Poverty is making our neighbors sick.
It is the Finger Lakes region’s number one health concern, and it drives health inequities that undermine wellness and cut lives short more than any other single cause of illness, more than cancer or diabetes or opioid overdose. It also costs the region more than $1 billion annually.
That’s a hard pill to swallow, said Common Ground Health CEO Wade Norwood, as his agency prepares for the release of “Overloaded: The Heavy Toll of Poverty on Our Region’s Health,” a project that has been three years in the making.
The full, 45-page report will be released during a media event Nov. 18 at the University Avenue offices of Common Ground Health, Rochester’s nonprofit community health planning organization. The report also will be available online that day.
“What we particularly are interested in helping people understand is the nature of health inequity in the Finger Lakes is such that it is not just urban folks that live in the heart of Rochester, that when we look at the picture of health outcomes we see health inequity spread across the entire region—urban, suburban and rural,” Norwood said.
Although poverty is more concentrated in urban and rural communities and among blacks and Latinos, the report states, roughly one third of people below the poverty line live in suburbs and the majority of those in poverty, some 55 percent, are white.
“We see the dimension of inequity across class,” Norwood said. “Poverty is at the heart of our most pressing health issue.”
In fact, when the more than 6,850 people who responded to the report’s survey were asked what their biggest health concern was, individuals who live in households with incomes under $25,000 a year said it was financial issues.
“Many areas within the Finger Lakes have the same level of poverty as areas in the city of Rochester,” said Diane Devlin, public health director for Wayne County Department of Public Health. “Health and human services, when available, are inaccessible when one has inadequate transportation. Rural areas lack comprehensive public transportation, thus making accessing any needed services difficult, to say the least.”
Urban areas have a lot of competing resources to offer those in need. Rural areas do not have that luxury, resources are scarce and pooled together to meet the need and many times it is not enough.
“Overloaded” began as an in-depth survey in 2017, Norwood explained, one that was designed to capture data that was new in the community. Common Ground Health partnered extensively with the health departments in each of the nine Finger Lakes counties and others to administer the survey and then interpret the responses.
The report found that:
- Residents of areas with a 30 percent or higher rate of poverty die eight years earlier than residents in areas with poverty rates below 5 percent;
- Diabetes is 154 percent more likely among those with incomes under $20,000 per year;
- In the Finger Lakes region, more than half of adults over the age of 35 with household incomes under $25,000 per year suffer from hypertension, a 38 percent higher prevalence than found among the high-income population; and
- The rate of asthma-driven emergency department visits by those living in areas with the highest rates of health-related housing violations was nearly nine times the rate in suburbs.
Without the experience of living paycheck to paycheck, it is hard to understand how people living in poverty can make the choice to either pay the rent or buy groceries or take a sick child to the doctor. When a large portion of a family’s income is spent on rent, less money remains for nutritious food, medical care, prescriptions and other health-related needs, the report notes.
“We know that persons who have access to wealth and opportunity are able to do more that will allow for them to live a healthier lifestyle, but one of the things that is important to note is that poor health is also the result of being impoverished, as it relates to increased stress, trauma and the things that are induced as a result of poverty,” said Leonard Brock, executive director of the Rochester-Monroe Anti-Poverty Initiative, or RMAPI, the convener of the region’s largest poverty reduction efforts.
The stress of worrying about housing has real impacts on physical and mental health, according to the report. Among Finger Lakes residents who identified as being “always stressed” about their rent or mortgage payment, 22 percent reported having poor physical or mental health, more than three times the rate of the residents who were less or not worried about housing costs.
“Folks in the Finger Lakes region, although we can be proud that 84 percent of us report that our mental and emotional health is good, very good or excellent, that leaves 16 percent of folks in our region saying their emotional and mental health is fair or poor,” Norwood said. “And that number doubles when we just look at those who are living in poverty. When we look at those in households under $25,000 a year who live in an unsafe neighborhood, that self-report of fair and poor mental and emotional health becomes 50 percent.”
And when those individuals talk about mental health, they talk about feelings of helplessness, anger and destructive behavior, Norwood added.
“Folks in poverty, when it comes to their health self-management, it’s not that they’re irresponsible, it’s not that they’re dumb, it’s not that they have a different set of things that they value or believe,” Norwood said. “It’s the fact that making it through the end of the day when you have too much month and not enough money is a hard thing to do.”
“Overloaded” suggests that moving forward will require a collaborative effort in the community “to untangle the web of structural barriers to wellness” and eliminate the influence poverty has on health outcomes in the region.
A number of coalitions and initiatives have sprung up in recent years to address both poverty and health. In the last decade, Rochester has seen a reduction in lead poisoning and high blood pressure as a result of collaborative efforts, and in 2015, RMAPI was founded to address the region’s high poverty rate.
“As we’re looking to improve or raise wages or increase income, by default and by design that’s going to have health related outcomes that are going to lead to positive changes,” Brock said of RMAPI’s guiding principles and how they relate to health. “The very fact that we’re working on two strategies—workforce development and basic needs—both of those strategies remove barriers to people who are impacted by poverty so they’re not ‘overloaded.’”
The issues addressed in “Overloaded” can only be overcome by community intervention, Norwood said.
“These issues do not exist in isolation,” the report states. “To truly achieve equity for all people living in our community, we cannot pretend that poverty has no impact on health. We can also no longer ignore that health impacts a person’s ability to move beyond poverty.”
Norwood said one important takeaway from the Common Ground Health report is the mental health aspect of living in poverty.
“This is data that’s letting us know what’s going on with the grownups,” he said. “If this is what’s going on with the grownups, we need to ask the question, how are the children?”