016
References
- NIMH—National Institute on Minority Health and Health Disparities. Minority Health and Health Disparities: Definitions. Available online: https://www.nimhd.nih.gov/resources/understanding-health-disparities/minority-health-and-health-disparities-definitions.html (accessed on 16 September 2024).
- World Bank Group. Understanding Poverty. Available online: https://www.worldbank.org/en/topic/poverty/overview (accessed on 15 September 2024).
- UNICEF. Child Poverty. Available online: https://www.unicef.org/social-policy/child-poverty (accessed on 16 September 2024).
- Blair, C.; Raver, C.; Granger, D.; Mills-Koonce, R.; Hibel, L. Allostasis and Allostatic Load in the Context of Poverty in Early Childhood Development. Psychopathology 2011, 23, 845–857.
- Geronimus, A.T.; Hicken, M.; Keene, D.; Bound, J. Weathering and age patterns of allostatic load scores among blacks and whites in the US. Am. J. Public Health 2006, 96, 826–833.
- Spears, D.E. Economic decision-making in poverty depletes behavioral control. BE J. Econ. Anal. Poverty 2011, 11, 72.
- Guidi, J.; Lucente, M.; Sonino, N.; Fava, G.A. Allostatic load and its impact on health: A systematic review. Psychother. Psychosom. 2020, 90, 11–27.
- McEwen, B.S.; Stellar, E. Stress and the individual: Mechanisms leading to disease. Arch. Intern. Med. 1993, 153, 2093–2101.
- Brown, C.C.; Marshall, A.R.; Snyder, C.R.; Cueva, K.L.; Pytel, C.C.; Jackson, S.Y.; Golden, S.H.; Campelia, G.D.; Horne, D.J.; Doll, K.M.; et al. Perspectives about racism and patient-clinician communication among Black adults with serious illness. JAMA Netw. Open 2023, 6, e2321746.
- Hamed, S.; Bradby, H.; Ahlberg, B.M.; Thapar-Bjorkert, S. Racism in healthcare: A scoping review. BMC Public Health 2022, 22, 988.
- Tong, M.; Artiga, S. Use of Race in Clinical Diagnosis and Decision Making: Overview and Implications. Issue Brief. KFF. 9 December 2021. Available online: https://www.kff.org/racial-equity-and-health-policy/issue-brief/use-of-race-in-clinical-diagnosis-and-decision-making-overview-and-implications/ (accessed on 6 October 2024).
- NIH. The Current State of Global Health Care Quality in Crossing the Global Quality Chasm: Improving Health Care Worldwide; National Academies Press: Washington, DC, USA, 2018. Available online: https://www.ncbi.nlm.nih.gov/books/NBK535654/ (accessed on 6 October 2024).
- Schoenthaler, A.; Williams, N. Looking beneath the surface: Racial bias in the treatment and management of pain. JAMA Netw. Open 2022, 5, e2216281.
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