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Poverty and race both impact the health outcome of a person.<ref name=":53">{{Cite book |last=Ventura |first=Stephanie J. |url=https://www.worldcat.org/oclc/1015648361 |title=Selected vital and health statistics in poverty and nonpoverty areas in 19 large cities : United States, 1969-71 |date=1975 |others=Ernell Spratley, Selma Taffel, National Center for Health Statistics |isbn=0-8406-0049-6 |location=Rockville, Md. |oclc=1015648361}}</ref> Of the residents in poverty-areas, well over half are [[Person of color|people of color]].<ref name=":53" /> When compared to White Americans, all other races are have lower outcomes of infant mortality, low birth weight, prenatal care, and deaths in cities.<ref name=":53" /> People of Color have an 80% higher mortality rate than White people, and this includes deaths from [[cancer]], accidents/[[homicide]]s, and disease.<ref name=":33"/> Those in severe poverty are more likely to be [[African Americans|Black Americans]] and [[Latinx]].<ref name=":62" /> More than one-fourth of the [[Native Americans in the United States|Native American]] and [[Alaska Natives|Alaska Native]] population lives in poverty.<ref name=":72">{{Cite journal |last=Sarche |first=Michelle |last2=Spicer |first2=Paul |date=2008-07-25 |title=Poverty and Health Disparities for American Indian and Alaska Native Children: Current Knowledge and Future Prospects |url=http://doi.wiley.com/10.1196/annals.1425.017 |journal=Annals of the New York Academy of Sciences |language=en |volume=1136 |issue=1 |pages=126–136 |doi=10.1196/annals.1425.017 |pmc=2567901 |pmid=18579879}}</ref> When adjusted for age, the death rate of Native Americans and Alaska Natives is 40% higher than the general population, and 39% of the children are obese or overweight.<ref name=":72"/> Mental health is the number one problem in the Native American and Alaska Native population.<ref name=":72" /> For Black Americans, [[racial segregation]] in neighborhoods are barriers for equitable health opportunities.<ref name=":04" /> Most current neighborhoods that are predominantly Black have been institutionally disinvested and have fewer public services and more housing insecurity.<ref name=":04" /> With these barriers, many Black Americans do not have the wealth of a family home passed down through generations.<ref name=":04" /> Latinx and [[Asian Americans|Asians]] may also have trouble with home ownership due to cultural and linguistic isolation.<ref name=":04" />
Poverty and race both impact the health outcome of a person.<ref name=":53">{{Cite book |last=Ventura |first=Stephanie J. |url=https://www.worldcat.org/oclc/1015648361 |title=Selected vital and health statistics in poverty and nonpoverty areas in 19 large cities : United States, 1969-71 |date=1975 |others=Ernell Spratley, Selma Taffel, National Center for Health Statistics |isbn=0-8406-0049-6 |location=Rockville, Md. |oclc=1015648361}}</ref> Of the residents in poverty-areas, well over half are [[Person of color|people of color]].<ref name=":53" /> When compared to White Americans, all other races are have lower outcomes of infant mortality, low birth weight, prenatal care, and deaths in cities.<ref name=":53" /> People of Color have an 80% higher mortality rate than White people, and this includes deaths from [[cancer]], accidents/[[homicide]]s, and disease.<ref name=":33"/> Those in severe poverty are more likely to be [[African Americans|Black Americans]] and [[Latinx]].<ref name=":62" /> More than one-fourth of the [[Native Americans in the United States|Native American]] and [[Alaska Natives|Alaska Native]] population lives in poverty.<ref name=":72">{{Cite journal |last=Sarche |first=Michelle |last2=Spicer |first2=Paul |date=2008-07-25 |title=Poverty and Health Disparities for American Indian and Alaska Native Children: Current Knowledge and Future Prospects |url=http://doi.wiley.com/10.1196/annals.1425.017 |journal=Annals of the New York Academy of Sciences |language=en |volume=1136 |issue=1 |pages=126–136 |doi=10.1196/annals.1425.017 |pmc=2567901 |pmid=18579879}}</ref> When adjusted for age, the death rate of Native Americans and Alaska Natives is 40% higher than the general population, and 39% of the children are obese or overweight.<ref name=":72"/> Mental health is the number one problem in the Native American and Alaska Native population.<ref name=":72" /> For Black Americans, [[racial segregation]] in neighborhoods are barriers for equitable health opportunities.<ref name=":04" /> Most current neighborhoods that are predominantly Black have been institutionally disinvested and have fewer public services and more housing insecurity.<ref name=":04" /> With these barriers, many Black Americans do not have the wealth of a family home passed down through generations.<ref name=":04" /> Latinx and [[Asian Americans|Asians]] may also have trouble with home ownership due to cultural and linguistic isolation.<ref name=":04" />


