This paper examines the interconnected relationships between poverty, health outcomes, and social exclusion in the United States. Beginning with contested definitions of both health and poverty, the paper surveys research on how low income increases mortality risk, limits access to resources, and generates chronic psychological stress. It further explores how social inequality amplifies poor health outcomes, how social exclusion manifests through income gaps, racial discrimination, housing instability, and incarceration, and how these forces drive homelessness. The paper concludes by arguing that meaningful poverty reduction requires Americans to adopt shared social responsibility and view poverty as a structural, rather than individual, problem.
More than half a century ago, the World Health Organization defined health as "a complete state of physical, mental and social well-being, and not merely the absence of disease or infirmity" (Ustun & Jakob, 2005). There were objections to this definition, and others were suggested to replace it. The Australian Aboriginal people define health as something beyond individual physical well-being. Their definition encompasses the social, emotional, spiritual, and cultural well-being of the whole community. The perception spans an entire life view and the cycle of life, death, and an afterlife (Ustun & Jakob, 2005).
Poverty, on the other hand, is defined as a threshold. In 2001, the Census Bureau set the poverty threshold at $9,214 for a single person, or at $18,022 for a family of one adult and three related children below 18 years of age (Oberg, 2003). This definition and measurement of poverty is deemed limited by contemporary standards (Benjamin, 2003). It does not take into consideration many significant changes that have occurred since the 1950s — including disproportionate family budget costs, expenses for childcare, cost of living variations across regions, changing policies over disposable income, and changes in the overall standard of living in the United States. By today's standards, families earning far above the low poverty threshold are still not considered financially comfortable (Benjamin, 2003).
An expert panel from the National Research Council of the National Academy of Sciences recommended revisions to the federal definition of poverty. They suggested the inclusion of actual costs for food, clothing, and shelter; adjustments for geographic housing costs; the incorporation of non-cash and tax-related benefits; and other relevant changes. Income should instead be measured as a percentage of the poverty line — for example, at 150% or 200% of that threshold. This method is already in use by many state and federal programs. Another approach is to estimate the actual minimum cost of basic necessities and compare disposable income to total cost (Benjamin, 2003).
Research suggests that poverty increases the risk of adverse conditions, such as poor health and crime (GAO, 2007). These adverse conditions are seen as consequences of limited access to health care, increased exposure to environmental hazards, and engagement in risky behaviors. Greater access to health insurance among low-income mothers, for instance, reduces infant mortality. Residing in urban areas increases exposure to high levels of air pollution. Risky behaviors — such as smoking, alcohol use, physical inactivity, and poor nutrition — mark a significant divide between lower- and upper-income groups. Poverty also links to crime, especially when unemployment levels are high. Poor health can be both the cause and the result of poverty. These factors limit individual growth, the development of skills and abilities, the acquisition of knowledge, and the formation of productive habits and practices (GAO, 2007).
The World Health Organization has pointed to poverty as "the greatest cause of suffering on earth" (Murali & Oyebode, 2004). Poverty and social inequality have direct and indirect harmful effects on the social, mental, and physical well-being of individuals. The two factors are deeply interlinked. Income inequality creates psychosocial stress and, in turn, produces poor health and high mortality. Deprived communities suffer from a lack of social and physical infrastructure. Poor health often leads to higher mortality rates for those in the lower socioeconomic classes.
The effects of social inequality extend to society itself, creating stress, frustration, and the breakdown of families. These conditions become breeding grounds for crime, homicide, and violence. Several adverse conditions are inherent to poverty. The poor are exposed to perilous conditions and disadvantages. If employed, they often perform routine, stressful, and depersonalizing work. They lack basic necessities and amenities, and because they are not fully integrated into the mainstream of society, they have limited access to information and support networks. Those in the lower socioeconomic levels are more exposed to disease and risky behaviors — behaviors that, while often harmful, frequently serve as coping mechanisms for stress and need.
As a consequence, a life of deprivation favors a continued increase in stressors and vulnerability to those stressors. Long-term social problems that follow from poverty include poor health and increased mortality, poor school performance, crime, and substance abuse or misuse (Murali & Oyebode, 2004).
"Income levels, mortality risk, and deprivation forms"
"Exclusion mechanisms driving homelessness by race"
"Shared responsibility as the path to poverty reduction"
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