I had the opportunity this week to attend a panel presentation on poverty hosted by a local church. The event was billed as a discussion on poverty and “to help bring awareness of the all-too real problem of poverty and homelessness within our county.” I needn’t identify the county, because one could insert any county in the title and it would still apply. On the panel was an esteemed gathering of homeless shelter/housing directors, the sheriff, a charity that helps with small bills and expenses, a school superintendent, and an attorney who specializes in guardianship and poverty law.
Naturally the discussion initially focused on homelessness which is the all-to-visible face of poverty. The director from the small charity, though, asked that we also consider poverty in whole; while not that we ignore homelessness, but the epidemic of poverty is by-in-large unseen – hidden right in front of us in plain sight.
Earlier this week I participated in an all-day strategic planning session for a health center for which I’m honored to serve as a board member. There we had a consultant present on a series of data that she collected about our area including health disparities, penetration rates, demographics, and poverty. What quickly emerged is that in our area – despite news reports of declining unemployment and an improving economy – is that poverty rates increased, health disparities worsened, and that demographics radically changed in several markets. Community Health Centers, by their very mission, tend to go where the grass is browner, so the ground is fertile for expansion of services.
But I’m drawn again to the panel discussion. Who was missing on that panel? Many discussed mental health and substance abuse as a key indicator – not cause – of poverty. Yet there was no representative from any mental health and substance abuse providers. Who else was missing?
In 2013 the U.S. Census released a report on poverty related to medical expenses. Depending on where you look, the national rate of poverty hovers around 15% in the United States. In data from 2011-2012, the report found that medical out-of-pocket (MOOP) expenses alone added nearly 3.4% of all Americans to the poverty rolls – or more accurately, 10.6 million people.(1) Digging deeper, of those working age adults living in poverty, 50% of them spend ten percent of their income on MOOP, the single highest expense other than shelter and food – and at a rate that doubled since 2001.(2)
So who was missing on that panel?
We already understand that the people living in poverty often live in food deserts, lack access to exercise facilities, and often work long hours at multiple jobs, and tend to not have advanced degrees. All of these factors are indicators in poor overall health and where you find health disparities, you’ll often find these indicators. Yes, education, employment, shelter are all important factors in stemming the rise of poverty, but clearly, access to affordable medical services and coverage is also important – if not on equal weight.
I often think of a 3-legged stool in terms of community stability: Housing, employment and healthcare. If any of those legs fall out of balance, the stool is unstable. It rings true for individuals as much as a community. Strength in one positively impacts the other, as much as a depletion of one burdens the others. If you want to add a fourth leg of education, you’ll get no argument from me.
So there was a glaring gap on that panel – as strong and passionate as the speakers were. The lack of access to quality affordable healthcare and MOOP costs are every bit a factor of poverty as anything else that we already knew, and according to the data, it’s worsened in since 2001. Will the ACA and state expansion of Medicaid help curb this tide? The early data is promising. In the small sample size that is our local health center, due to the tireless work of healthcare navigators, a sizable percentage of previously uninsured patients became covered from 2014 into 2015. That conversion alone shifted the payer mix significantly and helped provide better access to healthcare for those individuals – healthcare that will now be at least partially covered.
Look around your own community – really look. It will be hard to see the poverty, but if you look, you’ll find it. Single parents who line up at Minute Clinics in the early mornings before school; the waitress at your favorite restaurant who also works at the nursing home on weekends; the grocery store check-out lady who worries about her job as her store adds four more self checkout kiosks. Encourage your community to have similar conversations and panels.
And who will YOU remember to include?
(1) Weissmann, J. Census: Medical Expenses Put 10.6 Million Americans in Poverty. The Atlantic. Nov 3, 2013.
(2) Collins, S. New Census Poverty Measure Shows Medical Expenses Push 10 Million Americans into Poverty. The Commonwealth Fund. Nov 10, 2011.