== Health care effects ==
== Health care policy ==
{{Main|Health care in the United States}}
{{Main|Health care in the United States}}
Between 1987 and 2005, the number of people without [[health insurance]] in the United States rose from just over 30 million, to 46.6 million.<ref name=":1">{{Cite book|url=https://books.google.com/books?id=3WKOxUjs2UoC&pg=PA1|title=Income, Poverty, and Health Insurance Coverage in the United States: 2005|last1=DeNavas-Walt|last2=Proctor|last3=Hill Lee|first1=Carmen|first2=Bernadette|first3=Cheryl|date=2005|website=Consumer Population Reports|isbn=9781437920154|access-date=17 November 2019}}</ref> Insurance tends to increase the price of services,<ref name=":8">{{Cite journal |last=Wagstaff |first=Adam |date=2022-09-01 |title=Poverty and Health Sector Inequalities |url=http://dx.doi.org/10.2471/blt.00.000922 |journal=Bulletin of the World Health Organization |volume=100 |issue=9 |doi=10.2471/blt.00.000922 |issn=0042-9686}}</ref> and at that time, 8.5% of people belonging to households that made over $75,000 annually were uninsured. For families earning $25,000 or less, that percentage rose to 24.4% uninsured.<ref name=":1" /> This figure exhibits how lack of access to care via health insurance disproportionately affects those in poverty.
Between 1987 and 2005, the number of people without [[health insurance]] in the United States rose from just over 30 million, to 46.6 million.<ref name=":1">{{Cite book|url=https://books.google.com/books?id=3WKOxUjs2UoC&pg=PA1|title=Income, Poverty, and Health Insurance Coverage in the United States: 2005|last1=DeNavas-Walt|last2=Proctor|last3=Hill Lee|first1=Carmen|first2=Bernadette|first3=Cheryl|date=2005|website=Consumer Population Reports|isbn=9781437920154|access-date=17 November 2019}}</ref> Insurance tends to increase the price of services,<ref name=":8">{{Cite journal |last=Wagstaff |first=Adam |date=2022-09-01 |title=Poverty and Health Sector Inequalities |url=http://dx.doi.org/10.2471/blt.00.000922 |journal=Bulletin of the World Health Organization |volume=100 |issue=9 |doi=10.2471/blt.00.000922 |issn=0042-9686}}</ref> and at that time, 8.5% of people belonging to households that made over $75,000 annually were uninsured. For families earning $25,000 or less, that percentage rose to 24.4% uninsured.<ref name=":1" /> This figure exhibits how lack of access to care via health insurance disproportionately affects those in poverty.
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The [[medical-industrial complex]] also contributes to the difficulties of patients paying for medications and healthcare costs.<ref>Wohl, Stanley. ''The Medical Industrial Complex / Stanley Wohl.'' First edition. New York: Harmony Book, 1984: 100-234</ref>
The [[medical-industrial complex]] also contributes to the difficulties of patients paying for medications and healthcare costs.<ref>Wohl, Stanley. ''The Medical Industrial Complex / Stanley Wohl.'' First edition. New York: Harmony Book, 1984: 100-234</ref>

