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					  Is Poverty the Greatest
Predictor of Health Status?

       Barbara T. Baylor, MPH
   Minister for Health Care Justice
   Justice and Witness Ministries
       United Church of Christ
          October 19, 2009


Developed by Barbara T. Baylor, MPH
  Minister for Health Care Justice-
          UCC/JWM 2009
Objectives:
 Some understanding of the Poverty and
  how it is measured and computed
 Some understanding of health status
 Raise awareness about the extent and
  cost of health inequities
 Some understanding of the Social
  Determinants of Health




         Developed by Barbara T. Baylor, MPH
           Minister for Health Care Justice-
                   UCC/JWM 2009
Faces of Poverty




Developed by Barbara T. Baylor, MPH
  Minister for Health Care Justice-
          UCC/JWM 2009
    Poverty & Health Overview
 Loss of purchasing power
 Poor housing
 Overcrowding, greater liability to accidents
  in cramped homes and in the street
 Violence
 Diet (even if adequate in quantity may be
  deficient in quality and lacking in expensive
  ―protective‖ foods such as food and
  vegetables.
  Community Health in the 21st Century. Patricia Reagan and
  Jodi Brookins-Fisher

                Developed by Barbara T. Baylor, MPH
                  Minister for Health Care Justice-
                          UCC/JWM 2009
 Higher rates or premature death
 Tend to die younger
 Frequently ill
 Had less time disability free
 Less happy
 Endure inadequate housing, clothing and
  food
 Workplaces that are frequently
  hazardous
 Limited recreational opportunities
 Inaccessible health system
          Developed by Barbara T. Baylor, MPH
            Minister for Health Care Justice-
                    UCC/JWM 2009
         2009 Poverty Guideline
     48 Contiguous States and D.C.
Persons in the Family                 Poverty Guideline
1                                     $10,830
2                                     $14,570
3                                     $18,310
4                                     $22,050
5                                     $25,790
6                                     $29,530
7                                     $33,270
8                                     $37,010
                                                U.S. Census Bureau


          Developed by Barbara T. Baylor, MPH
            Minister for Health Care Justice-
                    UCC/JWM 2009
 Money income
Includes earnings, unemployment compensation,
   workers’ compensation, Social Security,
   Supplemental Security Income, public
   assistance, veterans’ payments, survivor
   benefits, pension or retirement income, interest,
   dividends, rents, royalties, income from estates,
   trusts, educational assistance, alimony, child
   support, assistance from outside the household,
   and other miscellaneous sources.

 Noncash benefits (such as food stamps and
  housing subsidies) do not count.
                                                 U.S. Census Bureau


           Developed by Barbara T. Baylor, MPH
             Minister for Health Care Justice-
                     UCC/JWM 2009
 Before taxes.


 Excludes capital gains or losses.


 If a person lives with a family, add up the
  income of all family members. (Non-
  relatives, such as housemates, do not
  count.)

                                                U.S. Census Bureau




          Developed by Barbara T. Baylor, MPH
            Minister for Health Care Justice-
                    UCC/JWM 2009
 Poverty thresholds are the dollar amounts used
    to determine poverty status
   Each person or family is assigned one out of 48
    possible poverty thresholds
   Thresholds vary according to:
   Size of the family
   Ages of the members
   The same thresholds are used throughout the
    United States (do not vary geographically)
   Updated annually for inflation using the
    Consumer Price Index for All Urban Consumers
    (CPI-U).
                                                  U.S. Census Bureau



            Developed by Barbara T. Baylor, MPH
              Minister for Health Care Justice-
                      UCC/JWM 2009
 If total family income is less than the threshold
  appropriate for that family,
      the family is in poverty
      all family members have the same poverty status
      for individuals who do not live with family members,
       their own income is compared with the appropriate
       threshold


 If total family income equals or is greater than
  the threshold, the family (or unrelated
  individual) is not in poverty

                                                   U. S. Census Bureau




             Developed by Barbara T. Baylor, MPH
               Minister for Health Care Justice-
                       UCC/JWM 2009
 Family A has five members: two
  children, their mother, father, and great-
  aunt.
 Their threshold was $26,338 dollars in
  2008. (See poverty thresholds for 2008)
 Suppose the members' incomes in 2008
  were:
Mother:      $10,000
Father:      $ 7,000
Great-aunt: $10,000
First child: 0
Second child: 0
Total family income: $27,000                       U.S. Census Bureau


             Developed by Barbara T. Baylor, MPH
               Minister for Health Care Justice-
                       UCC/JWM 2009
 Compare total family income with their
  family's threshold. Their income /
  Threshold = $27,000 / $26,338 = 1.03

 The income divided by the threshold is
  called the Ratio of Income to Poverty.

