About This Literature Summary
This summary of the literature on Poverty as a social determinant of health is a narrowly defined examination that is not intended to be exhaustive and may not address all dimensions of the issue. Please note: The terminology used in each summary is consistent with the respective references. For additional information on cross-cutting topics, please see the Discrimination, Employment, Housing Instability, and Incarceration literature summaries.
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Literature Summary
The United States measures poverty based on how an individual’s or family’s income compares to a set federal threshold.1 For example, in the 2021 definition, people are considered impoverished if their individual income is below $12,880 or their household income is below $26,500 for a family of 4.2 After 5 consecutive years in decline, the U.S. poverty rate increased to 11.4 percent in 2020, or a total of 37.2 million people.3
Poverty often occurs in concentrated areas and endures for long periods of time.1 Some communities, such as certain racial and ethnic groups, people living in rural areas, and people with disabilities, have a higher risk of poverty for a myriad of factors that extend beyond individual control.1,4–8 For example, institutional racism and discrimination contribute to unequal social and economic opportunities.4 Residents of impoverished communities often have reduced access to resources that are needed to support a healthy quality of life, such as stable housing, healthy foods, and safe neighborhoods.1,4,9 Poverty can also limit access to educational and employment opportunities, which further contributes to income inequality and perpetuates cyclical effects of poverty.1
Unmet social needs, environmental factors, and barriers to accessing health care contribute to worse health outcomes for people with lower incomes.10,11 For example, people with limited finances may have more difficulty obtaining health insurance or paying for expensive procedures and medications.12 In addition, neighborhood factors, such as limited access to healthy foods and higher instances of violence, can affect health by influencing health behaviors and stress.12
Across the lifespan, residents of impoverished communities are at increased risk for mental illness, chronic disease, higher mortality, and lower life expectancy.9,13–17 Children make up the largest age group of those experiencing poverty.18,19 Childhood poverty is associated with developmental delays, toxic stress, chronic illness, and nutritional deficits.20–24 Individuals who experience childhood poverty are more likely to experience poverty into adulthood, which contributes to generational cycles of poverty.25 In addition to lasting effects of childhood poverty, adults living in poverty are at a higher risk of adverse health effects from obesity, smoking, substance use, and chronic stress.12 Finally, older adults with lower incomes experience higher rates of disability and mortality.6 One study found that men and women in the top 1 percent of income were expected to live 14.6 and 10.1 years longer respectively than men and women in the bottom 1 percent.26
Poverty is a multifaceted issue that will require multipronged approaches to address. Strategies that improve the economic mobility of families may help to alleviate the negative effects of poverty.27–29 For example, tax credits such as the Earned Income Tax Credit and Child Tax Credit alleviate financial burdens for families with lower and middle incomes by reducing the amount of taxes owed.30 In addition, federal social assistance programs are designed to provide safety net services and specifically benefit individuals and families with lower incomes.31 Two of the nation’s largest social assistance programs are Medicaid, which provides health coverage, and the Supplemental Nutrition Assistance Program (SNAP), which provides food assistance. Medicaid and SNAP serve millions of people each year and have been associated with reductions in poverty along with overall health benefits.32,33 In order to reduce socioeconomic inequality, it may also be important to address factors that are associated with the health status of poor communities.27 Additional research and interventions are needed to address the effects of poverty on health outcomes and disparities.
