The Relationship between Poverty and Health Care Services in the USA

The right to good health is among the universal rights provided for under the United Nations Universal Declaration of Human Rights of 1948. It would, therefore, be correct to assume that the USA, being one of the global champions of basic human rights has provided good health for all its citizens (Squires & Anderson, 2015). Unfortunately, the assumption above, although sound, is not true as good health in America is directly proportional to financial and social status. Most Americans, approximately 85% of them live above the poverty line (Dickman, Himmelstein & Woolhandler, 2017). A good cross-section of those who live above the poverty line are within the two middle classes and the upper class, thus enjoy relatively good health. However, the remaining 15% happen to be almost 50 million people and have to endure poor health due to a variety of factors. Poor people have poor nutrition due to lack of variety of food choices (Batsis et al., 2017). They also have a higher propensity to pick jobs that are dangerous for them, including joining the military, if only to break the cycle of poverty (Adler et al., 2016) . Poor people lack a basic education which limits their understanding on how to protect their health, for example through avoidance of adverse behaviors (Persoskie, Hennessy & Nelson, 2017) . While poor people, faced with the above vagaries need better healthcare services, their access to health care is extremely limited. 

Unless poor people qualify for government insurance, they may not be able to afford premiums for available programs (Sommers et al., 2016). Being un-insured limits their treatment options exponentially. Further, available insurance for poor people is limited in the scope of available services. They will thus not afford proper treatment amenities and are likely to suffer more when sick (Sommers et al., 2016). Further, poor people are less likely to have a functional and effective relationship with health professionals, whom they only meet when they cannot avoid it any longer. Contact between the poor and professionals is also limited since the medical institutions, which they attend have a higher patient to professional ratio. Poor people are likely to get sick more often, but will normally avoid seeking medical services until it is inevitable. In such cases, they might not get clinical care or may only access diminished quality. This adversely affect their health specifically due to their pecuniary and social status. 

Why the Topic is Germane 

An interlocutor may wonder why it is necessary to canvass the subject of poverty and health care, specifically with regard to one of the greatest economies in the history of the world, the USA. On the one hand, the USA is home to the most advanced healthcare system in almost all perspectives including the training of professionals, advancements in research, oversight systems, pharmacological advancements, and healthcare institutions (Squires & Anderson, 2015). Many nations of the world bring their sick to America for specialized treatment, and their professionals for training in world-class institutions such as the Harvard Medical School in Boston, Massachusetts. Similarly, Americans are among the richest people in the world with the USA topping global lists in terms of millionaires and most profitable and valuable corporations in the world. It must, however, be noted that America is also a capitalist society where every citizen is expected to live according to the limits of their pecuniary capabilities (Squires & Anderson, 2015). Pecuniary limits determine what food one eats, their level of education, the nature of housing and neighborhood one lives in, vocation and most importantly, access to healthcare services. Most Americans are rich enough to handle this but about tens of millions are not (Dickman, Himmelstein, & Woolhandler, 2017). The important thing is that the minority amounts to about 50 million people. To put it in perspective, out of the hundreds of countries in the world, less than 30 have over 50 million people. 

Higher Propensity for Illness among the Poor 

The Nutritional Perspective 

The approximately 50 million people who fall within the scope of poor in the US have a higher propensity for needing healthcare services for reasons that can directly be attributed to their financial status. For a start, poor people have poor nutrition, a fact that increases their propensity for a variety of communicable and non-communicable diseases (Johnson, 2018). In most developing countries, the image of poor people embodies thin children, manifesting evidence of malnutrition and lean adults with small muscular bodies as evidence of hard labor (Mariapun, Ng & Hairi, 2018). Conversely, in the USA, thin children with lean muscular parents is often a sign of affluent and well-educated families. The poor will mainly comprise of obese children with equally obese or overweight parents, due to the kind of nutritional choices available to the poor in America (Batsis et al., 2017). Healthy foods, full of fruits, vegetables, white meats, and minerals are expensive in America while fatty, meaty and greasy foods are cheap. Poor families have to choose between eating well and eating at all, hence ends up eating poor quality foods to the detriment of their health (Johnson, 2018). Poor nutrition leads to poor immunity thus increasing propensity for communicable diseases such as the flu. Fatty and high-calorie foods also encourage obesity and an increased likelihood of suffering non-communicable diseases such as diabetes and cardiovascular disorders (Mariapun, Ng & Hairi, 2018). 

