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PubMed1998

Poverty and health: exploring the links between financial stress and emotional stress in Australia.

The links between poverty and health have been investigated in a number of independent studies, as well as by the Poverty Commission in the 1970s and, more recently, the National Health Strategy. However, much of the poverty research suffers from the lack of detailed information on health status, while the work conducted in the public health sphere has used rather rudimentary poverty measures. The research reported here attempts to overcome these limitations by using unit record data from two national household surveys conducted by the Australian Bureau of Statistics in 1990. Together, these two data sets contain an enormous amount of detailed information on household incomes and the health status of individuals. Data from the two surveys are combined in a way which allows the links between poverty and health to be explored in greater detail than has hitherto been possible in Australia. Analysis of the integrated data set focuses on the links between poverty and several measures of stress-related poor health. The results from a variety of different methods point to the existence of significant differences between the reported incidence of stress of those whose incomes place them either side of a poverty threshold. The size of the statistical association between poverty and stress is of both numerical and statistical significance, although further work, preferably using longitudinal data, is needed on the important issues of causation.

Adolescent↗

PubMed1975

Comparisons of poverty and nonpoverty groups on dental status, needs, and practices.

Poverty and nonpoverty adults have been screened in a program of Multiphasic Health Testing in which dental examinations were provided and in which information on dental care behavior was obtained through a health inventory using a video-terminal for recording replies. Findings of the dental examination indicate that, whatever measure of oral health was used, oral health of the poverty group was poorer than that of the nonpoverty group. The poverty group, for example, had more dental problems, and the problems they had were more severe. They also had lower levels of oral hygiene and less restorative treatment. The poverty group also was more likely to be edentulous, and to have higher levels of untreated decay and periodontal diseases. They had more missing teeth, and fewer restored teeth. Nearly all poverty-nonpoverty differences persisted when the data were controlled for age and sex. Information from the health inventory indicates that the poverty group is less likely than those in the nonpoverty group to seek dental care in general, and also specifically for rreventive dental services. Even among the nonpoverty group, however, one third stated that they never sought dental care for "cleanings or checkups." Daily toothbrushing, on the other hand, was generally reported by both poverty-status groups. Consistent relations were found between oral health practices and oral health in both poverty and nonpoverty groups...

Adolescent↗

PubMed2003

Racial/ethnic disparities in the use of mental health services in poverty areas.

OBJECTIVES: This study examined racial/ethnic disparities in mental health service access and use at different poverty levels. METHODS: We compared demographic and clinical characteristics and service use patterns of Whites, Blacks, Hispanics, and Asians living in low-poverty and high-poverty areas. Logistic regression models were used to assess service use patterns of minority racial/ethnic groups compared with Whites in different poverty areas. RESULTS: Residence in a poverty neighborhood moderates the relationship between race/ethnicity and mental health service access and use. Disparities in using emergency and inpatient services and having coercive referrals were more evident in low-poverty than in high-poverty areas. CONCLUSIONS: Neighborhood poverty is a key to understanding racial/ethnic disparities in the use of mental health services.

Adolescent↗

PubMed1998

Improvements in poverty and income in 1995 tempered by troubling long-term trends.

Census data on poverty and income show short-term improvements in 1995, but the trends were not as positive over the longer term. Poverty rates remained higher than they were at comparable points in previous economic cycles. The incomes of lower- and middle-income households grew in 1995, but only the wealthiest fifth of the population completely recovered from the recession of the early 1990s. Although poverty rates fell and incomes rose for most groups in 1995, Hispanic households did not share in the overall economic gains. In addition, economic improvements were not shared by all geographic areas--the reduction in poverty was concentrated in suburban areas. The current poverty measure does not show the full impact of government benefit programs on poverty, as it does not take into account the effect of non-cash benefits or taxes. An alternative poverty measure gives a much better picture of the effectiveness of government benefit programs in reducing poverty.

Censuses↗

PubMed2000

Joining together to combat poverty.

