No one should get sick because they’re poor. But they do, and the numbers linking poverty and chronic disease in the U.S. are frightening. The 2017 Poverty Guidelines published by the U.S. Department of Health and Human Services define poverty as earning at or below $24,600 a year for a family of four. That hardly leaves wiggle room to deal with expensive health issues.
Supporting a family of four on that amount (or less) would be hard enough, but people living in poverty are also more likely to experience depression, high blood pressure, asthma, and heart attacks. And risk for type 2 diabetes surges for those living in poverty.
Earning less than $15,000 a year doubles a person’s risk of developing type 2 diabetes, and people living in poverty are also more likely to suffer from the complications of diabetes. A 2011 study found that U.S. counties with the greatest diabetes rates were also the counties with the greatest poverty rates. Another study that examined the link between poverty and diabetes in Rhode Island found that the prevalence of diabetes was four times higher among those in its poorest income areas than in its highest—even when adjusted for education, body mass index, and physical activity levels. The diabetes rates rose as a neighborhood’s mean income fell.
But why? While the link between chronic disease and low-income is well-established, the reasons for that link are still being examined. But there are some correlations that are too strong to ignore.
Most every American worries about money at some point, but when someone is worrying about homelessness or choosing between paying rent or buying food, the stress reaches a new level.
Dennis Raphael, a professor of health management and policy at York University, notes that evidence suggests worrying about major needs such as employment and housing contributes to the onset of type 2 diabetes. High levels of chronic stress trigger the release of the hormone cortisol. While cortisol’s job is to help the body cope with stress, constantly having high levels of cortisol present lead to high blood sugar levels and high blood pressure, which are both contributing factors to type 2 diabetes. Professor Raphael notes, “Cortisol and other stuff literally messes up the ability of the body to use the insulin that’s available.” Over prolonged periods of time, the cortisol takes its toll.
Silvia Stringhini, of the University Hospital of Lausanne in Switzerland, led another study that found that people with low socioeconomic scores were twice as likely to develop type 2 diabetes, but the traditional reasons for the link (lack of physical activity, being overweight, and poor diet) only explained about half of the connection between poverty and the disease. She and her team surmised that the other half was related to chronic inflammation levels in the blood caused by the stress of living from paycheck to paycheck. Experts disagreed about whether or not inflammation was a direct cause of diabetes, or if it was only related. Still, the correlation is strong.
But the other link between poverty and type 2 diabetes is no longer up for debate.
Being overweight or obese is the best single indicator of type 2 diabetes risk. Why? Extra weight puts added pressure on the body’s ability to use insulin, and insulin resistance is more likely to develop. According to the Obesity Society, nearly 90% of those with type 2 diabetes are also overweight or obese.
But why is poverty linked to obesity? Isn’t that somewhat counterintuitive? Let’s first take a step back, way back, to take a look at obesity on a global scale.
Worldwide, high-income countries have higher rates of obesity than low-income countries, and obesity rates rise as a country’s wealth increases. That makes sense, and it also makes sense that since the United States is one of the richest countries in the world, it also has one of the highest obesity rates. And those rates are predicted to rise. On a global scale, wealth is clearly linked to wider waistlines. But if we zoom in on the U.S., we find there’s more to the story.
One-third of the U.S. population is classified as obese. But U.S. counties where greater than 35% of people live in poverty have obesity rates 145% higher than those in wealthy counties. The 10 poorest states in the U.S., by income, closely mirror those with the highest obesity rates.
So again there’s a connection, but why? Poverty leading to obesity, or vice versa, doesn’t seem to make sense. And certainly being born in an impoverished area in and of itself won’t make someone overweight, but is there a causal relationship?
There are no hard and fast answers, but there are several concerning links between poverty and risk factors for obesity.
Less physical activity
People living in poverty tend to lead more sedentary lifestyles. Poorer neighborhoods tend to have less access to safe parks, trails, and sports facilities. Violence is associated with less affluent neighborhoods, so it’s harder to walk or jog outside and feel safe. Gym memberships are harder to access because there is simply not enough disposable income to afford one.
Katie Taylor started writing in 5th grade and hasn't stopped since. Her favorite place to pen a phrase is in front of her fireplace with a cup of tea, but she's been known to write in parking lots on the backs of old receipts if necessary. She and her husband live cozily in the Pacific Northwest enjoying rainy days and Netflix.