Poor health: when poverty becomes disease
Talmadge King Jr., MD, dean of the UCSF School of Medicine, tells the story of an ER physician who had lost a document and was searching frantically for it in the garbage bins behind Zuckerberg San Francisco General Hospital and Trauma Center. What he found instead in the mountain of rubbish were crumpled prescription slips that patients had tossed in hospital trash cans throughout the week.
“Going forward, the conversations that ER doctor had with his patients changed. They became, ‘Well, you need these drugs. Which can you afford? How can I help?’ ” relates King. “Often it’s not that the patients aren’t adhering to advice. It’s that they can’t pay for the drugs, didn’t understand why they should take them, or simply that they did not feel the doctor even listened to them.”
Poverty collides with health every day at UCSF, compelling clinicians and scientists to engineer ways to disentangle the two, one complexity at a time. It’s the nurse trying to help a mom living in a single-room-occupancy hotel find refrigeration for her son’s antibiotic before an infection ruptures his second eardrum. Or the scientist gathering data on the toxic effects of stress on unborn children. Or the dentist trying to salvage the graying teeth in a toddler’s mouth – poverty’s most obvious portal.
Each is a temporary fix, merely scratching at the surface of what epidemiologists have long referred to as the “cause of causes” – poverty itself. This year marks the 50th anniversary of President Lyndon B. Johnson’s War on Poverty – part of his Great Society vision, which brought us such programs as Medicare, Medicaid and Head Start. Yet the income discrepancy between rich and poor has not been as wide as it is now since the late 1920s, an era Mark Twain termed the Gilded Age due to the abject poverty that existed beneath a thin veneer of great wealth. Today, from their front-row seats on the health effects of poverty, scientists and clinicians at UCSF are carefully documenting, and trying to blunt, poverty’s debilitating toll as it cycles through families, from one generation to another.
Mounting evidence
“Socioeconomic status is the most powerful predictor of disease, disorder, injury and mortality we have,” says Tom Boyce, MD, chief of UCSF’s Division of Developmental Medicine within the Department of Pediatrics. Socioeconomic status is a term that often includes measurements of income, education, and job prestige – individually or in combination. The predictive power of income alone is perhaps most obvious when considering life expectancy. Impoverished adults live seven to eight years less than those who have incomes four or more times the federal poverty level, which is $11,770 for a one-person household, whether you live in Silicon Valley, the Rust Belt or the rural South.
Discrepancies in life span grow significantly when race enters the equation. Paula Braveman, MD ’79, MPH, director of UCSF’s Center on Social Disparities in Health, points to a recent life-Poor health: when poverty becomes disease | University of California:
