Health and Well-being
This aspect describes chronic external and internal conditions that affect the physical and mental well-being of those most affected by poverty. These chronic conditions lead to a shorter life span, curtailed by individual, generational, place-based, or historical trauma that has left its mark as emotional and physical wounds carried by people in poverty and passed from one generation to the next. The hardships are exacerbated by harsh living conditions that include toxic stress, environmental hazards (air, water, and soil pollution), inequality in the health care system, violence, suicides, substance abuse and self-medicating, isolation, and lack of access to basic hygiene services.
A shorter life span pertains to people living with the multiple hardships of poverty regardless of their living conditions or their access to health care. Poor health related to poverty that starts in childhood is carried into adulthood and persists throughout life — for many, a shorter life than for those in better conditions — even if economic circumstances change for the better.
Historical trauma caused by government intervention and subsequent lack of governmental accountability has an enormous impact on the current mental health of people in poverty. Native Americans have extremely high suicide rates, particularly among the young; high rates of diabetes and heart problems; and high blood pressure, all stemming from the trauma caused by the “boarding school system” where children were taken from their families, placed in boarding schools, and stripped of their culture and language in order to be made more “American.”
Toxic stress — anxiety and stress that result in chemical changes in the brain — caused by historical trauma and poverty-related trauma can trigger mental health issues across generations. Self-medicating with drugs or alcohol has been used to mask mental health problems caused not only by historical trauma, but also by the stress resulting from the multiple hardships of poverty. Additionally, the over-surveillance and intrusion of government in the lives of people in poverty and the lack of trust of government by communities of color results in an under-reporting of mental health distress and undermines any attempted interventions. Even when mental health or substance abuse treatment is sought, it is often not available; and when people in poverty accept treatment, it increases the likelihood that children will be separated from their parents.
People living in both rural and urban areas generally have no control over damaging environmental conditions: lead in the water and soil, and carcinogens in the air, water, and soil. In urban areas, participants have noted used hypodermic needles being disposed of in parks and playgrounds. In rural areas, participants have noted black and brown lung disease due to coal mining and coal dust in the air (Appalachia), and uranium in the ground water and soil (New Mexico).
In rural areas, people often have to travel two hours or longer to have access to medical care or to visit a doctor. In some rural areas, thousands of people travel up to one hundred miles and wait in lines for up to three days to receive free basic medical care (an eye exam, a physical examination, or dental care) from a volunteer medical organization that serves people who do not have or cannot afford insurance coverage.
There may be more health care facilities in some urban areas, but many people’s access is limited due to high costs or lack of insurance coverage. In both rural and urban areas, people in these hardship circumstances try to ignore illnesses, hoping they will subside; they resort to home remedies and turn to emergency rooms as a last resort. Often a small ailment would be manageable with prompt medical care, but failing that, it grows into a more serious problem. In both rural and urban areas, people have reported waiting several hours in an emergency room and then being told to see their primary care physician for follow-up care, even though many of them do not have access to a primary care provider. This is another “Catch-22” scenario for people living with the multiple hardships of poverty.
“Third World country conditions within the U.S., a wealthy country”
Many people in poverty cannot practice preventive care because they have no access to nutritious food. At the same time, both malnutrition and obesity are prevalent in disadvantaged areas. Living in “food deserts” and not being able to afford nutritious food, people enduring the multiple hardships of poverty in both rural and urban areas cannot maintain diets that would aid in maintaining health. When available, food pantries can help subsidize a diet, but without those, many people have no access to fresh fruits or vegetables. The food that people in poverty do have access to — outdated, boxed, or canned items; fast food, and low-priced items that are high in sugar, salt, fat, and starch content — is what causes health problems to begin with, including diabetes, high blood pressure, and heart disease.
Dental care is often neglected because even if a person does have some form of health care insurance, dental coverage is rarely included or the services are very limited. In both rural and urban areas, it can be harder to find a dentist than a primary care physician. Lack of adequate dental care affects overall health and causes chronic pain that makes eating difficult, results in multiple tooth extractions, and erodes self-confidence by intensifying the stigma, shame, and self-isolation experienced by people in poverty who have difficulty talking or are humiliated when they smile.
“Just enough to keep you alive — sometimes.”
Lack of eye care leaves many adults in poverty with limited employment options due to uncorrected vision. Also, sight problems can cause headaches and dizziness and interfere with everyday tasks. Children with poor vision have difficulties in school if they cannot get appropriate care.
Even when access to health care is available, service providers may be unfamiliar with disorders common among people who have experienced the multiple traumas of poverty and may offer culturally inappropriate options to populations with high rates of poverty, such as people of color, Native Americans, and LGBTQ people. These realities of limited or no access to health care have been described as and “Just enough to keep you alive — sometimes.”