There is a wealth of evidence to suggest that health is correlated to individuals’ socioeconomic status and lifestyle.
The relationship between socio-economic status and health has Been corroborated by several studies conducted across the world. All studies have confirmed a profound impact of socio-economic status on health; however, the mechanism behind this correlation has been a matter of debate.
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What is poverty?
Individuals, families, and communities within a population can be said to be living in poverty when they lack resources to obtain the type of diet, participate in lifestyle activities, and have the living conditions and resources which are customary to the majority of the society in which these individuals, families, and groups belong.
In the UK, receiving income-related welfare benefits has been used as a measure of poverty. This can be job seekers allowance, housing benefits, council tax benefits, or working tax credit and child tax credit.
Objective and subjective measures of material deprivation have also been used as poverty measures; these can include celebrations, clothes appropriate for all weather, the ability to go on holiday, and access to a car.
Poverty in the context of other health-affecting factors
In 2000, the 2013 to 2020 World Health Organisation (WHO) Global Action Plan for the Prevention And Control of Noncommunicable Diseases had targeted seven risk factors.
These include use of alcohol, insufficient physical activity, tobacco use, increased blood pressure, elevated salt or sodium intake, diabetes, and obesity. These are referred to as the 25 x 25 risk factors; through targeting these risk factors, the WHO hoped to reduce early death from non-communicable diseases by 25% by the year 2025.
The Global Burden Of Disease Collaboration, which is the largest study with monitoring health changes globally, has similarly found risk factors that are associated with the burden of disease and injury across 21 world regions.
Among them, poor socio-economic circumstances are one of the strongest predictors of morbidity and premature mortality across the world; However, poverty is not considered to be a modifiable risk factor across both of these important global health strategies.
According to a paper published in The Lancet and coordinated by Imperial College London, socioeconomic status has been found to produce the same impact on health as smoking or a sedentary lifestyle, being associated with a reduced life expectancy of 2.1 years, a figure comparable to being inactive (which is estimated to cause a reduction in life expectancy of 2.4 years).
Socio-economic status refers to the measure of an individual's or family’s economic and social position relative to others in a population. This is assessed on income, education, and occupation. Despite these factors being known to affect health already independently, early studies have not compared the impact of low socioeconomic status with other major risk factors on health. Indeed global health policies do not consider risk factors such as poverty and poor education when predicting health outcomes.
In the study, 1.7 million people across the United Kingdom, Switzerland, Portugal, Italy, The United States, and Australia were surveyed. They compared individuals' socioeconomic status against several risk factors, including tobacco use, unhealthy diet, physical inactivity, and alcohol abuse, as defined by the WHO. Overall, researchers determined that those of low socioeconomic status were 46% more likely to die early compared to wealthier counterparts.
The greatest risk factors as estimated by the number of years lost in expected life were compared to a range of other factors. The factors that contributed to the greatest number of years lost were smoking and diabetes, reducing life expectancy by 4.8 and 3.9 years, respectively. High blood pressure, obesity, and high alcohol consumption were associated with fewer years lost; 1.6, 0.7, and 0.5 years respectively.
The results of this study demonstrated that low socio-economic status should be targeted alongside the conventional health risk factors as part of global and National Health strategies to minimize the risk of premature mortality.
What are the effects of poverty?
Poverty can impact people's health at all stages of life in several ways and impacts overall life expectancy. In England, for example, between 2009 and 2013, the life expectancy for those in the most deprived areas compared to the least deprived areas was 7.9 years greater for men and 5.9 years greater for women.
Moreover, the Kings' Fund found that between 1999 and 2010, the majority of areas in England that showed low life expectancy also showed high proportions of people earning minimal or no wages.
The psychological consequences of poverty
Poverty in childhood
Poverty can impact children before birth. A survey by the Royal College of Pediatrics and Child Health and the Child Poverty Action Group demonstrated that 2/3 of doctors showed that poverty in low-income areas was a significant contributor to the ill-health of children that they worked with.
On average, babies born in the most deprived areas in the UK weigh 200 g less than those born in more affluent areas, which may subsequently impact cognitive development.
Babies living in poverty are also more likely to die within the first year of birth and were more likely to be bottle-fed. Seventy-three percent of women in the most deprived areas were shown to initiate breastfeeding compared to 89% of women in the least deprived areas.
Children born into poverty are also more likely to suffer from chronic diseases such as asthma as well as diet-related problems such as tooth decay, malnutrition, diabetes, and obesity. A 2016 report by NHS digital found that children living in the most deprived areas of England are more than twice as likely to become obese compared to those living in the least deprived areas. By the age of 11, 26% of children living in the most deprived areas were obese compared with 11.7% in less deprived areas.
Alongside physical health, children living in low-income households are more than three times more likely to suffer from mental health issues compared to wealthier peers. Increased levels of child poverty have demonstrated direct negative effects on emotional, social, cognitive, and developmental outcomes.
As a result, poverty continues to have long-term implications on individuals' health as well as exacerbating this effect due to limited life chances. Those growing up in poverty are subsequently more likely to suffer poor mental and physical health into adulthood, risking life-limiting, severe, long-term illnesses.
Longitudinal studies have shown that children in poverty have a subsequent increased risk of death as adults. This includes all-cause mortality, including the risk of death from various cancers, cardiovascular diseases, and alcohol-related deaths.
Poverty and adult life
The prevalence of long-term conditions is greater in adults from lower socio-economic backgrounds. These conditions include diabetes, chronic obstructive pulmonary disease, arthritis, and hypertension. In England, for example, 40% of adults between the ages of 45 to 64 living with below-average income have long-term illnesses. This is double the rate of adults of the same age with above-average incomes.
The Mental Health Foundation has also found that 3/4 of people living in the lowest household income bracket have reported experience of poor mental health, compared to six in ten of those in the highest household income bracket. Moreover, poverty, unemployment, and social exclusion are correlated with increased incidents of schizophrenia, and rates of admission to specialist psychiatric care.
Overall, there is a strong need for systematic evidence-based interventions and policies to reduce health inequalities. a strategy that embeds lifestyle interventions in public health policies is one of several ways to improve the overall health of the population, particularly those in the most deprived areas living in poverty.