September 29, 2016

poor kidBy Catherine A. Porter, JD

SF Bay Area PSR has long recognized, and worked against, the interconnected ways that poverty, environmental degradation, unsustainable agricultural practices and social injustice combine to damage our health and the health of our neighbors. The need for such work has never been clearer. New census figures released this month show that even though California’s poverty rate declined in 2015, there are still nearly 6 million Californians, including 2 million children, who live in poverty.  According to the recent data, California ranked 17th highest when poverty was measured by the official poverty determinant, but when using the Supplemental Poverty Measure (SPM), the Golden State has the highest—yes, the highest—rate of poverty in all the country with nearly 8 million, or nearly 1 in 5 Californians living in poverty.  The SPM more realistically reflects the variation of the cost of living across the country and accounts for the array of resources families use to pay for basic expenses.

 Children are especially hard hit by poverty.[i] Even though children make-up a little less than 1/4th of the state’s population, almost 1/3rd of individuals living in poverty in California are children.  And the news is especially bad for African American and Latino children who are 3 times more likely to live in poverty than white children.

No surprise to those of us who live in this state, a major factor in California’s poverty rate is the cost of rent: “The majority of low-income households in California spend over half of their incomes on rent making it difficult to afford other necessities and save for the future.”[ii] San Francisco rates number 1, and Alameda County number 5, as far as the most expensive rental markets in California.[iii]

And what does all this have to do with health?  Plenty! According to Tom Boyce, MD, chief of UCSF’s Division of Developmental Medicine within the Department of Pediatrics, “Socioeconomic status is the most powerful predictor of disease, disorder, injury and mortality we have.”[iv]  In fact it can cut years off of life-expectancy: “Impoverished adults live seven to eight years less than those who have incomes four or more times the federal poverty level.”[v]   And the discrepancies grow when race is taken into account.

In addition to how long we live, poverty impacts how well we live in a range of ways. For instance, it can dramatically impact brain development. In studies conducted by Dr. Boyce, researchers found fundamental differences in brain functions essential to academic achievement and advancement: “The kids from poor families had lower IQs and less effective executive functioning, which takes place in the prefrontal part of the brain – things like working memory, semantic fluency and cognitive flexibility, the capacity to readily switch tasks.”[vi]  Dr. Boyce noted that these differences are not genetic in origin, “Rather, many or even most such socioeconomic disparities in brain structure and function are the direct consequences of early rearing in impoverished, chaotic and stressful conditions.”[vii]

 And poverty impacts other health issues such as obesity and diabetes. Ironically, even though wealthier nations such as the United States have the highest rates of obesity, higher rates of obesity in the United States correlate with poverty.[viii] The reasons for this are complicated. Even if poorer individuals have access to food stamps and other food benefits, they may not be able to access healthier foods.  “There is evidence of the association between sedentariness, poor health, obesity, diabetes, other metabolic diseases, and premature death.” Poorer counties in the U.S. tend to have the greatest rates of diabetes.[ix] 

Violence in poorer neighborhoods may prevent or discourage individuals from being active outdoors, and parks and sports facilities are less available.[x]Poorer people and some racial and ethnic groups tend to be more burdened with poorer air quality, a result of which can be premature death due to fine particle pollution.[xi] Economic insecurity itself can result in physical and mental stress.[xii]

Solutions to poverty are numerous but could include requiring the payment of a “fair” wage – not just a minimum wage, ensuring a more robust and well-funded safety net system including childcare, reining in the runaway rental rates in this state, and more.  As health professionals we have an obligation to support those and other solutions because poverty impacts the health and the very survival of too many Californians and others across this country.  SF Bay Area PSR promises to continue to do our part in raising awareness among our colleagues and communities about the need to solve this critical public health challenge that crosses our concerns about social and environmental justice.

[i] Alissa Anderson, California Budget Center, New Census Figures Show That Too Many Californians Are Struggling to Get By, Sept 2016,

[ii] Id.

[iii] Women’s Foundation, California Women’s Wellbeing Index,

[iv] Claire Conway, UCSF News Center, Poor Health: When Poverty Becomes Disease, January 6, 2016

[v] Id.

[vi] Id.

[vii] Id.

[viii] James A. Levine, Diabetes Journal, Poverty and Obesity in the U.S., American Diabetes Association, November 2011

[ix] Id.

[x] Id.

[xii] Sy Mukherjee, Four Ways that Poverty Hurts Americans’ Long Term Health, July 30, 2013