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When Good Intentions Go Wrong: A Call to Action for Physicians
Charles P. Vega, MD
May 06, 2014
Poverty and Health
Poverty affects more than 1 in 5 children and adolescents in the United States, and certain communities suffer much higher rates of chronic poverty. Poverty during childhood is associated with higher rates of chronic illness, including mental health disorders, during adulthood. Is it possible that a voucher system for public housing specifically designed to move families to more affluent communities can reverse this trend? A large national study[1] provides some surprising answers, and it also represents an exciting opportunity for physicians to question and confront social determinants of health.
America has been brought to its knees by the “great recession.” According to data from the US Census Bureau, 13.7% of adults between the ages of 18 and 64 years lived in poverty in 2012, a 20% increase since 2007.[2] Black adults experienced substantially higher rates of poverty (23.9%), as did Hispanic adults (21.6%).
The data for children and adolescents are even more concerning. The poverty rate among all individuals younger than 18 years in 2012 was 21.8%.[2] The respective rates among black and Hispanic youth were 37.9% and 33.8%.
Poverty leads to many social ills, but it also promotes physical illness. These health effects may not be obvious until decades later. In a cohort study of 5000 adults in California, low socioeconomic status in childhood was broadly associated with a higher risk for type 2 diabetes during adulthood in unadjusted analyses.[3] However, adjustment for multiple other risk factors rendered the positive result among men nonsignificant. These fully adjusted analyses also demonstrated that the hazard ratio for diabetes remained 1.7 (95% confidence interval [CI], 1.2-2.4) among women with a history of low socioeconomic status during childhood.
The association between childhood deprivation and glucose metabolism can have real clinical consequences. A study from England found a linear association between childhood socioeconomic status and the risk for coronary heart disease among women specifically.[4] Childhood nutrition, the adoption of adult-lifestyle cardiovascular risk factors, and insulin resistance appeared to promote the relationship between childhood poverty and coronary heart disease.
Lower socioeconomic status during childhood is not a health risk factor only for women. A study of 5645 men in Scotland found that men raised in low-income families were more likely to have manual occupations and live in low-income communities.[5] They experienced higher risks for mortality from cardiovascular disease, respiratory disease, and stomach cancer compared with men raised in higher-income families. However, low socioeconomic status during childhood failed to influence the risk for accidental or violent death.
Mental health among children and adolescents is also dependent on socioeconomic status. Poverty is associated with higher risks for depression and antisocial behavior, and these problems can persist into early adulthood and promote substance misuse.[6,7] Moreover, improvement in a family’s economic status has been associated with better mental health.[6]
medscape.com/viewarticle/824417?nlid=56991_439&src=wnl_edit_medp_publ&uac=35942FZ&spon=42
Peace
Charles P. Vega, MD
May 06, 2014
Poverty and Health
Poverty affects more than 1 in 5 children and adolescents in the United States, and certain communities suffer much higher rates of chronic poverty. Poverty during childhood is associated with higher rates of chronic illness, including mental health disorders, during adulthood. Is it possible that a voucher system for public housing specifically designed to move families to more affluent communities can reverse this trend? A large national study[1] provides some surprising answers, and it also represents an exciting opportunity for physicians to question and confront social determinants of health.
America has been brought to its knees by the “great recession.” According to data from the US Census Bureau, 13.7% of adults between the ages of 18 and 64 years lived in poverty in 2012, a 20% increase since 2007.[2] Black adults experienced substantially higher rates of poverty (23.9%), as did Hispanic adults (21.6%).
The data for children and adolescents are even more concerning. The poverty rate among all individuals younger than 18 years in 2012 was 21.8%.[2] The respective rates among black and Hispanic youth were 37.9% and 33.8%.
Poverty leads to many social ills, but it also promotes physical illness. These health effects may not be obvious until decades later. In a cohort study of 5000 adults in California, low socioeconomic status in childhood was broadly associated with a higher risk for type 2 diabetes during adulthood in unadjusted analyses.[3] However, adjustment for multiple other risk factors rendered the positive result among men nonsignificant. These fully adjusted analyses also demonstrated that the hazard ratio for diabetes remained 1.7 (95% confidence interval [CI], 1.2-2.4) among women with a history of low socioeconomic status during childhood.
The association between childhood deprivation and glucose metabolism can have real clinical consequences. A study from England found a linear association between childhood socioeconomic status and the risk for coronary heart disease among women specifically.[4] Childhood nutrition, the adoption of adult-lifestyle cardiovascular risk factors, and insulin resistance appeared to promote the relationship between childhood poverty and coronary heart disease.
Lower socioeconomic status during childhood is not a health risk factor only for women. A study of 5645 men in Scotland found that men raised in low-income families were more likely to have manual occupations and live in low-income communities.[5] They experienced higher risks for mortality from cardiovascular disease, respiratory disease, and stomach cancer compared with men raised in higher-income families. However, low socioeconomic status during childhood failed to influence the risk for accidental or violent death.
Mental health among children and adolescents is also dependent on socioeconomic status. Poverty is associated with higher risks for depression and antisocial behavior, and these problems can persist into early adulthood and promote substance misuse.[6,7] Moreover, improvement in a family’s economic status has been associated with better mental health.[6]
medscape.com/viewarticle/824417?nlid=56991_439&src=wnl_edit_medp_publ&uac=35942FZ&spon=42
Peace