Poverty and population health - The need for A Paradigm shift to capture the working poor and better inform public health planning

Brian Witrick; Timothy S Dotson; Frank Annie; Wesley Kimble; Emily Kemper; Brian Hendricks

doi:10.1016/j.socscimed.2023.116249

Poverty and population health - The need for A Paradigm shift to capture the working poor and better inform public health planning

Soc Sci Med. 2023 Nov:336:116249. doi: 10.1016/j.socscimed.2023.116249. Epub 2023 Sep 20.

Authors

Brian Witrick¹, Timothy S Dotson², Frank Annie³, Wesley Kimble², Emily Kemper², Brian Hendricks⁴

Affiliations

¹ West Virginia Clinical and Translational Science Institute, PO Box 9102, Morgantown WV 26506, USA. Electronic address: brian.witrick@hsc.wvu.edu.
² West Virginia Clinical and Translational Science Institute, PO Box 9102, Morgantown WV 26506, USA.
³ West Virginia Clinical and Translational Science Institute, PO Box 9102, Morgantown WV 26506, USA; Charleston Area Medical Center, PO Box 1547 Charleston WV 25301, USA.
⁴ West Virginia Clinical and Translational Science Institute, PO Box 9102, Morgantown WV 26506, USA; West Virginia University, Department of Epidemiology and Biostatistics, 64 Medical Center Dr, Morgantown WV 26506, USA.

Abstract

Background: Community-level socioeconomic disparities have a significant impact on an individual's health and overall well-being. However, current estimates for poverty threshold, which are often used to assess community-level socioeconomic status, do not account for cost-of-living differences or geography variability. The goals of this study were to compare geographic county-level overlap and gaps in access to care for households within poverty and working poor designations.

Methods: Data were obtained for 21 continental United States (US) states from the United Way's Asset Limited, Income Constrained, Employed (ALICE) households for 2021. Raw data contained the percentage of households at the federal poverty level, the percentage of households at the ALICE designations (working poor), and the total households at the county level. Local Moran's I tests for spatial autocorrelation were performed to identify the clustering of poverty and ALICE households. These clusters were overlaid with a 30-min drive time from critical access hospitals' physical addresses.

Findings: County-level clusters of ALICE (working poor) households occurred in different areas than the clustering of poverty households. Of particular interest, the extent to which the 30-min drive time to critical care overlapped with clusters of ALICE or poverty changed depending on the state. Overall, clustering in ALICE and poverty overlapped with 30-min drive times to critical care between 46 and 90% of the time. However, the specific states where disparities in access to care were prominent differed between analyses focused on households in poverty versus the working poor.

Interpretations: Findings highlight a disparity in equitable inclusion of individuals across the spectrum of socioeconomic status. Furthermore, they suggest that current public health programming and benefits which support low socioeconomic populations may be missing a vulnerable sub-population of working families. Future studies are needed to better understand how to address the health disparities facing individuals who are above the poverty threshold but still struggle economically to meet based needs.

Keywords: ALICE; Asset limited; Employed; Health disparities; Income constrained; Socioeconomic status; Working poor.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Health Planning
Humans
Population Health*
Poverty
Public Health
Socioeconomic Factors
United States
Working Poor*

Abstract

Publication types

MeSH terms

Grants and funding