The International Poverty and Health Network (IPHN) was created in December 1997 following a series of conferences organized by the World Health Organization, with the aim of integrating health into plans to eradicate poverty. Around 1.3 billion people live on less than US$1 per day. Of the 4.4 billion people in developing countries nearly 60% lack access to sanitation, 30% do not have clean water, 20% have no health care, and 20% do not have enough dietary energy and protein. Even among rich nations there are gross socioeconomic inequalities. Many children are robbed of their physical and mental potential through poverty. Expressed in constant 1963 US dollars, an average Croatian family needed the annual income of US$894 to meet the poverty line in 1960 and US$9,027 in 1995. Accordingly, 9-25% of Croatian households were below the poverty line between 1960 and 1995. The increase in the poverty rate after 1991 was compounded by the war that destroyed almost a third of industrial capacity and infrastructure. Dissipation of the communist economy and inadequate privatization have contributed to the increase in unemployment rate, corruption, and other social ills. IPHN invited Croatian Medical Journal to publish this editorial to help push the issue of poverty up political and medical agendas on a global level. We argue that a factor contributing to the failure of most large-scale programs against poverty to date is the excessive emphasis on material and infrastructure assistance at the expense of spiritual, moral, and intellectual development.

Croatia↗

PubMed1990

Gender differentials in poverty-mortality well-being.

"This paper explores the application of a life table approach to the analysis of poverty [in the United States]. After reviewing trends in gender differentials in poverty and mortality, we investigate an indicator of poverty-mortality well-being. The rationale for this approach is that to some extent poverty and mortality are causally interrelated phenomena which are both fundamental to well-being. The empirical results indicate that females are expected to live more years in poverty than are males, but females are expected to live more years in nonpoverty as well. Although the gender differential in poverty rates has increased to the disadvantage of females, and although most of the greater poverty of females cannot be attributed to their greater longevity, the gender differential in poverty-mortality well-being has nonetheless not deteriorated to the disadvantage of women in recent decades."

Americas↗

PubMed1987

The new immigration: implications for poverty and public assistance utilization.

Central to the controversy over the new immigration is the worry that it has promoted an increase in the level of poverty and welfare utilization among immigrants. This study documents and explains immigrant-native trends and differentials in poverty and public assistance utilization during the period from 1960-1980. Results show that there is ample evidence that the level of poverty among immigrants, particularly recent immigrants, increased over the 1960-1980 period. However, there was little indication of a commensurate rise in the propensity of families to receive public assistance. There is also little evidence of a disproportionate and increasing burden of immigrants on public assistance coffers as the new immigration proceeds. Recent immigrants are no more likely to receive welfare than otherwise comparable natives. Regarding average annual public assistance income among welfare families, the empirical results suggest that immigrants differ little from natives in their degree of utilization. Like immigrants of previous waves, the new immigrants appear to be industrious and able to capitalize on their labor force potential to keep them out of poverty. This conclusion derives from findings that 1) in both the tabular and multivariate context, multiple earners kept a greater % of immigrant than native families out of poverty, and 2) immigrants showed a relative disinclination to use welfare as an income maintenance strategy. Still, the decline over time in ameliorative impact of multiple earners should be a source of concern. Also central to the concern over the new immigration is the increasing prevalence of nonwhites among immigrant cohorts. The sizable Hispanic component of the new immigration is particularly controversial. Among the most consistent findings of this study is the apparent deterioration in the economic status of white immigrants and the noticeable lack of any similar deterioration among Hispanic families. For example, among all the groups studied, recent white immigrants registered the largest increases in poverty over time. Poverty among recent Hispanic immigrants did not increase as sharply. Also, Hispanics became increasingly reluctant to use public assistance income whereas recent white immigrants did not, and revealed an increase in mean annual welfare receipt not nearly as great as that for white and Asian families. Admittedly, rates of poverty and public assistance receipt continue to be greater among Hispanics than whites. Still, changes over time reveal a marked deterioration among whites but no such deterioration among Hispanics.

Acculturation↗

PubMed1992

The development and history of the poverty thresholds.

