Poverty Is Literally Making People Sick Because They Can’t Afford Food

The Atlantic, Jan. 14, 2014

by Matthew O’Brien

Income inequality is making us sick.

Well, it’s not making all of us sick. Only the poorest of us. That’s what a new paper in Health Affairs by Hilary Seligman, Ann Bolger, David Guzman, Andrea López, and Kirsten Bibbins-Domingo found they looked at when people go to the hospital for hypoglycemia (low blood sugar).

The basic idea is that people struggling to make it paycheck-to-paycheck (or benefits-to-benefits) might run out of money at the end of the month — and have to cut back on food. If they have diabetes, this hunger could turn into an even more severe health problem: low blood sugar. So we should expect a surge of hypoglycemia cases at the end of each month for low-income people, but not for anybody else.

That’s what researchers found when they looked at the numbers for California between 2000 and 2008. As you can see in their chart below, low-income people (red line) were 27 percent more likely to be hospitalized for hypoglycemia in the last week of the month than in the first. There was no week-to-week difference for high-income people (orange line).

(Note: The researchers defined someone as “low income” if they were from a ZIP code where the average household income was in the bottom 10 percent of all patients. In dollar terms, this cut-off was $28,000 for 2000-04, $31,000 for 2005-06, and $29,000 for 2007-08).

Okay, but isn’t it possible that poorer people just tend to be less healthy in general? Sure. That’s why the researchers also looked at when people go the hospital for appendicitis, which doesn’t depend on diet. So there shouldn’t be any end-of-the-month increase for low-income people if tight budgets are the problem. There wasn’t. As you can see above, appendicitis cases were flat across the month for both high (blue) and low (purple) income people.

In other words, poorer people don’t need more care at the end of the month for every kind of condition. Just the ones that get worse when you don’t have enough to eat.

We can do better. We could start by paying out welfare, food stamps, and Social Security twice a month, instead of just at the beginning. We could even pay out food stamps as cash instead of benefits, since we know people will trade them at deep discounts to turn them into cash (or, in Appalachia, into quasi-cash like … soda). These might help people plan a little bit better, and stretch their cash a little bit further, though it wouldn’t help their fundamental problem: not having enough money. But, luckily, there’s an easy fix for that. It’s called giving people money. (And it really works!). That might mean something like increasing the EITC … if Republicans were willing to increase poverty spending. But they’re not. That’s why Democrats are talking about hiking the minimum wage instead — it wouldn’t cost the government a dime, but would still make a dent in poverty. Indeed, economist Arin Dube shows that while his colleagues can’t agree whether or how many jobs a minimum wage increase would cost, they do agree that it would boost incomes at the bottom.

That’s spending — or in the minimum wage’s case, regulation — that could help pay for itself. Think about it this way: Poverty begets poverty. So anything that stops some of this cycle of bad jobs, bad health, and broken homes could reduce spending on the rest. Or, as Adrianna McIntyre puts it, we can’t separate social policy and health policy for low-income households. Maybe giving poorer people more cold, hard cash would let them afford more food at the end of the month — and save the $1,186 that an average hypoglycemia episode costs.

That’s a cure we can afford.