Calvert County’s top medical doctor said there is a correlation between income and health.
“That correlation accounts for many of the differences we see in both life expectancy and in disease incidents. That goes all the way from early childhood through late adulthood,” said Dr. Laurence Polsky, Calvert County health officer.
Polsky said due to Calvert’s small population, just over 90,000, it is harder to draw definitive conclusions, but national data shows when comparing people in the United States at the lower economic spectrum and at the poverty level to those in the upper spectrum, the disparity becomes apparent.
“The further you go toward poverty, the greater the health impact,” Polsky said.
The U.S. Department of Health and Human Services established guidelines for poverty in 2019 that starts at $12,490 for an individual and goes upward to $43,430 for households with eight members.
Low income is considered 200% of the federal poverty level. Middle class income is not officially defined by the federal government.
However, the Pew Research Center defines middle class income as falling between $45,200 and $135,600 in 2016.
Upper income is anything above $135,600.
Analyzing 2016 federal government data, in 2018 Pew issued a report title “Are you in the American middle class?“ by Richard Fry and Rakesh Kochhar. It reports that 52% of adults lived in middle-income households, 29% in lower-income households and 19% in upper-income households.
“For the average woman who is a the lower end of the spectrum, her life expectancy is 10 years less than for women who are at the upper end of the spectrum,” Polsky said.
He reports that there is a bigger “discordancy” with men who live in poverty. Their life expectancy is 15 years less than their counterparts in the upper edge of the income scale.
The statistics Polsky presented are consistent with a 2016 Journal of the American Medical Association study on the relationship between income and life expectancy, conducted by then-Stanford economist Raj Chetty and colleagues, which detailed a gap in life expectancies between men and women at the most affluent 1% to the poorest 1%.
Polsky said even for children in utero, if their mother is impoverished, there are stress hormones that are circulating through the mother’s body that impact the growth of the fetus. Women in poverty are more likely to deliver prematurely. Polsky said regardless of gestational age (premature or full-term), their babies are likely to weigh less and have more health problems.
“Those disadvantages at birth will often times carry through. For babies that are born prematurely they will often have cognitive and behavioral problems, which can translate into educational difficulties,” Polsky said, noting the potential for poverty to have long term effects beyond health.
As for health outcomes, Polsky said lower-income children have less access to health care. Those kids are more likely to miss days of school because of illness.
Polsky also said it is much more likely that factories and toxic dumps are placed in or near a low income neighborhoods. Additionally, housing in those neighborhoods are not maintained well and have poor conditions such as mold infestation that trigger asthma or yield an allergic reaction.
“You have environmental pollutants from a very early age leading to childhood asthma,” Polsky said, asthma is the leading childhood disease, regardless of economics.
Often, parents in the lower income spectrum are often unable to get their children healthcare provider and less able to afford medication such as an inhaler or follow treatments.
In addition to asthma, other chronic conditions that are prevalent in children are juvenile diabetes and Type II diabetes in adolescents due to obesity.
“For people at the lower end of the economic scale they are often times are buying food that is not as nutritious because its more affordable,” Polsky said, noting those foods are higher in calories, higher in salt and lower in nutrients leading to hypertension and chronic kidney ailments for adults.
“Education makes a difference because if you do not know how to cook properly then you can’t make nutritious meals,” epidemiologist Anjana Rao said, noting it takes knowledge and time to sauté vegetables properly. “It’s easier to get processed prepared foods that you don’t have to do anything with. It’s faster.”
Polsky said physical environment also impacts physical health, especially in lower income neighborhoods with high crime, where people are reluctant to go out to walk or get exercise. He also points to a lack of recreational facilities as a possible cause of poor health.
Polsky said low income is often tied to poor health in utero, poor diet and physical environment, which carries over into adulthood.
“Typical for lower income, we see higher rates of cancer and higher rates of cardiovascular disease — high blood pressure, diabetes that contribute to earlier onset heart attack, stroke and kidney disease,” Polsky said of health impacts in adults.