The Academic Perspective 

Poor people will stand in need of more health care services because they are less likely to have a good education, a precursor for more responsible behavior (Persoskie, Hennessy & Nelson, 2017) . Poor people in America have less access to education due to the high cost of education and the environments that they grow up in, which encourage gang-related activities, crime, and teenage pregnancies (Kneebone & Nadeau, 2015). According to available research, among the benefits of a good education is the ability to make good choices in life (Li & Powdthavee, 2015). Good choices are closely related with good outcomes from the perspective of healthcare. For example, a person who has completed formal education to a college level is less likely to engage in risky behavior such as promiscuity, which creates exposure to HIV, Hepatitis B, and related diseases (Zimmerman, Woolf & Haley, 2015). The risk for such behavior reduces with higher education such as a post-graduate education. Similarly, a good education reduces the propensity for other injurious conduct such as smoking cigarettes, abusing narcotics and prescription drugs, abusing alcohol, fighting, and many others. A person who avoids such behavior will be less likely to fall ill and be in need of clinical attention, an advantage that is denied to poor people, due to their limited access to education (Zimmerman, Woolf & Haley, 2015). 

The Environmental Perspective 

Poor people are more likely to live in more hazardous neighborhoods than rich people, a fact that increases their propensity for poor health. An overwhelming majority of Americans today live in urban centers as opposed to the situation a century ago. Urban centers were designed in a manner that the poor would live in the inner cities in crowded neighborhoods while the affluent would live in suburbs away from the crowded city centers (Kneebone & Nadeau, 2015). The situation has not changed much in the modern times. Poor people still find themselves living near factories, highways, and waterways in crowded and often polluted neighborhoods which increases the propensity for poor health. For example, available research shows that living near a highway increases the propensity for children suffering from a variety of non-communicable diseases (Erickson et al., 2017). This also applies to living near factories, mines, or crowded areas. The places where poor people live increases their chances of suffering from diseases. 

Poor Herd Immunity 

The combination of lack of money, a lack of proper education, and poor living conditions interfere with the preventative health concept of herd immunity, thus increasing the susceptibility for illness among the poor. Among the hallmarks of herd immunity is the vaccination of every member of the community. If a few members of a highly interactive community are not vaccinated against common communicable diseases, the entire community will be at risk from the diseases (Mallory & Lindesmith, 2018). Many poor people live in informal neighborhoods where close interaction between children is very common at play, in daycare centers, and in other settings. Further, due to lack of proper education and sensitization, children of the poor are less likely to be fully vaccinated than those of the affluent. The combination of the above increases tendency for sickness among the poor. 

The Professional and Vocational Perspective 

Due to the cycle of poverty for those in the lower echelons of the social stratum, there are limited vocational choices, which increases the chances of doing dangerous jobs. It can be argued that all jobs provide a potential health risk physically or mentally but some jobs are riskier than others (Adler et al., 2016) . For example, a white collar job in an office is less risky than working in a factory complex that deals in molten metals. The rich have a better chance for getting a better education and a choice on which vocations or professions to pursue. Availability of choice is inversely proportional to level of poverty hence poor people will take the job they get, instead of the job they want. For example, the poor are more likely to work in polluted environments, work with dangerous equipment, and be exposed to other risky professional activities (Adler et al., 2016) . The poor are also more likely to select dangerous or even illegal endeavors such as prostitution and drug peddling thus increasing the propensity for injury or disease. 

Stress and Poor Mental Health 

The combination of living in poverty and the physiological vagaries it presents, increases the chances of poor Americans having mental health problems (Adler et al., 2016) . Being brought up in a poor neighborhood exposes children to vagaries such as physical and sexual abuse, substance abuse, and domestic violence. All the above may leave an indelible mark in the minds of the children throughout their lives. Being a poor parent also creates a feeling of helplessness, anxiety, and stress (Nau, Dwyer & Hodson, 2015). Further, being unwell and unable to afford medical bills for the self or loved ones is depressing. Many poor people who lack proper healthcare insurance live in perpetual fear of what would happen if they or their loved ones get injured or suffer a major ailment. The combination of the factors above increases the propensity for poor people having mental health problems. 

Diminished Access to Healthcare Access among the Poor 

Cost of Modern Healthcare 

The laws, rules, and regulations that have made the US healthcare system the best in the world have also made it arguably one of the most expensive. Americans, for example, can only use drugs that have been developed by American companies under the close superintendence of the Food and Drug Administration. Developing a drug until it is ready for the American market takes years and millions of dollars, resulting in generally very expensive medication in the USA market (Dickman, Himmelstein, & Woolhandler, 2017). Some of the drugs in the American market have equally effective generic counterparts in the international market that go for as little as 10% of the cost. Similarly, the US trains some of the best doctors in the world, with the training programs for full certification spreading out for almost a decade of specialized study and practical programs. The same rigorous training and certification requirement applies to nurses, including the highly trained Advanced Practice Nurses. American hospitals are also among the best equipped in the world in terms of diagnosis, intranet, and advanced care. All the above requirements have been put in place to ensure that Americans get the best possible healthcare services. However, the high quality comes with a very high cost to the detriment of the poor (Dickman, Himmelstein, & Woolhandler, 2017). 

