My work as a DEI expert for institutions in the health ecosystem (think pharma, medical schools, hospital systems, etc.) has made one thing consistently clear: finding solutions to health disparities means addressing the issue of poverty. The two are inextricably intertwined, and businesses must lead out front. A recent study outlined poverty’s impact on mortality in the U.S. and highlighted the seldom-explored intersections between poverty and death. Put simply, poverty is dire for our health and is the 4th greatest cause of death in the U.S., behind heart disease, cancer, and smoking. We’re in a time of runaway inequality, with the wealth gap now more expansive than ever. Nearly 38 million people live in poverty. Societal, generational, and even professional tensions around wealth, power, and access to health are high.
Poverty is a complex and insidious determinant of health caused by systemic factors that can persist for generations in a family. Poverty occurs when an individual or family lacks the resources to provide necessities such as food, clean water, shelter, and clothing. It also includes a lack of access to such resources as health care, education, and transportation. For a single person in the continental United States, the 2023 federal poverty level is $13,590. The federal poverty level increases by $5,140 for each additional person in the household. So, for a household of three, the 2023 federal poverty level is $24,860. Because of the intersection with myriad social determinants of health, poverty is associated with various adverse health outcomes, including shorter life expectancy, higher infant mortality rates, and higher death rates among the leading causes of death.
Economic fears and realities create health crises. The 2023 Edelman Trust Barometer Special Report: Trust and Health revealed that financial insecurity and economic uncertainty (presented in the report as “inflation”) top the list of societal factors respondents (70%) believe are negatively impacting health and making us sick. In fact, 78% of respondents in the U.S. acknowledge a gap between how well they are currently taking care of their health and how well they should be. Among those, 50% percent say healthy options simply cost too much. Beyond the often prohibitive cost of healthcare, prescribed treatments – medications or medical devices – are unaffordable.
However, it is not enough for people to know the numbers and acknowledge the issue of poverty. Awareness is vital, but also, to get people to care, we need to achieve empathy for those experiencing poverty. People raised in poverty are most likely to be poor in old age. But, especially in times of so much need, any resource to support one group feels like a zero-sum game. When we pull apart the data on the patients who are most likely to experience poverty, it is, unsurprisingly, disproportionately women from Black and Hispanic communities. Women, in general, are more likely to be poor than men, and aged women of historically marginalized communities are more than twice as likely to be poor compared to their white counterparts. With data in hand, we can drive empathy by proving that the issues contributing to poverty didn’t just magically appear. They are systemic, and, more poignantly, they are solvable.
Sendhil Mullainathan, a behavioral economist, studies the impacts of poverty; he told NPR, “Put simply, being poor is like having just pulled an all-nighter.” According to a Gallup report, one-fifth of U.S. workers rate their mental health as fair or poor. Employers should be concerned, as workers experiencing poor mental health report an average of 12 more unplanned absences annually, which translates into a staggering $47.6 billion in lost worker productivity each year. The adverse effects of poverty go beyond the impact on employees; poverty also exacts a toll on businesses through a tangible cost manifested in reduced productivity.
We know that economic prosperity can provide individuals access to resources that aid them in avoiding or buffering exposure to health risks. Research shows that higher-income individuals consistently experience better health outcomes than those living in poverty. The Trust in Health report also revealed that health is more than physical in the mind of U.S. citizens; health exists across four key dimensions – physical health, mental health, social health, and community livability. Poverty affects health by limiting access to proper nutrition and healthy foods; adequate shelter; safe built environments to learn, live, and work; clean air and water; utilities; and other elements that define an individual’s community livability.
We saw how the tumult of the pandemic amplified the tension around low socioeconomic status and poverty, as health disparities across racial identity became much clearer and the demand for solutions louder. Trust is fragile in healthcare providers’ ability to address health-related concerns and to help keep people safe, healthy, and confident that their “whole self” would be kept in mind as they navigate the healthcare system.
In a world where our 24-hour news cycle is flooded with catastrophe and tragedy, health and poverty can too easily get drowned out. And yet, urgency and attention around societal problems are intensifying with an increased demand for scalable solutions.
Each of us, from individuals to business entities, has a responsibility and a role in acknowledging and addressing poverty and how it intersects with the workplace, the marketplace, and society as a whole. In a recent article published by Bain & Company, the authors reported that “health equity ranks among US healthcare executives’ top five priorities, yet only 18% say they have a well-defined strategy supported by goals, metrics, and milestones.” In short, every individual in the health ecosystem must lead with action. As a DEI practitioner, I advise that each action must achieve results for at least one of these three elements:
First, advocate for policy that advances significant investments. It’s often said that “poverty is a policy choice”. The excellent news is choices can be amended – ending poverty is a choice we can collectively make. Safety net programs (i.e., housing assistance, Medicaid, child care, Head Start, WIC, temporary assistance for needy families, SNAP, etc.) must be expanded amid the economic crisis and continuing unemployment exacerbated by the COVID-19 pandemic.
Second, businesses must lead the charge. As the most trusted entity, businesses must seek proactive and reactive opportunities to take the lead and encourage others to join. Prove your commitment by taking bold action to address underlying contributors to unemployment and poverty – like addressing pay equity, childcare gaps that impact workforce participation, expanded paid family leave, and supporting a livable minimum wage to bolster economic stability.
Third, elevate thought leadership and storytelling. Businesses and their top leaders have a distinct opportunity to set the tone for inclusive conversations around the role of employer strategies in reducing poverty. Evolve your understanding not just to fuel conversations but to change them. Drive empathy for patients experiencing poverty by changing the narrative, using data to show that poverty is an intersectional issue with value to the cultural conversation. Ensuring your approach connects with patients where they are, geared toward igniting conversation and humanizing the work with new voices. Show, rather than tell, what poverty looks like and its impact.
Poverty is a health equity imperative. Health equity is a business imperative, and it’s every company and organization’s business.
Amira Barger, MBA, CVA, CFRE is a strategic communications & marketing counselor working at the nexus of health equity, DEI, and employee engagement to aid organizations in addressing society’s most pressing public issues. She is an EVP, Head of DEI Advisory at a consulting firm, and a Cal State East Bay Professor.