On the poor and health outcomes

By now, we’re all familiar with the relationship between income and health status. Generally and relatively speaking, the poorer you are economically, the poorer your health. Compared to their wealthier counterparts, poorer people typically have higher rates of heart disease, cancer, obesity (and malnourishment), substance use and chronic and mental illnesses. The income-health status relationship has existed for centuries and has been seen in all types of countries —rich, poor, north, south, capitalist, communist, etc. And it makes sense. Poorer people often live in areas with greater levels of air, water or ground pollution, for instance, than their wealthier counterparts, and their housing and living conditions (e.g., construction, noise, heating/cooling, bugs, mold) may be worse or toxic. Access to healthcare facilities or recreational outlets may also be more limited for those in poverty. So being poor can affect you physically.

But so can feeling poor. Of course, a lot of the time being poor and feeling poor overlap. But they don’t always. And the health consequences of feeling poor might actually be worse than those of just being poor. Feeling poor can be depressing and stress you out. Many of the diseases (ulcers, cancers, cardiovascular and respiratory diseases) and chronic and mental illnesses are stress-related after all. Feeling poor can also lead to the “I’ll do it tomorrow” disease, which may be the leading cause of death in the U.S. That’s a hard one to vaccinate people against.

Unfortunately, it’s probably easier to be made to feel poor these days than ever before due to technological and communications advancements. Our worlds are simply bigger these days, allowing us to make more comparisons with others. Indeed, today, as Robert Sapolsky, professor of biology, neurology and neurosurgery at Stanford University, has suggested in one of his several wonderful works on stress and life, we can be made to feel poor or relatively deprived by folks we don’t even know.

So this brings me to an issue I confront as a public health professional, one I think we should all consider when dealing with others. Labeling. Labeling often matters and can affect people in positive or negative ways. Research is pretty clear on this. Labeling or categorizing people (e.g., “creative,” “slow,” “bright,” “troublemaker,” “aggressive,” etc.) can influence the expectations of both others and those who are actually being labeled, and those expectations can influence subsequent behaviors and outcomes. That is, labeling can lead to self-fulfilling prophecies. For instance, if I think nobody likes or ever will like me, eventually nobody will like me, for whatever reason, and I likely contributed to that through my attitudes and actions.

As a public health professional, we need to think more about how we approach those living in poverty. There’s a lot of funding out there for research on poverty, and rightfully so. Happier, healthier neighbors benefit us all. Undoubtedly, poverty researchers (and others engaged in the field) are some of the most selfless, caring and kind-hearted people in the world. But I wonder sometimes whether we need to be more cognizant and sensitive about recruiting or interviewing “poor,” “less fortunate,” “disadvantaged,” “underserved” or “most vulnerable” individuals or groups. I’m not sure what the answer is, and maybe the labeling in these instances — if these can even be considered instances of labeling — doesn’t matter. But what if it does? We ultimately want to take one or two steps forward and no steps backward when helping others and thus ourselves.

This story was originally published May 11, 2017 at 4:20 PM with the headline "On the poor and health outcomes."