With Poverty Comes Depression, More Than Other Illnesses

WASHINGTON, D.C. -- Americans in poverty are more likely than those who are not to struggle with a wide array of chronic health problems, and depression disproportionately affects those in poverty the most. About 31% of Americans in poverty say they have at some point been diagnosed with depression compared with 15.8% of those not in poverty. Impoverished Americans are also more likely to report asthma, diabetes, high blood pressure, and heart attacks -- which are likely related to the higher level of obesity found for this group -- 31.8% vs. 26% for adults not in poverty.

Importantly, these differences in chronic disease rates between those living in poverty and those who are not in poverty hold true after controlling for age.

Cancer or high cholesterol are the two conditions that buck the trend of higher prevalence among U.S. adults in poverty. This could reflect the fact that those in poverty are less likely to have healthcare, and thus are less likely to have regular screening tests. Those in poverty may be less likely than those who are not in poverty to seek out the preventative care, cancer screenings, and blood tests that allow doctors to diagnose cancer or high cholesterol. High cholesterol in particular usually has no direct symptoms, and therefore its diagnosis depends on the patient having access to screening tests that measure cholesterol. Similarly, the fact that many cancers in early or dormant stages do not cause the afflicted to exhibit symptoms could mean those Americans without routine access to various cancer screening tests would be less likely to report having been diagnosed with cancer.

These findings are based on more than 288,000 interviews conducted Jan. 2-Dec. 31, 2011 with American adults as a part of the Gallup-Healthways Well-Being Index.

Respondents' poverty status is based on Gallup's best estimate of those in poverty according to the most recent U.S. census poverty thresholds, which are from 2011 -- hence, the use of 2011 Gallup data for this analysis. The government's income thresholds for poverty vary significantly according to age of householder, number of related adults in the household aged 18 years or older, and number of related children in the home younger than age 18. Gallup thus made a determination of individual respondents' poverty status based on their annual household income in conjunction with their position on these demographic characteristics. In addition to household income, Gallup's categorization of respondents in poverty uses marital status to account for number of related adults in the household aged 18 or older and includes number of children in the home younger than age 18.

Higher Levels of Chronic Diseases Partly Explained by Poorer Health Habits

Those in poverty report generally worse health habits than adults who are not in poverty, which may be at least partly contributing to the higher levels of chronic diseases among the impoverished. Smoking is the most significant issue for Americans in poverty -- 33% of those in poverty smoke compared with 19.9% of those who are not in poverty.

Those in poverty are also less likely to exercise frequently and eat fruits and vegetables regularly. However, they are just as likely as adults not in poverty to say they ate healthy all day "yesterday."

Impoverished Adults Much Less Likely to Have Healthcare Necessities

Americans living in poverty are significantly less likely to have access to basic health necessities that could help them either treat or prevent numerous chronic health problems. Nearly four in 10 Americans in poverty lack health insurance, contrasting with the 14.3% of Americans who are not in poverty and uninsured -- a difference of 23.8 percentage points.

Similarly, those in poverty were more than twice as likely as those who are not in poverty to say there have been times in the past 12 months when they did not have enough money to pay for the healthcare or medicine that they or their families needed -- 37.8% vs. 16.5%. Impoverished Americans are also significantly less likely than those who are not in poverty to say they have a personal doctor.

Americans in poverty are also significantly less likely than those who are not in poverty to say it is easy to find a safe place to exercise, easy to get affordable fresh fruits and vegetables, and easy to get medicine in the city or area where they live.

Implications

Impoverished Americans are more likely than those who are not in poverty to say they have ever been diagnosed with many chronic health problems -- with depression being a particularly pronounced issue. The interplay between depression and other chronic diseases is unclear, and the causal direction of the relationship between depression and poverty itself is unclear. Depression could lead to poverty in some circumstances, poverty could lead to depression in others, or some third factor could be causing both. Regardless, it is clear that those in poverty are twice as likely as those who aren't to have ever been diagnosed with a potentially debilitating illness and one that could be impeding them from getting out of poverty.

This group's health habits aren't helping either -- Americans in poverty are more likely to smoke and less likely to get the recommended amount of fruits, vegetables, and exercise. This may be due, in part, to a lack of access to affordable fresh fruits and vegetables and a safe place to exercise in the places they live.

Impoverished Americans' poorer health and health behaviors are also likely linked to their lack of access to healthcare -- they are significantly more likely to be uninsured, to lack a personal doctor, and to lack the money needed to afford healthcare or medicine.

Fixing the health of Americans in poverty will likely take a multi-pronged approach. Clearly getting people out of poverty is the key, but the journey could be difficult for those hampered with health problems that aren't being properly addressed. Educating low-income Americans about good health habits is one critical component of improving their health.

Getting these Americans the care they need and can't afford is also important. Although some in poverty have access to Medicaid, they still do not necessarily have the resources to pay for all of the treatments needed. It is possible that when the main components of the Affordable Care Act -- including the individual mandate and insurance exchanges -- go into effect in 2014, or if alternative health policies are put into place, Americans in poverty could become more likely to be able to afford preventative healthcare and medicine. This may, in turn, decrease their likelihood of suffering from chronic health problems like diabetes and heart attack. It may also prevent those who develop chronic -- and expensive -- health issues from ever falling into poverty in the first place.

Health insurance alone, though, is likely not enough to turn the health of impoverished Americans around. Community leadership and individual responsibility for improving health also play necessary roles in getting Americans in poverty on track to a better life.

About the Gallup-Healthways Well-Being Index

The Gallup-Healthways Well-Being Index tracks well-being in the U.S., U.K., and Germany and provides best-in-class solutions for a healthier world. To learn more, please visit well-beingindex.com.