Poverty and Integrative Health Care

Just after I submitted my last blog article on hospice care, I read an article in the Nation exposing how difficult it is for poor uninsured Americans to obtain this end-of-life care, and I was distressed to have overlooked this significant point¹. Lack of hospice can be added to the list of public health indicators that describe the health disparities between the poor and the general population of people here and all over the world. In poverty, lifespan is shorter, infant and maternal mortality are higher, and chronic diseases such as diabetes, cardiovascular disorders, and obesity are much more common. In fact, poverty is the greatest predictor of poor health, and “Poverty Makes You Sick,” is a fitting motto of the worldwide charity Partners In Health². Since sickness can also make you poor (which I will discuss below), poverty and poor health often create a disastrous vicious cycle that is difficult to halt.

Medical research confirms that childhood poverty may result in long-term health consequences. A recent forty year follow-up study of overweight adolescents demonstrated higher cardiovascular and all-cause mortality in adulthood; since obesity is more common with lower socioeconomic status, this may partially explain the lower lifespan experienced by the poor.³ In my residency training at Bellevue Hospital, which has been providing care for the poor of New York City since 1736, I saw that pregnant patients who grew up in poverty were at higher risk for obstetrical complications. Mental as well as physical health is impacted when a new mom is unsure of when her next meal will be, or if she will soon be homeless. Perri Klass, MD, a pediatrician at Bellevue, recently wrote an enlightening article for the New England Journal of Medicine, entitled “Saving Tiny Tim- Pediatrics and Childhood Poverty in the United States,” in which she illustrates how shelter-insecurity may impact health:

"I saw a toddler who was seriously overweight, and I tried to talk with his mother about ending the practice of night-time milk bottles. The mother became very distressed when I broached the subject of the child’s weight…. if she didn't give her son a milk bottle, he would cry—loudly and at length—and his crying at night disturbed the other people sharing the apartment, who all had to get up early for work or school. She was clearly worried that following my advice might mean losing her living situation, which was already tenuous. The toddler in my room was already suffering from some of the chronic diseases- obesity, dental caries- that are part of the medical risk of poverty. That child was growing up in circumstances of insecurity and uncertainty about his housing situation, clearly putting his mother under great stress, which in turn had ramifications for the emotional dynamic between mother and child…”⁴

The effect of poverty on health is easy to observe at homeless shelters. I am privileged to know fellow Body and Brain Yoga member, Riquelma Moreno, MSW, who expertly administrates 7 family shelters in Brooklyn and Bronx, New York. During my visits and workshops at one of the shelters, many clients used canes, crutches, walkers, and wheelchairs. In Riquelma’s estimation, 85% of her clients are in shelter due to ramifications of poor health, or because they have a child with a serious health issue and the parents’ time is consumed by the child’s medical care. The most common illnesses she sees in the adult population are obesity, diabetes, joint disease, heart disease, asthma, emphysema, strokes, lung cancer, and mental illness—especially depression, bipolar disorder, and schizophrenia.  Children often suffer from asthma, obesity, and autism. Chronic illnesses are often worsened by substance abuse disorders.

Food-insecurity remains an underlying cause of illness in the poor of America. Both insufficient quantities of food (affecting 1 in 5 children) and poor food quality lead to poor health⁵. Because wholesome fresh produce and unprocessed foods are hard to obtain in many poor neighborhoods, unhealthy diets that lead to obesity and diabetes are common. Generations of Americans have grown up on food of low nutritive value, and it is all that many know. At the 350 occupant Starbright Family Residence in Brooklyn, Riquelma and her clients planted a vegetable garden, which may be a first for a homeless shelter, and it is bringing education, happiness, and even a new Earth Citizens Club.



On a larger scale, activist groups such as the Union of Concerned Scientists are working for a national food policy that will improve access to healthful food for all Americans and promote food education as an integral part of school curriculums⁶.

The chronic illnesses so common in the poor are difficult to control with conventional Western medicine alone.  Although millions rely on pharmaceuticals to lower blood sugar, cholesterol, and blood pressure, and surgeries to open blocked blood vessels and treat obesity, our high-tech approaches alone cannot adequately or sustainably counteract the increasing frequency and consequences of chronic illness; thus today’s children are expected to have shorter lifespans on average than their parents.  Integrative health care, which includes natural complementary therapies, mind-body practices, and lifestyle changes, is proving in many studies to be our answer. 

At Starbright, Riquelma teaches Body and Brain Yoga and Tai Chi regularly; the clients enjoy the classes immensely, and benefit both physically and mentally. They journal about their feelings before and after each class, documenting improvements in motivation and self-advocacy. Half of clients taking yoga have been successfully moved into permanent housing so far, which is a much higher proportion than usual, and a measure of the program’s success.

We can all do our part to improve the health of the poor on our planet, by taking action to bring changes that encourage healthier lifestyles and natural healing. These changes include affordable housing, walkable, safe, and toxin-free neighborhoods, a fair minimum wage, access to healthful food from green sustainable agriculture, food education in schools and family programs, compassionate care for the disabled, and extending mind-body programs, such as that created by Riquelma at Starbright, to underprivileged populations.



References
1. https://www.thenation.com/article/the-devastating-process-of-dying-in-america-without-insurance/
2. http://www.pih.org/pages/poverty-makes-you-sick
3. http://www.nejm.org/doi/full/10.1056/NEJMoa1503840
4. http://www.nejm.org/doi/full/10.1056/NEJMp1603516#t=article
5. http://www.feedingamerica.org/hunger-in-america/impact-of-hunger/hunger-and-poverty/hunger-and-poverty-fact-sheet.html
6. http://www.ucsusa.org/our-work/food-agriculture/solutions/expand-healthy-food-access/why-we-need-national-food-policy#.V4vDD6vbmPk