What’s better for your health, an apple a day or no bills to pay?
Does being financially healthy help us stay physically healthy too? Based on an abundance of medical and economic research, the answer is a resounding “yes.”
We’re all familiar with the conventional wisdom about how to stay healthy. Adages like You are what you eat and Your body is a temple focus on the choices we make to stay healthy and presume that we all have the time and resources we need to make the healthiest choices. But the healthiest choices aren’t always available to many of us. Instead, the reality for many American families is that just keeping food on the table or a roof overhead can be a challenge, economic survival is a daily struggle, affordable meals are often the least nutritious, the built environment crowds out regular exercise, and a gym membership is a luxury. So what really helps keep the doctor away for the tens of millions of Americans in poverty – an apple a day or having no bills to pay?
The answer is both, of course. But until recently most doctors and public health officials have paid little attention to economic hardship as a health risk. That’s beginning to change, however, as we learn more and more about all the factors that keeps us healthy and those that put our health at risk.
‘Social determinants of health’, such as poverty, homelessness, discrimination, poor early childhood education, food insecurity, and other forms of social disadvantage, are increasingly recognized as major drivers of poor health. In fact, differences in economic and social circumstances have been shown to account for much greater gaps in our national rates of premature death and chronic illness than health care services and individual genetics. This has lead those of us in health care and public health to adopt new adages like Your zip code is more important to your health than your genetic code.
These kinds of insights are based on half a century of research on the health impacts of living in an unequal world. A study of British civil servants in the 1960s is largely credited for first demonstrating that rates of chronic illness and death are much higher among blue collar workers compared to white collar workers. The rates of unhealthy behaviors like smoking were higher too, but even after accounting for these differences blue collar workers were still twice as likely to die early of cardiovascular disease compared to their white collar peers. This pattern of rising health risk as social class and income decline has since been borne out in countless studies and the phenomenon now has a name: the ‘social gradient’ in health.
The implications are staggering. The disparities in wealth and class found in our society – whether by neighborhood, race, ethnicity, education, or other circumstances – all have huge consequences for our nation’s health when we see them through the lens of the social gradient. In this light, it’s little surprise that the U.S. is consistently much less healthy compared to other developed nations in terms of key measures like infant mortality and overall life expectancy.
The formal definition of health has changed too over the years to reflect our greater understanding of the importance of social context. Decades ago the World Health Organization broadened the definition of health from simply the absence of disease to a state of physical, mental, and social well-being (WHO definition of health). In the last ten years, organizations like the Centers for Disease Control and Prevention have put this definition into practice by prioritizing health improvement efforts that address social circumstances. Healthy People 2020, our national health promotion strategy and set of health goals developed by over a dozen Federal Agencies including the CDC, FDA, and NIH, includes addressing social determinants of health as a central theme.
Even with all of these changes based on what we know about the health hazards of living in poverty and the risks of other social determinants of health, don’t expect to be asked about finances at your next clinic visit. But even though there’s no prescription-strength poverty panacea (yet?), LIFT’s anti-poverty work could be exactly what the doctor ordered to treat many social determinants of health.
At LIFT-Los Angeles we are about to learn a lot more about the specific health effects of a new financial coaching and savings program being offered to our members. Through a year-long pilot surveying members in the program about their physical and emotional well-being, the goal is to understand all the ways that LIFT’s anti-poverty services benefit our members – including benefits to their health. Based on all that is known about how health and finances are linked, we might just find that a penny saved is more than just a penny earned – it could also be how health is earned.
So, what catchy sayings might our grandkids hear one day about how to stay both financially and physically healthy? Stay tuned to the work happening here at LIFT to find out!
About LIFT-Los Angeles’s Financial Coaching Program
Through LIFT-Los Angeles’s Financial Coaching program, at least 150 LIFT members with children will learn how to increase their assets and reduce debt as they move forward in achieving interconnected goals (housing, job, and health). LIFT plans to track the following outcomes: the percent of members who open bank accounts or utilize bank accounts, achieve an EARN match, increase credit score, and increase financial knowledge. With Dr. Schickedanz, the RWJF Fellow, LIFT will use validated measures to track reductions in stress and anxiety, as well as other relevant health outcomes.
About Adam Schickedanz
Adam Schickedanz is currently a Robert Wood Johnson Clinical Scholar at UCLA with a placement in the LIFT-Los Angeles offices. He is a physician and researcher in California, where he has a clinical focus in urban underserved patient care. He maintains active interests in health policy and medical education, and he has authored peer-reviewed publications on medical professionalism, cultural competency, medical education, clinician-patient communication, health care value, and the Adam co-founded a nonprofit medical-financial partnership organization, The Financial Fitness Clinic, as a first-year pediatric resident. The organization has been recognized by the San Francisco Medical Society, the California Association of Public Hospitals, and the American Academy of Pediatrics for its work reducing socioeconomic drivers of poor health.
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