The Poor Feel Poorly

The passage of health insurance reform is truly an historic step that will provide access to insurance for approximately 32 million Americans, increase affordability for many millions more, do away with unfair insurance practices and, if the CBO is right, lower costs for our country as a whole.

But while it's critical that we are now making it possible for more Americans to afford to see a doctor, we can't lose focus on making it much less likely that they even need to. We still need a better balance between repairing our health after it is damaged and preventing its deterioration.

The fact of the matter is that our opportunity for better health starts long before we need to make an insurance claim.

Your neighborhood or job shouldn't be hazardous to your health. Yet some Americans will die 20 years earlier than others who live just a few miles away because of differences in education, income and where they live.

So as we work on improving the health of America, we need to start where health starts, not just where it ends.

This is why, regardless of the impact of this specific piece of legislation, there is still much work to be done and also cause for optimism. Just consider the following two examples:

  • Recently, the National Governors Association and the Council of Chief State School Officers proposed common academic standards that would have all students ready for college or a career after high school. What does this have to do with our health? Maybe everything. We know that those young Americans who graduate from college live, on average, seven years longer than those who don't graduate high school. Our investment in education could turn out to be one of the best dollar for dollar deals we make towards improving the health of Americans.
  • And perhaps more encouragingly, a new measurement based on a report from the National Academy of Sciences holds the promise of changing the way poverty is estimated in the U.S. and how it can be reduced. How could this impact our health? Well, the poverty threshold helps establish the eligibility for a variety of poverty alleviation programs, such as food stamps and Medicaid. A more accurate measure will first help ensure more people have access to some basic necessities for health - better food and access to preventative care - while at the same time providing hard working Americans a little more financial freedom and flexibility to make healthier choices for their families.
  • Historically, poor has been "a four-letter word" in America. No one likes to think that a country as great as ours could have so many that, even though they work hard, struggle just to get by.

    To some, being poor is a personal failure of responsibility. To others, poverty is a systemic failure of society.

    But regardless of how you see the causes of poverty, we are united by the desire to see less of it. It saps hope more often than it drives ambition, especially without paths up like through education. It drains our pocketbooks as our society tries to protect poor families and children. And in the long run each life that is diminished by poor education, diminished goals and achievements drains growth, innovation and health at the expense of our nation's future.

    The current measure of poverty in the U.S. was established during the administration of President Johnson. It was based on the premise that the average family spends a third of its income for food and therefore simply triples the cost of the USDA's cheapest meal plan. Since food spending now only represents one-seventh of an average family's income, the net effect, even after adjusting for inflation, is that poor families today are on average poorer than they were 40 years ago.

    So the updated measure will now be based on not just food but also on clothing, housing and utility costs--reflecting a more accurate picture of what it takes to meet family needs today.
    On one side of the ledger, it will also take into consideration poverty alleviation programs (food stamps, child care subsidies, earned income tax credits, housing subsidies) as income while on the other side of the ledger it will include expenses as transportation, childcare, work expenses and out-of pocket medical costs, in addition to clothing and shelter. And who could sustain a family without these?

    A more accurate measurement of poverty could allow us to more accurately gauge which Americans can and should benefit from such a program and perhaps by how much.

    We measure what we want to improve. Poverty defined as not having enough to eat is not good enough. Now we have an opportunity to expand our view. Realizing that raising a family today with escalating housing, childcare, health care, transportation and food costs coupled with stagnant wages requires us to not only measure the issue differently but to create better solutions from better information.

    New health insurance legislation will mean more opportunities for Americans to get health care. But taking a long view on how things like better education and the income that often comes with it affect our health will make us healthier and wealthier.

    Many things can cause poor health but poverty shouldn't be one of them.

    Dr. James Marks is currently the Senior Vice-President, Director of the Health Group at the Robert Wood Johnson Foundation and is former Assistant Surgeon General, Director of the Centers for Disease Control's National Center for Chronic Disease Prevention and Health Promotion.