=== Policy Recommendations ===
One recommendation to address the inequity of healthcare for the poor is to take community-based action.<ref name=":3">{{Cite journal |last=Patrick |first=Donald L. |last2=Stein |first2=Jane |last3=Porta |first3=Miquel |last4=Porter |first4=Carol Q. |last5=Ricketts |first5=Thomas C. |date=1988 |title=Poverty, Health Services, and Health Status in Rural America |url=https://www.jstor.org/stable/3349987?origin=crossref |journal=The Milbank Quarterly |volume=66 |issue=1 |pages=105 |doi=10.2307/3349987}}</ref><ref name=":11">{{Cite journal |last=Erwin |first=Paul Campbell |date=September 2008 |title=Poverty in America: How Public Health Practice Can Make a Difference |journal=American Journal of Public Health |volume=98 |issue=9 |pages=1570-2}}</ref> One example of this is county health councils in [[Tennessee]]. These are volunteer groups from the community who assess health inequities within their county and decide what policies to implement.<ref name=":11" /> Another idea is to implement community-oriented primary care where physicians consider the environment and culture of the patient to further their health.<ref name=":3" /> To improve housing, [[weatherization]] programs are recommended to refurbish poor housing to be more health friendly.<ref name=":102">{{Cite journal |last=Tonn |first=Bruce |last2=Hawkins |first2=Beth |last3=Rose |first3=Erin |last4=Marincic |first4=Michaela |date=2021-03 |title=Income, housing and health: Poverty in the United States through the prism of residential energy efficiency programs |url=https://linkinghub.elsevier.com/retrieve/pii/S2214629621000384 |journal=Energy Research & Social Science |language=en |volume=73 |pages=101945 |doi=10.1016/j.erss.2021.101945}}</ref>


== References ==
== References ==

Revision as of 15:36, 4 April 2023

U.S. Poverty Trends

Poverty and health are intertwined in the United States.[1] As of 2019, 10.5% of Americans were considered in poverty, according to the U.S. Government's official poverty measure. People who are beneath and at the poverty line have different health risks than citizens above it, as well as different health outcomes. The impoverished population grapples with a plethora of challenges in physical health, mental health, and access to healthcare. These challenges are often due to the population's geographic location and negative environmental effects. Examining the divergences in health between the impoverished and their non-impoverished counterparts provides insight into the living conditions of those who live in poverty.

Environment and Health

The environment of people in poverty impacts their health in many aspects.[2] High poverty areas experience problems associated with poor air quality, water pollution, hazardous and toxic waste, and noise pollution.[2][3] Poor air quality results in higher rates of children with asthma living in these areas, and nearly 2 million children with asthma live in areas that do not meet national ozone standards.[3] These children are also exposed to greater amounts of allergens that trigger their asthma.[2] Water pollution is also present impoverished cities due which results in unsanitary practices due to poor water supply and sanitation.[4] Impoverished communities are prone to be in proximity to hazardous waste facilities which result in toxic waste dumping, chemical runoff, and water pollution within the area.[3] Because many residents of low-income areas are desperate, they tend to not protest against incoming hazardous facilities.[3] Therefore, these facilities tend to seek out these communities to build in, and this results in more health costs for those in the area.[3] Low-income populations are also more exposed to pesticides, and a significantly higher amount of lead was found in African-American children living in inner-city areas.[2] Neglected Tropical Diseases (NTDs) are also more prevalent in areas of high poverty such as the South and inner-city areas though they often get overlooked by physicians for other diseases.[5]

Climate change also affects the health of those living in low-income communities. Climate change can result in a greater frequency of bad allergy days which results in weakened immune systems and increase asthma cases within the community.[6] From air pollution, respiratory and cardiovascular diseases can worsen due to the greater amounts of chemicals in the atmosphere and hotter temperatures.[6] The warmer temperatures also result in warmer surface water bodies which are better environments for tropical diseases to take root and spread.[6] Climate change also results in higher frequency of storms, hurricanes, and floods which can result in greater damage to infrastructure resulting in more financial stress for people in low-income communities.[6]

Spatial

Main article: Spatial inequality

Health outcomes of those in poverty can also be determined by spatial, or geographic, location which is another aspect of the environment. Opportunities for healthcare, goods and services like food, and community are all based on geography.[7] Childhood/early adulthood settings highly influence behavior, education, and careers.[7] Those who are financially unstable can usually only find homes that are lower-priced in neighborhoods that are not invested in and are not managed well.[2] These homes are often lower quality, and the costs are higher than what can be managed.[2] Residents in a high-poverty neighborhood reports poor health 1.63 times more than a person in a low-poverty neighborhood, even when controlling for factors like education, marital status, and labor force status.[7] For those living in rural areas, health services are not as accessible, and impoverished people go to doctors fewer times than their counterparts.[1] The effect of spatial location is seen in both phyiscal and mental health.

