Some of the ways in which poverty contributes to poor health are immediately obvious. Absolute deprivation leading to poor nutrition may lead to susceptibility to infection and chronic disease and crowded housing may increase disease transmission.
Consider the following case.
Shelley is a 19 year old low-income mother of a four year old. Shelley has been living with asthma for several years without treatment, and is a smoker. Her daughter recently began wheezing, especially on hot, humid days. In addition to Shelley’s smoking, the only place they are able to afford is a dilapidated apartment over a restaurant. The apartment has cockroaches, and the air ducts have never been cleaned.
Shelley has not been to see her doctor in three years. In part, she is afraid that the doctor may judge her personal life and circumstances. In addition, she works at a minimum-wage contract shift job with no paid leave and irregular on-call hours, so appointments are difficult to make. At her last appointment, she was kept waiting for over an hour, which meant lost wages for the transportation and waiting time for the appointment.
Although important, absolute material deprivation cannot explain the health differentials that exist all the way up the socioeconomic ladder, including in social classes in which material needs are met. An important connection between the nervous and immune systems is key to understanding some of the remaining link between social status and health. Individuals at the lower end of the social scale may experience chronic levels of stress, and may be less able to downregulate this response, in part because they lack a sense of control over their life situation. While a stress response is adaptive in the short term, long term stress is harmful, and may decrease the body’s performance of maintenance functions and impair the function of the immune system.
1. Canadian Public Health Association. Board of Directors Discussion Paper. Health impacts of social and economic conditions: Implications for public policy. 2001. Ottawa, Canadian Public Health Association.