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Social Determinants of Health in Poor and Low-Income American Families

Poverty is a great social factor and determinant in healthcare. This is especially true for the USA, which has an imperfect healthcare system of insurances, which are hard to afford even for the low-medium income citizens. As of 2011, 32.1% of families are considered low-income families, while 10.6% of families live below the poverty line (“U.S. low-income,” 2011). This presents a great healthcare risk, as many of these families are unable to afford insurance and are faced with even greater fees when paying out of their pocket. Poverty and lack of finances influence a great deal of other related social determinants that contribute to the increased mortality, morbidity, and health hazards experienced by poor and low-income American families. The purpose of this paper is to analyze the variety of social determinants that affect the health status of these families and reflect on the change of perspective towards these families during hospital practice.

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Differences between Poor and Low-Income Families and Predominant Health Issues

There is a difference between the poor, the absolutely poor, and the low-income families. Poor families are families whose income per person is below the 100% poverty line (Braveman & Gottlieb, 2014). These families, while they have the funds for basic needs and accommodations, do not have the ability to purchase certain goods and services to fully function in society. Low-income families’ income per person is considered below 200% of the poverty line (Braveman & Gottlieb, 2014). In general, these families can afford both the basic and the additional needs to function in society, but barely. Quality education and medicine are often an impossible ventures for them. The absolutely poor families are homeless and often cannot afford even the basic needs of sustenance, such as bathing, food, water, and shelter. Thus, predominant health issues for all three groups are lack of available healthcare, lack of available and comprehensive information, and lack of necessities to maintain a relatively healthy way of life, such as food, clear water, and habitable spaces to live in. Additional needs connected to healthcare are the need for stable, safe, and better-paying jobs in addition to social security Braveman & Gottlieb, 2014).

Social Determinants of Health


As it was stated at the beginning, the greatest social determinant that affects low-income families is the lack of money to afford insurance. Even though the government offers a substantial cut to acquiring it, the sum that families have to pay still remains substantial enough for many low-income and poor families to avoid getting it. According to The Kaiser Family Foundation, 8 out of 10 uninsured families are 400% below poverty level, meaning that even some families of moderate income cannot afford quality healthcare (“Key facts about the uninsured population,” 2016). This creates a serious problem, as people without insurance are less likely to address their healthcare needs until they are physically forced to due to the morbidity of their conditions. Due to late hospital admissions, the mortality rates for poor and low-income families are significantly higher, with the frequent causes of death being cardiovascular diseases, lung diseases, and cancer. Poverty also affects other social determinants that influence the health status of poor and low-income families.


Education as a social determinant is directly tied to poverty levels. As a rule, the lower are the education levels among the population, the poorer they are. Almost all high-end paying jobs require at least a Bachelor’s degree. Managerial and supervisory positions often require a Master’s degree in the required field of expertise. That kind of education many families could not afford due to fear of being in debt, as higher education in the USA is one of the most expensive in the world. As a result, many hard-working families are forced to take low-end jobs, which leave them below the poverty line (Braveman & Gottlieb, 2014).

The word education, however, is not related strictly to academic knowledge. Many poor and low-income families have limited knowledge about their own body, possible health hazards, and health practices, thus leaving them vulnerable to illnesses and diseases, which they are unable to recognize or counteract. All viral outbreaks that happened in the USA in the last 20 years have started among the poor, as they are the least socially-protected stratum of the society (Braveman & Gottlieb, 2014).

Healthy Living Conditions

There is a direct correlation between the level of poverty and the healthiness of living. The poor and low-income families are often unable to conduct a healthy way of life, as they are unable to afford healthy foods, medicine, and are forced to work dangerous jobs in order to provide for themselves and their families (Braveman & Gottlieb, 2014). Another factor that contributes to the lack of health is overcrowdedness and poor living conditions. Unable to afford their own home or apartment, the poor often have to rent living space in the most unsavory parts of the city and live together in small and enclosed spaces. These spaces often turn into breeding grounds for such diseases as tuberculosis, pneumonia, and other respiratory infections (“Key facts: Poverty,” n.d.). Unavailability or scarcity of nutrition, sanitation, and clear water are the main underlying causes for the appearance of diseases and other health problems within the vulnerable populations. The slums are also known for increased levels of criminal activity, which is associated with physical trauma and weapon-related injuries. All these factors, together, make up for the lower life expectancy for the members of poor and low-income families.

Personal Reflection

When I first started working with poor and low-income families, I noticed that many of them avoided visiting hospitals unless the situation was critical. At first, I assumed that the cause of this behavior was a lack of insurance. The fees for out-of-pocket payments are significantly higher and impose a great strain on the family budget. However, as I talked to patients, I discovered that the main reason for such behavior, while still related to poverty, was different. In many cases, the primary determinant was the so-called generational poverty (Wagmiller & Adelman, 2009). Many members of low-income families were born in poverty themselves and were not used to quality healthcare (Zeller, 2013). Instead, they were taught by their parents to rely on themselves and treat themselves using the knowledge passed from mother to daughter or from father to son. This wrought the creation of a strange notion of “folk medicine,” existing within urban environments, which largely revolved around using very cheap and available medicines in order to treat complex diseases and mitigate their negative effects. Because these practices often lacked the actual medical knowledge to back them up, the majority of them revolved around reducing the symptoms of particular diseases, namely pain. However, these practices did not contribute much towards actually curing the disease, which often led to the development of the disease and worsening of the present conditions. Many patients I talked with said that they did not seek medical help not because they were unable to afford it, but because they thought they could deal with it on their own. In these cases, direct lack of money was not the primary social determinant of health. Instead, the patients’ health was influenced by a lack of education and medical knowledge in conjunction with the poverty-induced necessity of self-reliance.

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Braveman, P., & Gottlieb, L. (2014). The social determinants of health: It’s time to consider the causes of the causes. Public Health Reports, 129(2), 19-31.

Key facts about the uninsured population. (2016). Web.

Key facts: Poverty and poor health. (n.d.). Web.

U.S. low-Income working families increasing. (2011). Web.

Wagmiller, R.L., & Adelman, R.M. (2009). Childhood and intergenerational poverty. Web.

Zeller, T. (2013). For America’s least fortunate, the grip of poverty spans generations. The Huffington Post. Web.

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