Poverty and physical health

Poverty can affect health outcomes throughout a person's entire life. The affect may not always be expressed while an individual is impoverished. Mothers who are in poverty during their pregnancies may experience more health risks during their delivery, and their newborn may experience more health risks and markedly more behavioral problems during their development.[8] Furthermore, children in poverty have worse health outcomes during adulthood. This effect is especially pronounced for specific ailments, such as heart disease and diabetes. The impact persists even if a youth escapes poverty by adulthood, suggesting that the stress of poverty encountered during childhood or adolescence has a lasting effect.[9] Previous research has identified the labor environments of the impoverished as more likely to contain risk factors for illness and disability relative to their non-impoverished counterparts.[10] The implication is that the unique stresses of life within an impoverished community contribute to poorer health outcomes, even if the resident does not engage in any specific behavior detrimental to their health.[11] Early into the COVID-19 pandemic in North America, being impoverished was associated with an increased likelihood of contracting COVID-19, as well as dying from it.[12]

Poor housing results in many health problems. Accidents, respiratory disease, and lead poisoning can be caused by poorly built housing.[2] There can also be a lack of safe drinking water, pests, and dampness in the house, and gonorrhea is associated with deteriorating houses.[2] Mothers who live in poverty areas have lower rates of prenatal care and higher rates of infant mortality and low birth weight.[13] Tuberculosis rates are also higher in high-poverty areas.[13] Obesity is associated with poverty due to lack of infrastructure that supports a healthy lifestyle.[14] Often, poverty-areas do not have places to walk or get healthy food nearby, and they are bombarded with unhealthy promotions like cigarettes, alcohol, and fast food.[14] High-poverty areas also had higher death rates than low-poverty areas.[15][16]

Cost of housing is a huge detriment to physical health. Housing is what the poor pay the most for on a regular basis, and this results in lack of funds for other basic needs like food and health.[2][14][17] Around 10% of American families did not receive needed medical care because of cost.[18] Food insecurity also increases due to being unable to buy food due to cost.[19]

Poverty and mental health

Poverty also has a complex relationship with mental health. Being in poverty may itself provoke a condition of elevated emotional stress, known as "poverty distress".[20]  Poverty is also a precursor or risk factor for mental illness, particularly mood disorders, such as depression and anxiety. Schizophrenia is also strongly associated with poverty, occurring most frequently in the poorest classes of people all over the world, especially in more unequal countries.[21]  In a sort of reciprocating relationship, having mental illness is a major risk factor for being in poverty.  Having a mental illness may inhibit a person's ability to work or deter employees from hiring them.

A hypothesis known as "drift hypothesis", posits that for people with psychiatric disorders (primarily schizophrenia), they tend to fall further down the socio-economic ladder as their condition reduces their functionality.  This hypothesis is an effort to establish that people with profoundly limiting psychiatric symptoms are more likely to descend economically, not that the financially challenged are more likely to present severe psychiatric disorders. People experiencing less severe symptoms are less likely to be affected by "drift".[20]  

Receiving treatment has shown positive effects for those struggling with mental illness and poverty.

