Living In Poor Conditions

[Pernilla Gendron]

Worldwidea child under the age of 15 dies every five seconds, mostly of preventable causes that poverty exacerbates. And though impoverished living conditions are often perceived as confined to cities, the poverty rates in rural areas continue to exceed those in urban areas in several countries, including Romania, Indonesia and the U.S.

In many regions of the world, the number of low-income households far exceeds the affordable housing units available. In the U.S., for every 100 renter households classified as extremely low-income, just 35 rental units are both available and affordable. Globally, the housing affordability gap, meaning the difference between income available for housing and the market price of a standard housing unit in a region, amounts to nearly $650 billion per year.

Nowhere in the U.S. can a worker earning the federal or prevailing state minimum wage rent a two-bedroom apartment without having to pay more than 30% of their income. In fact, a minimum wage worker must clock nearly 127 hours per week, more than three full-time jobs, to afford a two-bedroom rental, or 103 hours per week, more than 2.5 full-time jobs, to afford a one-bedroom, according to the National Low Income Housing Coalition.

But a safe, decent, affordable place to live can make a real difference in the life of a family. Homeownership has long been the primary way for families to build wealth. Homeownership also offers stability because monthly mortgage payments are predictable whereas rents can increase year over year. A stable home is important for academic achievement. Children who change schools as their families move in search of more affordable housing can struggle to keep up academically.

Habitat for Humanity proves that decent housing can be a path out of poverty for families in need of a hand-up, and every day, you help us partner with families in the U.S. and nearly 70 other countries to create stable homes and vibrant neighborhoods.

Together, we have helped millions of people build or improve the place they call home. With your help, we also advocate to improve access to decent and affordable shelter and offer a variety of housing support services that enable families with limited means to make needed improvements on their homes as their time and resources allow.

Service members reported to GAO that the conditions of barracks affect their quality of life and readiness. However, GAO found weaknesses in the Department of Defense's (DOD) efforts to maintain and improve their conditions. For example,

By developing or clarifying guidance related to these weaknesses, DOD could better prioritize investments in barracks to improve living conditions for service members and help ensure that barracks housing programs across military services are consistently implemented and support quality of life and readiness.

The Joint Explanatory Statement and Senate Report 117-39, accompanying bills for the National Defense Authorization Act for Fiscal Year 2022, included provisions for GAO to review DOD's efforts to maintain and improve military barracks. This report examines, among other things, the extent to which DOD has (1) reliably assessed barracks conditions, (2) made informed decisions on barracks funding, and (3) conducted oversight to improve barracks.

GAO analyzed DOD policies, budgets, and other documentation; interviewed DOD housing officials; toured barracks at a non-generalizable sample of 10 installations; and met with installation officials and barracks residents.

GAO is making 31 recommendations for DOD, including the military departments, to, among other things, provide guidance on barracks condition assessments, obtain complete funding information, and increase oversight of barracks programs. DOD concurred with 23 of the recommendations and partially concurred with 8, in some cases noting ongoing actions that would address them. GAO continues to believe DOD should fully implement all of these recommendations.

Poverty occurs when an individual or family lacks the resources to provide life necessities, such as food, clean water, shelter, and clothing. It also includes a lack of access to such resources as health care, education, and transportation.5 In the United States, federal poverty is expressed as an annual pre-tax income level indexed by the size of household and age of household members. For example, in 2020, the federal poverty income level was $12,760 for an individual younger than 65 years and $26,200 for a family of four.6 In 2019, approximately 10.5% of Americans were living below the poverty line. While overall poverty rates had been declining in the past several years, inequalities remain by SDoH, including race and racism, ethnicity, educational attainment, and disability status.7

Location matters, and there are often dramatic differences in health care delivery and health outcomes between communities that are only a few miles apart. For example, the Robert Wood Johnson Foundation (RWJF) found a 25-year difference in average life expectancy in New Orleans, LA, between inner city and suburban neighborhoods. Similarly, there is a 14-year difference in average life expectancy between two Kansas City, MO, neighborhoods that are roughly three miles apart.15

SDoH are the conditions under which people are born, grow, live, work, and age, and include factors such as socioeconomic status, education, employment, social support networks, and neighborhood characteristics.4 These social factors have a more significant collective impact on health and health outcomes than health behavior, health care, and the physical environment.17,18 SDoH, especially poverty, structural racism, and discrimination, are the primary drivers of health inequities.19,20

Because they intersect with so many SDoH, poverty and low-income status dramatically affects life expectancy.26 Education and its socioeconomic status correlate to income and wealth. These have powerful associations with life expectancy for both sexes and all races at all ages. Students from families with low income are five times more likely to drop out of high school than students from families with high income.27 In 2008, the life expectancy among U.S. adult men and women with fewer than 12 years of education was not much better than the life expectancy among all adults in the 1950s and 1960s.28

However, the effects of poverty are not predictably uniform. Longitudinal studies of health behavior describe positive (e.g., tobacco use cessation) and negative (e.g., decrease in physical activity) health behavior trends in populations with lower and higher socioeconomic status. However, there is a socioeconomic gradient in health improvement. In other words, populations with lower socioeconomic status lag behind populations with higher socioeconomic status in positive gains from health behavior trends. Health behaviors are important in that they account for differences in mortality.34 The fact that positive changes in health behaviors are possible despite the challenges of poverty points to the importance of developing and implementing interventions that promote healthy behaviors in populations with low income.

Thinking of poverty as a risk regulator rather than a rigid determinant of health allows family physicians to relinquish the feeling of helplessness when providing medical care to families and individuals with low income.

Strong primary care teams are critical in the care of patients with low income. These populations often have higher rates of chronic disease and difficulty navigating health care systems. They benefit from care coordination and team-based care that addresses medical and socioeconomic needs.

Care team members can positively affect the health of patients with low income by creating a welcoming, nonjudgmental environment that supports a long-standing therapeutic relationship built on trust. Familiarity with the National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care can prepare practices and institutions to provide care in a manner that promotes health equity.37

Patients with low socioeconomic status and other marginalized populations rarely respond well to dictation from health care professionals. Instead, interventions that rely on peer-to-peer storytelling or coaching are more effective in overcoming cognitive resistance to positive health behavior changes.38 Physicians and care team members can identify local groups that provide peer-to-peer support. Such activities are typically hosted by local hospitals, faith-based organizations, health departments, or senior centers.

Local hospitals, health departments, and faith-based organizations often are connected to community health resources that offer services such as installing safety equipment in homes; providing food resources; facilitating behavioral health evaluation and treatment; and providing transportation, vaccinations, and other benefits to individuals and families with low income.

Practices can make a resource folder of information about local community services that can be easily accessed when taking care of patients in need. This simple measure incorporates community resources into the everyday workflow of patient care, thus empowering the care team.

2. Commission on Social Determinants of Health. Closing the gap in a generation. Health equity through action on the social determinants of health. World Health Organization (WHO). Accessed March 22, 2021. www.who.int/social_determinants/final_report/csdh_finalreport_2008.pdf

17. Booske BC, Athens JK, Kindig DA, Park H, Remington PL. County health rankings working paper. Different perspectives for assigning weights to determinants of health. University of Wisconsin Population Health Institute. Accessed March 22, 2021. www.countyhealthrankings.org/sites/default/files/differentPerspectivesForAssigningWeightsToDeterminantsOfHealth.pdf

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