8.4: Economic Stability
Economic stability refers to the ability to afford things like housing, food, and health insurance, and the social structures and built environments that come along with wealth. Economic stability can certainly be assessed with income levels, but income alone may not provide a complete picture. Other metrics like home ownership (which can be a surrogate for wealth), or self-reported stress about food or housing are also important ways to measure the effects of money on health. Population economic stability is certainly affected by macroeconomic and political factors such as inflation, unemployment rates, and the minimum wage. Individual changes in socioeconomic status such as job gain or loss, property ownership or loss, and even marriage or divorce can also be factors that impact health outcomes.
Poverty is a significant factor in many different health outcomes. Poverty in America is defined as an income at or below a certain standard set by the U.S. federal government, which changes over time due to inflation. In 2022, the poverty level for an individual annual income was set at $14,880, or $29,950 for a family of 4. This is up from $12,880 and $26,500 respectively just a year prior in 2021 (U. S. C. Bureau, 2023b). Over 37 million Americans currently live at or below the poverty rate by this official poverty measure, which in 2022 was 11.5% (as seen in Figure 8.2 below). Notably, these income limits do not change in different areas to reflect the geographic variance in the cost of living. So it may require an income significantly higher than the poverty rate to be able to afford housing and food in a larger metropolitan area where these things can be more expensive. Additionally, some folks who receive government assistance may not be factored into the official poverty measure, so a supplemental poverty measure (SPM) is also used as a metric to account for these factors. The SPM for 2022 was 12.4%, and although the official poverty measure did not change between 2021-2022, the SPM increased by 4.6% over that year (Shrider & Creamer, 2023). See Figure 8.4 below.
Many of those living in poverty are children. Childhood poverty is calculated using the SPM which takes into account people receiving social assistance like the Supplemental Nutrition Assistance Program (SNAP). There are also racial differences with poverty for children, with the highest poverty rates in Hispanic and Black children, and the lowest poverty rates in non-Hispanic White children. In 2020 and 2021, social assistance programs were expanded in response to the pandemic, which included SNAP and the Child Tax Credit (CTC). The latter specifically reduced childhood poverty significantly (in all groups) - lifting 5.3 million people out of poverty, including 2.9 million children (U. S. C. Bureau, 2022). In 2021 childhood poverty hit a historic low at 5.4%, but then climbed back up to 12.8% in 2022. The expiration of the expanded CTC benefits is at least partially to blame for this relapse in poverty (Parrott, 2023). Food and housing insecurity negatively impact childhood health in several ways; including poor nutrition, a lack of physical activity, behavioral and academic problems in school, and higher risk of health problems like obesity and type II diabetes ( U.S. Department of Health and Human Services, Health Resources and Services Administration, Office of Health Equity., 2020).
Whether you have a lived experience of poverty or can imagine it, wondering if you’ll be able to pay rent, utilities, buy food, and medicine can be mentally and emotionally debilitating. Worrying about housing costs can cause severe psychological distress, and is associated with poorer self-reported health. Even risks of chronic diseases like heart disease, high blood pressure, and diabetes are associated with higher stress around housing affordability. Additionally, home ownership is often a proxy for wealth, so renters are more likely to experience this kind of stress than homeowners. The majority of renters who live in government-subsidized housing are women (⅔), and often these renters are single or divorced, and experience much higher distress levels than those who own a home. (U.S. Department of Health and Human Services, Health Resources and Services Administration, Office of Health Equity., 2020).
Obesity rates, diabetes rates, and sedentary rates increase inversely with wealth (American Diabetes Association). Wealthy people are more likely to engage in healthy behaviors like exercise and less likely to engage in unhealthy behaviors like smoking. Wealth in terms of home ownership also increases the social cohesion of a neighborhood, with those who own homes reporting more trust in their neighborhood. This social cohesion also results in more engagement in voluntary organizations and local activities (religious centers, sports, community activities, etc.). In fact, parents living in wealthier neighborhoods are far more likely to report social support of their community in watching out for each other’s children and helping each other out. People who own their home are also likely to live there for longer than if they were renting ( U.S. Department of Health and Human Services, Health Resources and Services Administration, Office of Health Equity., 2020). Wealth and home ownership are thus strong factors in health and well-being outcomes for individuals and communities.