With those in poverty having greater likelihood of suffering from mental illness, the benefit of access to clinical psychotherapy treatments has been explored. Despite numerous barriers for access to care for low-income individuals, there is evidence that those who do receive care respond with significant improvements. This research supports policy measures for improved outreach and access-to-care measures designed to benefit those with low-incomes and mental health disorders.[22]

Mental health is affected by location as well. Noisy housing impacts reading in children and promotes psychological stress.[2] Many poor families move more often and are residentially instable. This results in children experiencing instability with relationships with peers.[2] They also experience more stressful life events which places strain on their mental state as the events cumulate.[2][6] As both parents and children try to cope, they may cut themselves off from social interactions and healthy development.[2]

Race and Health

Poverty and race both impact the health outcome of a person.[23] Of the residents in poverty-areas, well over half are people of color.[23] When compared to White Americans, all other races are have lower outcomes of infant mortality, low birth weight, prenatal care, and deaths in cities.[23] People of Color have an 80% higher mortality rate than White people, and this includes deaths from cancer, accidents/homicides, and disease.[1] Those in severe poverty are more likely to be Black Americans and Latinx.[14] More than one-fourth of the Native American and Alaska Native population lives in poverty.[24] When adjusted for age, the death rate of Native Americans and Alaska Natives is 40% higher than the general population, and 39% of the children are obese or overweight.[24] Mental health is the number one problem in the Native American and Alaska Native population.[24] For Black Americans, racial segregation in neighborhoods are barriers for equitable health opportunities.[2] Most current neighborhoods that are predominantly Black have been institutionally disinvested and have fewer public services and more housing insecurity.[2] With these barriers, many Black Americans do not have the wealth of a family home passed down through generations.[2] Latinx and Asians may also have trouble with home ownership due to cultural and linguistic isolation.[2]

Health care policy

Main article: Health care in the United States

Between 1987 and 2005, the number of people without health insurance in the United States rose from just over 30 million, to 46.6 million.[25] Insurance tends to increase the price of services,[26] and at that time, 8.5% of people belonging to households that made over $75,000 annually were uninsured. For families earning $25,000 or less, that percentage rose to 24.4% uninsured.[25] This figure exhibits how lack of access to care via health insurance disproportionately affects those in poverty.

Demonstrators rallying for healthcare reform

Despite the cost of healthcare being an obstacle for those with relatively low incomes, research suggests that insurance coverage will not dramatically change outcomes related to physical health.  Access to Medicaid for low-income adults aided in diagnosis of metabolic disease, saw a reduction in diagnosis of mental health disorders, and reduced incurrence of "catastrophic medical costs" by patients dramatically. While these positive effects were observed, outcomes for heart disease, diabetes, and other physical health characteristics were not meaningfully improved. It has been posited that one year, the duration of the study, is an insufficient length to fully observe the divergent health outcomes that would be characteristic of an experiment with a lengthier time-table.[27] Also, minorities have an excess amount of deaths due to diseases like cancer and cardiovascular disease compared to whites.[28]

The medical-industrial complex also contributes to the difficulties of patients paying for medications and healthcare costs.[29]

Policy Recommendations

One recommendation to address the inequity of healthcare for the poor is to take community-based action.[30][31] One example of this is county health councils in Tennessee. These are volunteer groups from the community who assess health inequities within their county and decide what policies to implement.[31] Another idea is to implement community-oriented primary care where physicians consider the environment and culture of the patient to further their health.[30] To improve housing, weatherization programs are recommended to refurbish poor housing to be more health friendly.[32]