In recent years there has been renewed interest in the United States in the definition and measurement of poverty. In early 1992, the Committee on National Statistics of the National Academy of Sciences began a 30-month study requested by Congress that includes an examination of statistical issues involved in measuring and understanding poverty. Some 2 years earlier, in January 1990, the Administration had approved an initiative on improving the quality of economic statistics. The current poverty measure was one of several dozen statistical series examined as part of that initiative. In April 1990, Urban Institute economist Patricia Ruggles published a book that urged the revision of the poverty line to reflect changes in consumption patterns and changing concepts of what constitutes a minimally adequate standard of living. In July 1990, two private organizations concerned with the poor and the elderly issued a report reviewing current poverty measurement procedures and describing a Gallup poll in which a nationally representative sample of Americans set an average dollar figure for the poverty line that was higher than the current official poverty line. In view of these and other examples, it may be useful to reexamine the development and subsequent history of the current official poverty thresholds.

Age Factors↗

PubMed1998

Poor people on the move: county-to-county migration and the spatial concentration of poverty.

"Poverty rates in high-poverty and low-poverty rural [U.S.] counties, and, thus, the spatial concentration of poverty, are affected by poverty-specific differences in in-migration and out-migration patterns. These patterns are investigated using 1985-90 county-to-county migration data from the decennial census. Effects on poverty rates of four migration flows (in- and out-migration of poor, in- and out-migration of nonpoor) are quantified, and their impacts on spatial concentration of poverty are assessed. The effect of selected county characteristics on the migration of the poor and nonpoor in nonmetro counties [is] estimated."

Americas↗

PubMed2005

The global distribution of risk factors by poverty level.

OBJECTIVE: To estimate the individual-level association of income poverty with being underweight, using tobacco, drinking alcohol, having access only to unsafe water and sanitation, being exposed to indoor air pollution and being obese. METHODS: Using survey data for as many countries as possible, we estimated the relative risk association between income or assets and risk factors at the individual level within 11 medium- and low-income subregions of WHO. WHO and The World Bank data on the prevalence of risk factors and income poverty (defined as living on < US$ 1.00 per day, US$ 1-2.00 per day and > US$ 2.00 per day) were analysed to impute the association between poverty and risk factors for each subregion. The possible effect of poverty reduction on the prevalence of risk factors was estimated using population-attributable risk percentages. FINDINGS: There were strong associations between poverty and malnutrition among children, having access only to unsafe water and sanitation, and being exposed to indoor air pollution within each subregion (relative risks were twofold to threefold greater for those living on < US$ 1.00 per day compared with those living on > US$ 2.00 per day). Associations between poverty and obesity, tobacco use and alcohol use varied across subregions. If everyone living on < US$ 2.00 per day had the risk factor profile of those living on > US$ 2.00 per day, 51% of exposures to unimproved water and sanitation could be avoided as could 37% of malnutrition among children and 38% of exposure to indoor air pollution. The more realistic, but still challenging, Millennium Development Goal of halving the number of people living on < US$ 1.00 per day would achieve much smaller reductions. CONCLUSION: To achieve large gains in global health requires both poverty eradication and public health action. The methods used in this study may be useful for monitoring pro-equity progress towards Millennium Development Goals.

Health Services Accessibility↗

PubMed1991

Poverty and psychiatric status. Longitudinal evidence from the New Haven Epidemiologic Catchment Area study.

We assessed the effect of poverty on psychiatric status using two waves of New Haven (Conn) Epidemiologic Catchment Area data. Poverty was defined using federal poverty guidelines; psychiatric status was assessed by the Diagnostic Interview Schedule (DIS). When examining the course of healthy respondents at the first interview, respondents in poverty had a twofold-increased risk (controlling for demographic factors) for an episode of at least one DIS/DSM-III Axis I psychiatric disorder. Rates of most specific psychiatric disorders were comparably higher for respondents meeting poverty criteria compared with those not in poverty, although these differences were not always statistically significant. The effects of poverty did not differ by sex, age, race, or history of psychiatric episodes.