 Since their income was greater than their
  threshold, Family A is not "in poverty"
  according to the official definition.

                                               U.S. Census Bureau


         Developed by Barbara T. Baylor, MPH
           Minister for Health Care Justice-
                   UCC/JWM 2009
 The poverty thresholds were originally
  developed in 1963-1964 by Mollie
  Orshansky of the Social Security
  Administration. Published in a January
  1965 Social Security Bulletin article.

  Orshansky based her poverty thresholds
  on the economy food plan — the
  cheapest of four food plans developed
  by the Department of Agriculture

  Source: Brief Overview of the U.S. Poverty Threshold. DHHS.
  Gordon M. Fisher

             Developed by Barbara T. Baylor, MPH
               Minister for Health Care Justice-
                       UCC/JWM 2009
        Some Health Facts
 47 million uninsured (25 million
  underinsured; 5 million uninsured.
 Spend approx. $6,697 per person on
  health care in this country. Over 2 Trillion
  dollars
 Among the worst health outcomes of any
  industrialized nations
 Greatest health inequities.
 High Chronic conditions

          Developed by Barbara T. Baylor, MPH
            Minister for Health Care Justice-
                    UCC/JWM 2009
Developed by Barbara T. Baylor, MPH
  Minister for Health Care Justice-
          UCC/JWM 2009
The Social Determinants of Health
 The social determinants of health are the
  conditions in which people are born,
  grow, live, work and age, including the
  health system. These circumstances are
  shaped by the distribution of money,
  power and resources at global, national
  and local levels, which are themselves
  influenced by policy choices.

  Source: World Health Organization (WHO)


            Developed by Barbara T. Baylor, MPH
              Minister for Health Care Justice-
                      UCC/JWM 2009
 Social Determinants of Health
 Jobs
 Working conditions
 Education
 Housing
 Social inclusion
 Political power




         Developed by Barbara T. Baylor, MPH
           Minister for Health Care Justice-
                   UCC/JWM 2009
       What is Health Equity?
 Those differences in population health
  that can be traced to unequal economic
  and social conditions and are systemic
  and avoidable – thus inherently unjust
  and unfair.




  Source: Unnatural Causes: Is Inequality Making Us Sick?



              Developed by Barbara T. Baylor, MPH
                Minister for Health Care Justice-
                        UCC/JWM 2009
The Mystery:
 Given our wealth and medical advances,
  why does the United States rank 29th in
  the world for life expectancy (as of
  December 2007)?

 What are the connections between
  healthy bodies and healthy bank
  accounts and race/ethnicity?

  Source: Unnatural Causes: Is Inequality Making us Sick?

              Developed by Barbara T. Baylor, MPH
                Minister for Health Care Justice-
                        UCC/JWM 2009
Themes to Consider:
 Class status correlates with health
  outcomes
 Our economic, social and built
  environments shape health
 People who are middle to lower on the
  class pyramid are exposed to more
  health threats (material deprivation and
  chronic stressors) and have less access
  to the opportunities and resources
  needed to control their destinies.
         Developed by Barbara T. Baylor, MPH
           Minister for Health Care Justice-
                   UCC/JWM 2009
 People middle to higher on the class
  pyramid have access to more power and
  resources and in general live longer,
  healthier lives.
 Chronic activation of the body’s stress
  response wears down our organs over
  time and increases disease risk.
 Racism also threatens health, both
  ―upstream‖ and independent of class.
 Social and economic policies have
  reduced health inequities in the past and
  in other countries.              Unnatural Causes

           Developed by Barbara T. Baylor, MPH
             Minister for Health Care Justice-
                     UCC/JWM 2009
 Layoffs, unemployment, and job
  insecurity have a negative effect on
  health.
  Public policies that provide a social
  safety net can buffer unemployed
  workers and their families from economic
  disruptions and uncertainties that affect
  health.
 Societies that take a ―we’re all in this
  together’ approach to policy have better
  health outcomes than those that leave
  individuals and communities to fend for
  themselves.                       Unnatural Causes



           Developed by Barbara T. Baylor, MPH
             Minister for Health Care Justice-
                     UCC/JWM 2009
“The choices that people
 make are shaped by the
   choices they have.”



 Source: Unnatural Causes: Is Equality Making Us Sick?



        Developed by Barbara T. Baylor, MPH
          Minister for Health Care Justice-
                  UCC/JWM 2009
―Of all the forms
  of inequality,
    injustice in
  health care is
     the most
  shocking and
   inhumane.”
  Rev. Dr. Martin Luther
        King, Jr.


          Developed by Barbara T. Baylor, MPH
            Minister for Health Care Justice-
                    UCC/JWM 2009

				
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