Poor, Sick, And Addicted: Inequality’s Effect On Population Health


March 31, 2017   Jacob Levenson

Published in Huffington Post, March 31, 2017. View the Article Here

The 2016 Presidential campaign, among many other issues, propelled debates about the cost and effectiveness of healthcare policies in the United States to the forefront of the national conscience. Healthcare has been in headlines everywhere since then, especially in the recent contentious debate over reforming or replacing the Affordable Care Act. The arguments, criticisms, and proposed improvements and solutions are wide and varied. The question of how to fix a system that repeatedly under-delivers on outcomes has yet to be definitively answered.

However, nearly everyone agrees that healthcare must be made affordable and effective, especially for those with low income or limited access to treatment options. What people may be less aware of is the significant impact economic inequality within populations can have on health outcomes.

US Healthcare Lags Behind Other Countries

Economic inequality is a reality in the US. This is especially apparent in low-income households where individuals must work more physically demanding jobs. Because of the physical demands of their work, they’re more likely to retire early but at the same time are unable to collect Social Security until the age of 66.

This disparity can lead to higher levels of income insecurity in retired seniors, an age group that’s more susceptible to injury and health problems. This gap in income, limited access to healthcare options, and an increased demand in healthcare needs creates a challenging puzzle for payers and providers to solve.

The healthcare system in the United States, which spends almost 50% more on healthcare than the next highest-income country, has some of the worst outcomes compared to any other developed nation.

Income Inequality and Social Cohesion

The World Bank reported that in 2012, in an examination of cross-national comparisons of income inequality and population health, people had a lower sense of personal well-being in nations where the top 1% holds a greater share of national income. Chronic stress, fear, and insecurity are all at a greater risk of appearing in countries with poor income inequality, which can lead to an increase in individuals developing behavioral and social disorders like schizophrenia.

This disparity has a direct effect on the the opportunity for those in the lower income percentiles to benefit from social mobility. The Brookings Institute has evidence that boys in the lower and middle income distribution have a disproportionately high rate of dropping out of school than those of the same age in higher income percentiles. They found a 4.1% higher dropout rate for boys living in high inequality locations. In examining the explanations for those links there is evidence that educational, poverty, demographics, along with additional factors in those high income inequality locations have “economic despair” - the sense that they could flourish economically from their perceived returns in their investment own educational development.

In the United States, we’ve seen states with a smaller gap in income distribution have a higher level of life expectancy across the board. This gap varies widely from state to state due to a variety of circumstances, so focusing solely on narrowing the income distribution gap could be construed as shortsighted, in the pursuit of improving outcomes. However, the socioeconomic effects income inequality has on behavioral health at large makes it an issue we must consider.

Income Inequality and Addiction

One area where income has little effect on illness is in substance use disorders and addiction. In a study published by the National Library of Medicine found that drug and alcohol use increase in higher income groups. One explanation for this is stress-inducing activities across the board, regardless of income, have the same addiction causing effects like anxiety and depression.

In some cases, the wealthier an individual is the more likely they are to engage in addictive behavior. For instance, young adults in the highest income, highest wealth, and highest parental education groups were more likely to be drinkers, but heavy drinking is still higher among low income populations.

Moving Beyond Inequality Toward Improving Outcomes

Income inequality in the United States is a complicated and dense issue without a comprehensive solution in sight. At MAP Health Management, we stay focused on improving outcomes in behavioral health. Tackling those issues is enough of a task to undertake. However, we still believe that it’s important to look at all aspects of a problem in order to move toward the most effective solution. After all, isn’t that what data is for?

We know that addiction is a chronic brain disease influenced by or attributed to certain social, environmental, and genetic factors. Through the rapidly evolving technology landscape and improved methods of data collection, we’re finally able to analyze entire populations of individuals with substance use disorders.

By engaging in long-term, chronic care models of treatment with a focus on value-based care we know long-term recovery is possible. Effectively shifting behavioral healthcare providers and payers toward a chronic treatment model, for a chronic disease, is one way we are able to do our part in improving healthcare outcomes, and hopefully reduce the more harmful effects inequality can have on patients.


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