Can poverty make you sick?

Why your financial health can be the biggest predictor of physical health

We all know staying healthy is a mix of good genes, living a healthy lifestyle and having access to quality preventive and health care services. But did you know that is only half the story?

According to the Robert Wood Johnson Foundation, 50% of health outcomes are determined by income, housing and access to social support services. Some “health-wealth” links are obvious. When you are in good health, you are better able to sustain a job and earn an income. But what about the reverse – can poverty make you sick?

There is growing research into the effects of poverty on the health of children and families:

• Children who are homeless are twice as likely to have developmental delays and four times more likely to develop asthma.
• Children in families who are behind on rent are more likely to be in poor health and hungry, contributing to below average growth and developmental delays.
• Parents in households who are behind on rent are more likely to forgo medical care for themselves in order to pay basic household expenses.

What’s more, the stress of being poor can harm mental and physical health, and that impact sets the stage for intergenerational poverty. Numerous studies on “toxic stress” show that chronic exposure to hunger, violence and other day-to-day effects of poverty significantly interrupts the development of the brains of young children, increasing the need for early intervention services and influencing a child’s ability to learn and their future academic performance.

Innovative prescriptions to improve health

The strong ties between financial health and physical health are causing both medical and human services experts to develop innovative approaches to integrating services that address financial insecurity into their work.

“Often the prescription I want to write is for a safe and stable home,” says Dr. Megan Sandel, pediatrician at Boston Medical Center and principal investigator at Children’s HealthWatch. Dr. Sandel noted that the negative health effects of homelessness on children are also seen among those who have moved at least twice in one year and those whose families have fallen behind on their rent. “Housing is a vaccine,” Sandel added. “It will help keep children healthy now and in the future.”

Children’s HealthWatch at Boston Medical Center is piloting “Housing Prescriptions as Health Care,” providing targeted housing and legal services, along with case management, to families who are both behind on rent and heavy utilizers of emergency room services. They are partnering with Project Hope, Boston Housing Authority, Nuestra Communidad Development Corporation and Medical-Legal Partnership to improve children’s health by prescribing safe, secure housing as a treatment.

Chelsea Health Starts at Home is another innovative screening program. Through the partnership, MGH Chelsea and Chelsea-based Roca will screen mothers and families for issues of unstable housing during the regular course of care, and refer them to services at Chelsea CONNECT, one of United Way’s financial opportunity centers, for a variety of services, including access to short-term rental assistance and long-term supports such as benefits screening, financial coaching and services, workforce development resources and housing counseling.

“We know that CONNECT is a game changer for our clients and we are excited to leverage our results with MGH, Roca, and Metropolitan Boston Housing Partnership to help vulnerable families achieve stable housing and good health,” said Ann Houston, Executive Director at The Neighborhood Developers, when the project was announced. Blue Cross Blue Shield of Massachusetts Foundation is also a funder of the effort.

Benefits extend beyond the patients

Addressing patients’ income and housing instability not only improves health outcomes, the approach also saves money. A 2015 Blue Cross Blue Shield report found that “providing housing support for low-income, high-need individuals results in net savings due to reduced health care costs.” The report further notes how “in some studies, the medical savings more than offset the additional costs of providing housing supports. The net savings range from $9,000 per person per year to nearly $30,000 per person per year for the Housing First model.”

Under a Housing First model, homeless individuals or families are moved into permanent housing as quickly as possible, and then provided the supportive services such as financial coaching and job training to set them on a path toward stability. It’s the approach that underpins the Massachusetts Housing and Shelter Alliance and United Way’s innovative Pay for Success model to reduce chronic individual homelessness. And it has connected over 330 chronically homeless individuals to health care, paving the way for significant savings in emergency medical services and shelter costs.

These “health-wealth” connections provide a number of opportunities for donors and policy makers to make a difference, such as investments in high-quality early education to foster healthy development of children and increasing resources for financial opportunity centers that offer housing assistance, job placement services and financial coaching.

We may not all be able to write prescriptions to improve the health of children and their families, but we can be part of the cure.