A recent paper describes the impact of poverty on various health outcomes and social conditions using an elegant, easy-to understand method. The authors used the 2015 County Health Rankings National Data to determine the five-year averages for median household income for each of the 3,141 US counties. Desiring to look at the poorest counties in the nation, regardless of where they were geographically located, the authors rearranged the counties sorted by increasing income into 50 new states each representing 2% of the counties in the US. They then compared the poorest and wealthiest states.
The poorest states are clustered in an area of exponential increase for potential life lost. Its obvious that income matters for ones health. Many other measures were significantly skewed (p<0.01) towards the poorest states: higher African-American population, more elderly, more rural living, more smoking, more obesity, more physical inactivity, more children in poverty, more unemployment, more income inequality, and lower high-school graduation rates.
The authors even created a map of the world depicting countries with longer life expectancy than the poorest state. Countries such as Haiti, Chile, Libya, and Sri Lanka have longer life expectancies than the poorest state in the United States.
State-level data may be less useful as an indicator of public health than local county data. It follows then that statewide public health programs may be less effective than more targeted programs. Indeed, the finding that the poorest state was comprised of 37% African-Americans as opposed to only 8% in the wealthiest state and that in the poorest state 75% of the population was living in a rural area as compared to only 21% in the wealthiest state reinforces that accounting for specific demographic factors in poor counties is crucial in planning a successful public health program.
The authors have identified an effective mechanism to demonstrate the impact of poverty on health. Public health professionals must advocate for the poor by educating our students, communities, and leaders about the power that poverty has over health. We must disabuse others of the notion that poverty arises from individual factors such as bad luck, laziness, and poor choices, and instead attack poverty in America as a societal issue that deserves a societal response.
commentary by Megan Doede
OBJECTIVES: To more clearly articulate, and more graphically demonstrate, the impact of poverty on various health outcomes and social conditions by comparing the poorest counties to the richest counties in the United States and to other countries in the world.
METHODS: We used 5-year averages for median household income to form the 3141 US counties into 50 new “states”-each representing 2% of the counties in the United States (62 or 63 counties each). We compared the poorest and wealthiest “states.”
RESULTS: We documented dramatic and statistically significant differences in life expectancy, smoking rates, obesity rates, and almost every other measure of health and well-being between the wealthiest and poorest “states” in the country. The populations of more than half the countries in the world have a longer life expectancy than do US persons living in the poorest “state.”
CONCLUSIONS: This analysis graphically demonstrates the true impact of the extreme socioeconomic disparities that exist in the United States. These differences can be obscured when one looks only at state data, and suggest that practitioners and policymakers should increasingly focus interventions to address the needs of the poorest citizens in the United States.