Adolescent↗

PubMed1995

Assessing poverty: some reflections on the literature.

"This paper examines the quantitative poverty measurement literature. After describing the literature a number of issues in poverty research are discussed. It can be concluded that the framework for poverty assessments is not always fixed. Much has been written about the poverty line but the issue of updating it seems to have attracted less attention than deserved. Substantial advancements in poverty research have been gained by fuller reports on the extent of poverty through the use of poverty indices and because of increased availability of panel data."

Economics↗

PubMed2006

Cigarette smoking and poverty in China.

Drawing on the 1998 China national health services survey data, this study estimated the poverty impact of two smoking-related expenses: excessive medical spending attributable to smoking and direct spending on cigarettes. The excessive medical spending attributable to smoking is estimated using a regression model of medical expenditure with smoking status (current smoker, former smoker, never smoker) as part of the explanatory variables, controlling for people's demographic and socioeconomic characteristics. The poverty impact is measured by the changes in the poverty head count, after smoking-related expenses are subtracted from income. We found that the excessive medical spending attributable to smoking may have caused the poverty rate to increase by 1.5% for the urban population and by 0.7% for the rural population. To a greater magnitude, the poverty headcount in urban and rural areas increased by 6.4% and 1.9%, respectively, due to the direct household spending on cigarettes. Combined, the excessive medical spending attributable to smoking and consumption spending on cigarettes are estimated to be responsible for impoverishing 30.5 million urban residents and 23.7 million rural residents in China. Smoking related expenses pushed a significant proportion of low-income families into poverty in China. Therefore, reducing the smoking rate appears to be not only a public health strategy, but also a poverty reduction strategy.

China↗

PubMedDate not supplied

The ghost of Christmas past: health effects of poverty in London in 1896 and 1991.

OBJECTIVES: To compare the extent to which late 20th century patterns of mortality in London are predicted by contemporary patterns of poverty and by late 19th century patterns of poverty. To test the hypothesis that the pattern of mortality from causes known to be related to deprivation in early life can be better predicted by the distribution of poverty in the late 19th century than by that in the late 20th century. DESIGN: Data from Charles Booth's survey of inner London in 1896 were digitised and matched to contemporary local government wards. Ward level indices of relative poverty were derived from Booth's survey and the 1991 UK census of population. All deaths which took place within the surveyed area between 1991 and 1995 were identified and assigned to contemporary local government wards. Standardised mortality ratios for various causes of death were calculated for each ward for all ages, under age 65, and over age 65. Simple correlation and partial correlation analysis were used to estimate the contribution of the indices of poverty from 1896 and 1991 in predicting ward level mortality ratios in the early 1990s. SETTING: Inner London. RESULTS: For many causes of death in London, measures of deprivation made around 1896 and 1991 both contributed strongly to predicting the current spatial distribution. Contemporary mortality from diseases which are known to be related to deprivation in early life (stomach cancer, stroke, lung cancer) is predicted more strongly by the distribution of poverty in 1896 than that in 1991. In addition, all cause mortality among people aged over 65 was slightly more strongly related to the geography of poverty in the late 19th century than to its contemporary distribution. CONCLUSIONS: Contemporary patterns of some diseases have their roots in the past. The fundamental relation between spatial patterns of social deprivation and spatial patterns of mortality is so robust that a century of change in inner London has failed to disrupt it.

Cause of Death↗

PubMed1997

The effects of poverty on child health and development.

Poverty has been shown to negatively influence child health and development along a number of dimensions. For example, poverty-net of a variety of potentially confounding factors-is associated with increased neonatal and postneonatal mortality rates, greater risk of injuries resulting from accidents or physical abuse/neglect, higher risk for asthma, and lower developmental scores in a range of tests at multiple ages. Despite the extensive literature available that addresses the relationship between poverty and child health and development, as yet there is no consensus on how poverty should be operationalized to reflect its dynamic nature. Perhaps more important is the lack of agreement on the set of controls that should be included in the modeling of this relationship in order to determine the "true" or net effect of poverty, independent of its cofactors. In this paper, we suggest a general model that should be adhered to when investigating the effects of poverty on children. We propose a standard set of controls and various measures of poverty that should be incorporated in any study, when possible.

