Health is about more than just health care

The Erica Chang/MGN

Relieving the burdens of poverty is also necessary

Did you know that even poverty can get deep? A recently published report by my colleagues at the Minnesota Department of Human Services explores the impacts on health and opportunity that being in deep poverty have on individuals and families.

Deep poverty is defined as someone’s income reaching less than half of the federal poverty level. For a single adult without children, being at the poverty level equates to an income of $1,034 a month; being in deep poverty then is having income of less than $517 a month. For a family of three, the numbers are $1,777 and $888, respectively.

The report lays out the extensive research showing that living in deep poverty contributes to poor health, which in turn keeps people in deep poverty. It looks at what opportunities exist to improve health and move people out of deep poverty by drawing on the experiences of people living in deep poverty, health care and social service providers, and published research.

It also demonstrates how structural racism is tied to disparities in health among African American and American Indian people in Minnesota when compared to White Minnesotans.

A mother of three, who found out just two weeks before she delivered her youngest child that she would not receive any paid maternity leave from her work, shared this story: “So I had to really scramble trying to find out how I was going to pay my rent, make ends meet. Because I wasn’t on MFIP before having my son, I had to figure out how I was going to pay rent, buy food and still maintain after I had him, because I had to take the six weeks off…

“When I did get approved, I was already two months behind in rent. And before that I didn’t qualify because of my income. When I went to the landlord and tried to give him what I had for MFIP, they wouldn’t take it by that time… So I ended up getting evicted. So that’s why I’m here [in a shelter].”

This mother’s story illustrates several of the ways individuals, through no direct fault of their own, can find themselves in deep poverty. Once in deep poverty, several mechanisms can directly affect health.

The consistent lack of necessities, like appropriate nutrition, housing, transportation or regular health care, impact one’s ability to work. If someone has a job, they can find themselves with a lack of time for healthy behaviors like exercise, adequate sleep, or getting the medications they need regularly because of a need to rely on public transportation or working multiple jobs.

Living in a neighborhood without access to green spaces or healthy food or with excessive pollution or noise contributes to chronic stress. The report details how chronic stress is linked to numerous long-term health problems in both children and adults.

U.S.-born African Americans, along with American Indians, have the highest rates of deep poverty of adults enrolled in Minnesota’s Medicaid program, and this report touches on how this results from generations of discrimination and structural racism. Our communities see the highest prevalence of asthma, hypertension and heart failure among Minnesotans on Medicaid.

This can be tied to generational trauma and stress dating back to slavery and Jim Crow laws like residential redlining and racial covenants that segregated U.S.-born African Americans into neighborhoods exposed to more pollutants as well as providing less intergenerational wealth. As a result, Minneapolis has the widest racial homeownership gap out of the 100 U.S. cities with the largest Black populations.

Community members who are able to get to the doctor can find themselves experiencing poor treatment because of structural racism within medicine. Thus, for African American families in deep poverty, these barriers put in place by government policies and institutions make escaping poverty and maintaining one’s health incredibly difficult.

Health is about more than just health care, and this report provides several recommendations to that point. Improving the design of programs like the Minnesota Family Investment Program (MFIP), also known as cash assistance, and the Supplemental Nutrition Assistance Program (SNAP), or food stamps, by working with community leaders to address structural racism are among the initial steps the report lays out in its recommendations.

These programs improve people’s ability to care for themselves and their families as well as being shown to improve health outcomes. Additionally, policies like the federal earned income tax credit, unemployment insurance, and paid parental and sick leave can improve not only the mental and physical health of adults, but potentially the health of their children too.

This quote from a physician succinctly captures what is detailed in the deep poverty report: “It is time-consuming and expensive to be poor. You have to jump through so many hoops, constantly, to survive… We should be decreasing the bureaucratic burden. It is a full-time job being poor. How are you even going to try to get employed?”

Too many people in our community cannot achieve their health and potential because of how a number of our policies have historically been, and currently are, structured. The report is well worth the read. My hope is that we not look too deeply at the despair and instead see the opportunity to improve the health of people living in deep poverty.

Dr. Nathan T. Chomilo is medical director for the State of Minnesota’s Medicaid/Medical Assistance & MinnesotaCare programs and practices as a general pediatrician in Brooklyn Center with Park Nicollet. He is a board member of the Minnesota Chapter of the American Academy of Pediatrics and an adjunct assistant professor of Pediatrics at the University of Minnesota Medical School. He lives in Minneapolis with his wife and son.