Volume 12, Number 2
To assert that poverty is bad for health is certainly not a new concept. It has long been known that there is a socioeconomic status (SES) gradient when it comes to health. The poor have poorer health, for a number of reasons.
For context, in the United States in 2014, the poverty threshold was an income of $12,071 for one person, or $24,230 for a family of four. For the US population, 14.8% (nearly 47 million people) were at or below this threshold, but for children under the age of 18 the rate was 21.2%.
One of the most troubling aspects of poverty for young children is that it impacts cognitive function. By kindergarten, poor children are already found to have an achievement deficit. And the longer exposure to poverty continues, the wider the achievement gap between the poor and the not poor becomes. Perhaps even more troubling is that childhood poverty is related to deficits in working memory when these children reach young adulthood. Working memory, sometimes referred to as short-term memory, is required for reading, the comprehension of language, and various types of problem solving. Working memory sets the stage for information to be stored in long-term memory. It appears that the chronic stress associated with poverty impairs brain development.
Aside from the contribution of poverty-related stress on brain function, it has also been demonstrated that the cognitive demands of poverty interfere with the application of cognitive resources to other matters. Because cognitive capacity is limited under the best of circumstances, attention given to one set of problems reduces the availability of resources to address other matters. Poverty functions like a cognitive tax, because the necessity for the poor to attend to a multitude of financial matters impairs their ability to attend to other things. In a study published in Science in 2014, experimentally evoking financial concerns among poor research participants affected cognition to a degree comparable to losing a full night’s sleep. If this is put on an IQ scale, the impact is similar to losing 13 IQ points.
How does the cognitive tax of poverty affect health? First of all, poverty is already associated with poorer health for a number of reasons… the negative physical and mental health effects of chronic stress, unhealthy housing and/or hazardous environmental exposures, and less access to health care, among others. With respect to health behavior, persons who are well off financially know how difficult it can be to make health behavior changes, including the cognitive demands of monitoring behavior, maintaining awareness of cues for healthy or unhealthy behaviors, and exercising willpower. Health behavior change is that much more difficult for persons who must devote cognitive resources to the financial challenges of meeting their basic needs. On average, the poor are found to have less healthy behavior in a number of spheres.
Of course, there are marked differences of opinions about how matters of poverty and income inequality should be addressed. Whatever one’s perspective, however, it is clear that economic and financial matters have profound health implications, so that initiatives to reduce poverty, especially for young children, can appropriately be also understood as health promotion.
Paul J. Hershberger, Ph.D.
… is a clinical health psychologist. He is Professor of Family Medicine and Director of Behavioral Science for the Family Medicine Residency Program, Wright State University Boonshoft School of Medicine. His clinical practice includes psychotherapy, consultation, and coaching.
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