Citations
U.S. Department of Agriculture, Economic Research Service. (n.d.) Rural poverty & well-being. Retrieved December 13, 2021, from https://www.ers.usda.gov/topics/rural-economy-population/rural-poverty-well-being/
U.S. Department of Agriculture, Office of the Assistant Secretary for Planning and Evaluation. (2021, February 1). 2021 Poverty guidelines. https://aspe.hhs.gov/topics/poverty-economic-mobility/poverty-guidelines/prior-hhs-poverty-guidelines-federal-register-references/2021-poverty-guidelines
Shrider, E. A., Kollar, M., Chen, F., & Semega, J. (2021, September 14). Income and poverty in the United States: 2020. U.S. Census Bureau. https://www.census.gov/library/publications/2021/demo/p60-273.html
Williams, D. R., Mohammed, S. A., Leavell, J., & Collins, C. (2010). Race, socioeconomic status, and health: Complexities, ongoing challenges, and research opportunities. Annals of the New York Academy of Sciences, 1186(1), 69–101. https://doi.org/10.1111/j.1749-6632.2009.05339.x
Kaiser Family Foundation. (n.d.). Poverty rate by race/ethnicity. https://www.kff.org/other/state-indicator/poverty-rate-by-raceethnicity/
Minkler, M., Fuller-Thomson, E., & Guralnik, J. M. (2006). Gradient of disability across the socioeconomic spectrum in the United States. New England Journal of Medicine, 355(7), 695–703. https://doi.org/10.1056/NEJMsa044316
Brucker, D. L., Mitra, S., Chaitoo, N., & Mauro, J. (2015). More likely to be poor whatever the measure: Working-age persons with disabilities in the United States. Social Science Quarterly, 96(1), 273–296. https://doi.org/10.1111/ssqu.12098
Rank, M. R., & Hirschl, T. A. (2015). The likelihood of experiencing relative poverty over the life course. PLoS ONE, 10(7), e0133513. https://doi.org/10.1371/journal.pone.0133513
Singh, G. K., & Siahpush, M. (2006). Widening socioeconomic inequalities in US life expectancy, 1980–2000. International Journal of Epidemiology, 35(4), 969–979. https://doi.org/10.1093/ije/dyl083
Phelan, J. C., Link, B. G., & Tehranifar, P. (2010). Social conditions as fundamental causes of health inequalities: Theory, evidence, and policy implications. Journal of Health and Social Behavior, 51(Suppl 1), S28–S40. https://doi.org/10.1177/0022146510383498
Thompson, T., McQueen, A., Croston, M., Luke, A., Caito, N., Quinn, K., Funaro, J., & Kreuter, M. W. (2019). Social needs and health-related outcomes among Medicaid beneficiaries. Health Education & Behavior: The Official Publication of the Society for Public Health Education, 46(3), 436–444. https://doi.org/10.1177/1090198118822724
Khullar, D., & Chokshi, D. A. (2018). Health, income, & poverty: Where we are & what could help. Health Affairs Health Policy Brief. https://doi.org/10.1377/hpb20180817.901935
Braveman, P. A., Cubbin, C., Egerter, S., Williams, D. R., & Pamuk, E. (2010). Socioeconomic disparities in health in the United States: What the patterns tell us. American Journal of Public Health, 100(Suppl 1), S186–S196. https://doi.org/10.2105/AJPH.2009.166082
Belle, D., & Doucet, J. (2003). Poverty, inequality, and discrimination as sources of depression among U.S. women. Psychology of Women Quarterly, 27(2), 101–113. https://doi.org/10.1111/1471-6402.00090
Caughy, M. O., O’Campo, P. J., & Muntaner, C. (2003). When being alone might be better: Neighborhood poverty, social capital, and child mental health. Social Science & Medicine, 57(2), 227–237. https://doi.org/10.1016/S0277-9536(02)00342-8
Ward-Smith, P. (2007). The effects of poverty on urologic health. Urologic Nursing, 27(5), 445–446.
Mode, N. A., Evans, M. K., & Zonderman, A. B. (2016). Race, neighborhood economic status, income inequality and mortality. PLoS ONE, 11(5), e0154535. https://doi.org/10.1371/journal.pone.0154535
Kaiser Family Foundation. (n.d.). Poverty rate by age. https://www.kff.org/other/state-indicator/poverty-rate-by-age/
Cellini, S. R., McKernan, S. M., & Ratcliffe, C. (2008). The dynamics of poverty in the United States: A review of data, methods, and findings. Journal of Policy Analysis and Management, 27(3), 577–605. https://onlinelibrary.wiley.com/doi/abs/10.1002/pam.20337
Eamon, M. K. (2001). The effects of poverty on children’s socioemotional development: An ecological systems analysis. Social Work, 46(3), 256–266.