References

  1. ^ a b c Patrick, Donald L.; Stein, Jane; Porta, Miquel; Porter, Carol Q.; Ricketts, Thomas C. (1988). "Poverty, Health Services, and Health Status in Rural America". The Milbank Quarterly. 66 (1): 105. doi:10.2307/3349987.
  2. ^ a b c d e f g h i j k l m n o p q Saegert, Susan; Evans, Gary W. (July 2003). "Poverty, Housing Niches, and Health in the United States: Poverty, Housing Niches, and Health". Journal of Social Issues. 59 (3): 569–589. doi:10.1111/1540-4560.00078.
  3. ^ a b c d e Fitzpatrick, Kevin (2010). Unhealthy Cities : Poverty, Race, and Place in America. Mark La Gory. Hoboken: Taylor & Francis. ISBN 978-0-203-84376-5. OCLC 798533280.
  4. ^ Wagstaff, Adam (2022-09-01). "Poverty and Health Sector Inequalities". Bulletin of the World Health Organization. 100 (9). doi:10.2471/blt.00.000922. ISSN 0042-9686.
  5. ^ "Project MUSE - Poverty and the Impact of COVID-19". muse.jhu.edu. Retrieved 2023-03-10.
  6. ^ a b c d e Tonn, Bruce; Hawkins, Beth; Rose, Erin; Marincic, Michaela (August 2021). "A futures perspective of health, climate change and poverty in the United States". Futures. 131: 102759. doi:10.1016/j.futures.2021.102759.
  7. ^ a b c Do, D. P.; Finch, B. K. (2008-07-15). "The Link between Neighborhood Poverty and Health: Context or Composition?". American Journal of Epidemiology. 168 (6): 611–619. doi:10.1093/aje/kwn182. ISSN 0002-9262. PMC 2584357. PMID 18687664.
  8. ^ Larson, Charles (October 2007). "Poverty during pregnancy: its effects on child health outcomes". Oxford Academic. Retrieved 17 November 2019.
  9. ^ Raphael, Dennis (May 2011). "Poverty in childhood and adverse health outcomes in adulthood". Maturitas. 69 (1): 22–6. doi:10.1016/j.maturitas.2011.02.011. PMID 21398059.
  10. ^ Murray, S. (2006-03-28). "Poverty and health". Canadian Medical Association Journal. 174 (7): 923. doi:10.1503/cmaj.060235. ISSN 0820-3946. PMC 1405857. PMID 16567753.
  11. ^ Haan, Mary; Kaplan, George; Camacho, Terry (June 1987). "Poverty and Health Prospective Evidence from the Alameda County Study". Oxford Academic. Retrieved 17 November 2019.
  12. ^ Finch, W. Holmes; Hernández Finch, Maria E. (2020). "Poverty and Covid-19: Rates of Incidence and Deaths in the United States During the First 10 Weeks of the Pandemic". Frontiers in Sociology. 5: 47. doi:10.3389/fsoc.2020.00047. ISSN 2297-7775. PMC 8022686. PMID 33869454.
  13. ^ a b Ventura, Stephanie J. (1975). Selected vital and health statistics in poverty and nonpoverty areas in 19 large cities : United States, 1969-71. Ernell Spratley, Selma Taffel, National Center for Health Statistics. Rockville, Md. ISBN 0-8406-0049-6. OCLC 1015648361.{{cite book}}: CS1 maint: location missing publisher (link)
  14. ^ a b c d Woolf, S; Johnson, R; Geiger, H (October 2006). "The Rising Prevalence of Severe Poverty in AmericaA Growing Threat to Public Health". American Journal of Preventive Medicine. 31 (4): 332–341.e2. doi:10.1016/j.amepre.2006.06.022.
  15. ^ Ventura, Stephanie J. (1975). Selected vital and health statistics in poverty and nonpoverty areas in 19 large cities : United States, 1969-71. Ernell Spratley, Selma Taffel, National Center for Health Statistics. Rockville, Md. ISBN 0-8406-0049-6. OCLC 1015648361.{{cite book}}: CS1 maint: location missing publisher (link)
  16. ^ Ram, Rati (2005-12-01). "Income inequality, poverty, and population health: Evidence from recent data for the United States". Social Science & Medicine. 61 (12): 2568–2576. doi:10.1016/j.socscimed.2005.04.038. ISSN 0277-9536.
  17. ^ Tonn, Bruce; Hawkins, Beth; Rose, Erin; Marincic, Michaela (March 2021). "Income, housing and health: Poverty in the United States through the prism of residential energy efficiency programs". Energy Research & Social Science. 73: 101945. doi:10.1016/j.erss.2021.101945.