Asthma↗

PubMed2006

Geographical clustering of mortality from systemic lupus erythematosus in the United States: contributions of poverty, Hispanic ethnicity and solar radiation.

The objective was to investigate whether spatial variation in poverty, Hispanic ethnicity, and solar radiation explains the strong pattern of geographical clustering of mortality from systemic lupus erythematosus (SLE) in the United States. SLE mortality counts for women and men of black and white race in US counties, 1979-1998, were obtained from the National Center for Health Statistics. County-level poverty rates and proportions of Hispanic residents were drawn from the 1990 national census. The annual cumulative level of ambient ultraviolet 'B' radiation (UVB) was estimated for each county according to latitude, longitude, and elevation. Maps for the full study population and for sex - and race-specific subpopulations showed that the national pattern of geographical variation in SLE mortality primarily reflected the experience of white women. Formal spatial analysis of the data for white women identified 10 statistically significant, multi-county clusters--four with elevated and six with reduced SLE mortality rates. Multivariate regression modeling established that higher levels of poverty, Hispanic ethnicity, and UVB were each associated with elevated local rates of SLE mortality among white women. Statistical adjustment via the regression model was used to remove effects of these factors on local rates. In a re-application of spatial analysis to the adjusted rates, four clusters 'disappeared'. In those clusters, poverty, Hispanic ethnicity and UVB had explained an average of 58.2% of the deviations between local and national SLE mortality rates. In six clusters (including three that disappeared with adjustment), Hispanic ethnicity explained a larger percentage of the deviations between local and national rates than either poverty or UVB. In multivariate models based on data for black women and for men of both races, poverty and UVB had similar effects on SLE mortality rates to those observed among white women. However, Hispanic ethnicity was not a significant predictor of SLE mortality in any of these other groups. The contributions of poverty, Hispanic ethnicity and solar radiation to geographical variation of SLE mortality in the United States are substantial, but these factors do not fully account for the clustering phenomenon.

Black or African American↗

PubMed2003

Why poverty remains high: the role of income growth, economic inequality, and changes in family structure, 1949-1999.

After dramatic declines in poverty from 1950 to the early 1970s in the United States, progress stalled. This article examines the association between trends in poverty and income growth, economic inequality, and changes in family structure using three measures of poverty: an absolute measure, a relative measure, and a quasi-relative one. I found that income growth explains most of the trend in absolute poverty, while inequality generally plays the most significant role in explaining trends in relative poverty. Rising inequality in the 1970s and 1980s was especially important in explaining increases in poverty among Hispanics, whereas changes in family structure played a significant role for children and African Americans through 1990. Notably, changes in family structure no longer had a significant association with trends in poverty for any group in the 1990s.

Adult↗

PubMed2004

A decomposition of trends in poverty among children of immigrants.

Poverty levels among all children in the United States have tended to fluctuate in the past 30 years. However, among the children of immigrants, child poverty increased steadily and rapidly from about 12% in 1970 to 33% in the late 1990s before declining to about 21% in 2000. Using 1970, 1980, 1990, and 2000 Public Use Microdata Samples data, we identified key factors that underlie the fluctuations in immigrant child poverty from 1969 to 1999 and the divergence from children of natives. We found that roughly half the absolute increase in immigrant child poverty can be linked to changing conditions in the U.S. economy that make it more difficult to lift a family out of poverty than 30 years ago. These changes occurred disproportionately among children of parents with lower levels of education, employment, and U.S. experience but not among racial/ethnic minorities. Poverty risks among various racial and ethnic groups converged over time. The relative increase in poverty for immigrant versus native children owes largely to the divergence between immigrant and native families in racial/ethnic composition, parental education, and employment.

Adolescent↗