Evans, G. W., & Kim, P. (2013). Childhood poverty, chronic stress, self-regulation, and coping. Child Development Perspectives, 7(1), 43–48. https://doi.org/10.1111/cdep.12013
Shaw, D. S., & Shelleby, E. C. (2014). Early-starting conduct problems: Intersection of conduct problems and poverty. Annual Review of Clinical Psychology, 10(1), 503–528. https://doi.org/10.1146/annurev-clinpsy-032813-153650
Justice, L. M., Jiang, H., Purtell, K. M., Schmeer, K., Boone, K., Bates, R., & Salsberry, P. J. (2019). Conditions of poverty, parent-child interactions, and toddlers’ early language skills in low-income families. Maternal and Child Health Journal, 23(7), 971–978. https://doi.org/10.1007/s10995-018-02726-9
Council on Community Pediatrics, Gitterman, B. A., Flanagan, P. J., Cotton, W. H., Dilley, K. J., Duffee, J. H., Green, A. E., Keane, V. A., Krugman, S. D., Linton, J. M., McKelvey, C. D., & Nelson, J. L. (2016). Poverty and child health in the United States. Pediatrics, 137(4), e20160339. https://doi.org/10.1542/peds.2016-0339
Wagmiller Jr, R. L., & Adelman, R. M. (2009). Childhood and intergenerational poverty: The long-term consequences of growing up poor. National Center for Children in Poverty. https://www.nccp.org/publication/childhood-and-intergenerational-poverty/
Chetty, R., Stepner, M., Abraham, S., Lin, S., Scuderi, B., Turner, N., Bergeron, A., & Cutler, D. (2016). The association between income and life expectancy in the United States, 2001–2014. JAMA, 315(16), 1750–1766. https://doi.org/10.1001/jama.2016.4226
Yoshikawa, H., Aber, J. L., & Beardslee, W. R. (2012). The effects of poverty on the mental, emotional, and behavioral health of children and youth: Implications for prevention. The American Psychologist, 67(4), 272–284. https://doi.org/10.1037/a0028015
Riccio, J. A., Dechausay, N., Greenberg, D. M., Miller, C., Rucks, Z., & Verma, N. (2010). Toward reduced poverty across generations: Early findings from New York City’s conditional cash transfer program. MDRC.
Love, J. M., Kisker, E. E., Ross, C. M., Schochet, P. Z., Brooks-Gunn, J., Paulsell, D., Boller, K., Constantine, J., Vogel, C., Fuligni, A. S., & Brady-Smith, C. (2002). Making a difference in the lives of infants and toddlers and their families: The impacts of early Head Start. Volumes I–III: Final technical report and appendixes and local contributions to understanding the programs and their impacts. U.S. Department of Health and Human Services, Administration for Children and Families.
Maag, E., & Airi, N. (2020). Moving forward with the earned income tax credit and child tax credit: Analysis of proposals to expand refundable tax credits. National Tax Journal, 73(4), 1163–1186. https://doi.org/10.17310/ntj.2020.4.11
Blank, R. M. (2002). Evaluating welfare reform in the United States. Journal of Economic Literature, 40(4), 1105–1166.
Currie, J., & Chorniy, A. (2021). Medicaid and Child Health Insurance Program improve child health and reduce poverty but face threats. Academic Pediatrics, 21(8), S146–S153. https://doi.org/10.1016/j.acap.2021.01.009
Keith-Jennings, B., Llobrera, J., & Dean, S. (2019). Links of the Supplemental Nutrition Assistance Program with food insecurity, poverty, and health: Evidence and potential. American Journal of Public Health, 109(12), 1636–1640. https://doi.org/10.2105/AJPH.2019.305325