  18. ^ Martinez, Michael E.; Clarke, Tainya C. (2020). "Percentage of Families That Did Not Get Needed Medical Care Because of Cost, by Poverty Status--National Health Interview Survey, United States, 2013 and 2018". Morbidity and Mortality Weekly Report. 69 (23): 727. ISSN 0149-2195.
  19. ^ Gundersen, Craig; Hake, Monica; Dewey, Adam; Engelhard, Emily (2021). "Food Insecurity during COVID-19". Applied Economic Perspectives and Policy. 43 (1): 153–161.
  20. ^ a b Kuruvilla, Jacob (November 2007). "Poverty, social stress & mental health". The Indian Journal of Medical Research. 126 (4): 273–8. PMID 18032802. Retrieved 17 November 2019.
  21. ^ Read, John (January 2010). "Can poverty drive you mad? 'Schizophrenia', socio-economic status and the case for primary prevention". Research Gate. Retrieved 17 November 2019.
  22. ^ Decarlo Santiago, Catherine (December 2012). "Poverty and Mental Health: How Do Low-Income Adults and Children Fare in Psychotherapy?". Journal of Clinical Psychology. 69 (2): 115–126. doi:10.1002/jclp.21951. PMID 23280880.
  23. ^ a b c Ventura, Stephanie J. (1975). Selected vital and health statistics in poverty and nonpoverty areas in 19 large cities : United States, 1969-71. Ernell Spratley, Selma Taffel, National Center for Health Statistics. Rockville, Md. ISBN 0-8406-0049-6. OCLC 1015648361.{{cite book}}: CS1 maint: location missing publisher (link)
  24. ^ a b c Sarche, Michelle; Spicer, Paul (2008-07-25). "Poverty and Health Disparities for American Indian and Alaska Native Children: Current Knowledge and Future Prospects". Annals of the New York Academy of Sciences. 1136 (1): 126–136. doi:10.1196/annals.1425.017. PMC 2567901. PMID 18579879.
  25. ^ a b DeNavas-Walt, Carmen; Proctor, Bernadette; Hill Lee, Cheryl (2005). Income, Poverty, and Health Insurance Coverage in the United States: 2005. ISBN 9781437920154. Retrieved 17 November 2019. {{cite book}}: |website= ignored (help)
  26. ^ Wagstaff, Adam (2022-09-01). "Poverty and Health Sector Inequalities". Bulletin of the World Health Organization. 100 (9). doi:10.2471/blt.00.000922. ISSN 0042-9686.
  27. ^ Baicker, Katherine; Taubman, Sarah; Allen, Heidi; Bernstein, Mira; Gruber, Jonathan; Newhouse, Joseph; Schneider, Eric; Wright, Bill; Zaslavsky, Alan; Finkelstein, Amy (May 2013). "The Oregon Experiment - Effects of Medicaid on Clinical Outcomes". New England Journal of Medicine. 368 (18): 1713–1722. doi:10.1056/NEJMsa1212321. PMC 3701298. PMID 23635051.
  28. ^ Patrick, Donald L.; Stein, Jane; Porta, Miquel; Porter, Carol Q.; Ricketts, Thomas C. (1988). "Poverty, Health Services, and Health Status in Rural America". The Milbank Quarterly. 66 (1): 105–136. doi:10.2307/3349987. ISSN 0887-378X. JSTOR 3349987. PMID 3262817.
  29. ^ Wohl, Stanley. The Medical Industrial Complex / Stanley Wohl. First edition. New York: Harmony Book, 1984: 100-234
  30. ^ a b Patrick, Donald L.; Stein, Jane; Porta, Miquel; Porter, Carol Q.; Ricketts, Thomas C. (1988). "Poverty, Health Services, and Health Status in Rural America". The Milbank Quarterly. 66 (1): 105. doi:10.2307/3349987.
  31. ^ a b Erwin, Paul Campbell (September 2008). "Poverty in America: How Public Health Practice Can Make a Difference". American Journal of Public Health. 98 (9): 1570–2.
  32. ^ Tonn, Bruce; Hawkins, Beth; Rose, Erin; Marincic, Michaela (2021-03). "Income, housing and health: Poverty in the United States through the prism of residential energy efficiency programs". Energy Research & Social Science. 73: 101945. doi:10.1016/j.erss.2021.101945. {{cite journal}}: Check date values in: |date= (help)
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