Getty Images/iStockphoto

County Struggles with Income Affect Social Determinants of Health

Income and wages are key social determinants of health issues for counties across the country, stunting the nation’s efforts to recover from COVID-19.

Income is a leading social determinant of health impacting wellness, but a living wage is far out-of-reach in nearly every county in the United States, according to the 2022 County Health Rankings.

Lack of living wage, plus gender-based income disparities and limited educational opportunity, are poised to stunt the health recovery necessary as the US faces an endemic COVID-19. The past two years have had disastrous health consequences, the report authors said, with COVID-19 sparking a historic decrease in life expectancy and increase in death rates.

Concurrently, people across the country struggled financially. Pandemic-era shutdowns shook many economic sectors, skyrocketing the unemployment rate. Meanwhile, virtual learning pushed many people—mostly women—from the workforce in order to fill childcare gaps.

That economic instability is going to stunt the nation’s efforts to restore health and wellness, as income serves as a key social determinant of health that impacts other SDOH.

“The data reinforces what we’ve known for some time. People in both rural and urban communities face avoidable and systematic barriers to living long, healthy lives,” Sheri Johnson, co-director of County Health Rankings & Roadmaps and director of the University of Wisconsin Population Health Institute, stated publicly.

“The struggle for economic security is shared across many communities, and evidence-informed solutions that address past harms, increase economic security and promote health for everyone can be implemented.”

Lack of living wage impacts health, lifestyle

Currently, most people in the US are not making a living wage, which the researchers defined as $35.80 an hour for a household with one adult and two children. In some counties, wages need to make a 73 percent jump for people to be making a living wage; in others, the requisite increase would be 229 percent, the researchers said.

Income is an uphill battle for women and women of color, in particular. The report noted that women make about 80 cents on the dollar compared with men, and for a White woman to make a living wage comparable to her White male colleagues, she’d need to work an extra 103 days. For Asian women, it’d be an extra month, while Black women would need to work an extra 223 days, American Indian/Alaska Native women an extra 266 days, and Hispanic women an extra 299 days.

These gaps in livable wages are tricking down to the entire household. Childcare costs, for example, are extraordinary and out of reach for many. For a family with two kids, parents would need to earmark a third of their income for childcare. And for those making what the authors said is the federal minimum wage of $7.25, childcare costs could add up to nearly 90 percent of income.

Few families go that route, instead keeping a parent at home to take care of young kids, the researchers pointed out. Income or employment then becomes a self-fulfilling prophecy of limited opportunity for health and recovery.

Even when kids reach school age, county income and finances are stifling opportunity. Half of the counties included in the report are operating under a deficit, with the average district posting per-student spending around $3,000 below the estimated amount necessary to support average test scores.

This was true in urban and rural areas, although the rural counties were overrepresented among those with inadequate school funding.

There were key racial disparities at play, as counties with larger Black, Hispanic, and AI/AN populations saw lower per-student spending and operating deficits. This is likely the result of racial discrimination and systemic injustice, the researchers posited.

Again, poor school funding is a self-fulfilling prophecy, as kids get inadequate education that hampers efforts to then obtain high-earning jobs. This can cause multigenerational SDOH problems and stunt national recovery.

Income has impact on health

Ample research has indicated the impact that income has on overall health. Individuals with low incomes are less likely to access preventive care or screenings due to cost. Medication adherence, too, can take a major hit due to cost and income.

Moreover, income has a direct impact on other key social determinants of health. As noted above, educational attainment can suffer in tandem with income. Low-income people might also have more limited access to other social services, increasing the prevalence of food or housing insecurity or transportation issues.

Those challenges are amplified as the nation looks toward pandemic recovery—a recovery that won’t just include physical symptoms, but recovery from multiple issues related to social justice.

“As we look to recover, we have opportunities to imagine what is possible and rebuild in ways that work for everyone,” the report authors wrote. “We can create fair economic systems and address past harms to ensure that we are a nation where we all thrive.”

The report authors recommended policy changes that could support income, which they noted will have a ripple effect on other SDOH and healthcare issues. Policy changes may include baby bonds, community development and financial institutions, housing reparations, reparations for descendants of enslaved people, and universal basic income.

“Working together, we can transform public goods such as affordable and accessible childcare, quality public schools, and jobs that treat people with the dignity they deserve and the wages that will support their families,” Marjory Givens, co-director of the County Health Rankings & Roadmaps, stated in a press release. “This would not only ensure a just recovery from the pandemic for families and communities today but greater economic security, better health and well-being for generations to come.”

Next Steps

Dig Deeper on Patient responsibility

xtelligent Health IT and EHR