“The primary contributors tend to be general life stress,” Polsky added, which transcends race and ethnicity. “People at the end of the lower income level scale do have higher rates of chronic disease. The severity tends to be worse.”
Stressors for low-income citizens is the inability to pay bills and possible jeopardy of losing their home.
“The chronic stress hormones [cortisol] that are produced as a response to all these pressures accelerate heart disease, raising blood pressure,” Polsky said, drawing a correlation between income, stress and physical health.
The symptoms can start to reveal themselves in people in their 30s or 40s, whereas those with lower amounts of stress hormones may not exhibit symptoms of those chronic conditions until they are in their 60s and 70s.
Polsky emphasized that health officials are not just looking at extremes of poverty, where the impact is the greatest.
“What we see is a pretty clear stair step that at each level of income you see a gradation,” Polsky said. “Even for people who are middle class or lower middle class these impacts aren’t as dramatic, but we still have measurable impacts.”
That gradient between economic well-being and health was broached in the 2015 brief titled “How income and wealth link to health and longevity?” produced by the Urban Institute and the Virginia Commonwealth University Center on Society and Health.
Looking at data, the study surmised that “the greater one’s income, the lower one’s likelihood of disease and premature death.” The study further indicated that families of greater resources can afford healthier lifestyles and experience place-based health benefits, yielding positive health effects influenced by the conditions in their living environment.
Extracting data from various studies and research sources such as the Centers for Disease Control and Prevention, the Commission on Health, the Social Security Administration and the National Center for Biotechnology Information, the researchers concluded that “better economic conditions for American families means longer lives in better health and better health means lower healthcare costs.”
Lack of access to affordable health care presents impacts to health.
However, in Calvert County the rate of uninsured has dropped from 11% to 4% since the implementation of the Affordable Care Act, according to Polsky. He said the rate of those without dental insurance is still problematic.
The consequence is poor dental health, which correlates with poor nutritional health and poor heart health.
Polsky said the state’s health departments are here to serve anybody in the community regardless of income. For behavioral healthcare, he said they see people all along the scale of the economic spectrum.
“Health departments always have an obligation to serve as a safety net provider for those who are unable for various reasons cannot access care through the private sector. We’re here to help them,” Polsky said. “But we are not exclusive.”
While the door is open to all, Polsky admits lower income level toward the federal poverty level makes up the majority of those serviced at the state’s local health departments in each county.
“I deal with the data aspect of it,” Rao said, of foot traffic and participation at Calvert’s health department, tracking and reporting trends.
Rao said their programs do not track income levels.
However, they do offer a variety of programs with income guidelines and age requirements such as the Colorectal Cancer Screening Program, funded by the Maryland Cigarette Restitution Fund Program. She reported in FY19, in Calvert County 54 people received colonoscopy services, of which 44% of those screened had precancerous polyps.
Their Breast and Cervical Cancer Screening Program, funded by Maryland Department of Health and Centers for Disease Control is also offered to residents who meet income guidelines and age requirements. In FY19, 101 women were served through the program, of which 23% of those screened had an abnormal result, according to Rao.
The Calvert County Health Department offers Living Well with Diabetes Workshops throughout the year for individuals seeking assistance to take control of their diabetes and a Diabetes Prevention Program also funded by the CDC.
Rao said another offering is their Quit Tobacco Program which offers a six-session class. Roughly 100 people came through for cessation classes; individual or group.
The local health departments also provide services beyond medical and mental health care and screenings to include partnering with the county’s Department Social Services, job placement agencies and case management.
“We realize people’s physical health is tied into their economic well-being,” Polsky said, of the impetus of the health departments offerings. “For people who have struggled for various reasons to to have a job that pays enough that supports themselves that if we don’t help in those aspects of their lives that their physical health will continue to suffer.”