Lack of Medical Insurance and Money 

The high cost of healthcare services is met with the diminished pecuniary capacity of the poor, who neither can afford clinical services directly nor health insurance. The lower strata of the US social systems can be divided into two groups, which are critical when it comes to healthcare. The first is the working poor, which are individuals who have an income through employment, but their income is not sufficient for their day to day needs (Kneebone & Nadeau, 2015). This includes scenarios like minimum wage single parents with children or homes with a good income but with special economic needs such as too many dependents. The working poor is entitled to some government-sponsored insurance covers, such as Medicare as expanded by the Patient Protection and Affordable Care Act of 2010. It is important to state that Medicare is not sufficient to cover all the healthcare needs of the working poor and the extension of Obamacare is limited to only a few states (Dickman, Himmelstein & Woolhandler, 2017). 

The second classification of the lower social stratum is the underclass, which denotes people with no income at all and may thus be unable to access any medical services or healthcare insurance. The underclass includes people of a working age who may not be able to work at all due to reasons such as poor mental or physical health (Kneebone & Nadeau, 2015). It also includes people who are too old to work yet lack a pension, or too young to work and have no guardians to meet their pecuniary needs. Some members of the underclass such as military veterans, the very old, and very young may qualify for government programs such as Medicaid. However, Medicaid may not cover all medical needs and it also does not cover all the underclass (Grabowski et al., 2017). There are thus Americans in the underclass who neither have any money for their healthcare needs nor have any form of healthcare coverage. Such people might and often die, even when faced with treatable diseases. 

Not Seeking Help for Curable Diseases 

Among the fundamental prerequisites of good health lies in the ability to regularly seek professional medical attention, seek medical attention as early as possible, and finally get the best medical attention possible. Because of pecuniary reasons, all the above are not available for the poor. Most poor will not regularly consult a doctor as they do not have money for consultation or to pay transport services (Dickman, Himmelstein, & Woolhandler, 2017). Similarly, many of the poor will avoid seeking medical attention at the advent of symptoms of an ailment in the hope that it will go away without having to spend too much money on it. Instead of seeking medical attention, the poor will focus on the relatively cheaper, off the counter medication to treat symptoms. It is also common for the poor to seek available medication from friends and relatives or use old prescription medication that had been left over from previous treatments. Many of the poor in America fear medical expenses more than they fear the ailments themselves. According to Folley (2018), a woman in Massachusetts who got injured in a public place shouted for people not to call an ambulance instead of shouting for help because she was afraid of the cost of the ambulance. The fact that poor people avoid seeking treatment because they are afraid of the cost increases their propensity for poor overall health. 

Not seeking help for Curable Diseases 

The fear of seeking medical services results in the poor not seeking clinical services at the earliest, to the detriment of their overall health and even lives. Within the last century, technology in healthcare has advanced exponentially with most diseases and ailments being either manageable or treatable as long as they are diagnosed on time (Young et al., 2015). For professionals to be able to handle these diseases and ailments effectively, it is important for a patient to be attended to at the advent of symptoms. As indicated above, most poor will try to avoid going to the hospital at all costs due to the fear of costs. Others will be aware of the diseases that ail them but still be in denial and refuse to seek medical attention, hoping that the problem will go away (Young et al., 2015). For example, a single mother with children to feed may fall and suspect a fracture but refuse to go to the hospital in the fear that hospitalization will lead to her losing the children to the system. The fears create delays which exacerbate health issues that would have been solved easily, leading to poorer health and preventable deaths among the poor. 

Medical Tourism 

The fear of the high cost of medical care in American hospitals and the lack of proper health insurance has also resulted in the concept of medical tourism (Lunt, Horsfall & Hanefeld, 2016). According to available research and commentary, medical expenses are the leading cause of bankruptcy in America (Squires & Anderson, 2015). Advancement in healthcare technology in the modern world has ensured that people can live longer, better lives, even when faced with life-threatening injuries or ailments such as cancer or HIV. However, these people with chronic conditions will require expensive treatment and medication that most cannot afford, at least in the USA. In many cases, people with chronic or terminal conditions prefer to sell all their possession and make one-way trips to countries where health services are cheaper such as India, South Africa, and South America (Lunt, Horsfall & Hanefeld, 2016). Similarly, some insurance companies have come up with health tourism packages where those who are in need of acute care and expensive procedures are transported to China, India, Africa or South America to get their treatment, then returned if they get better. Travelling while unwell is also expensive and dangerous (Braverman, 2016). The irony of medical tourism lies in the fact that most of the professionals, equipment, and medication from these countries cannot be allowed to be used in the USA due to safety reasons, yet the poor go to seek them for economic reasons. A good number of those who travel for medical tourism never make it back alive. 

Poor Quality of Health Services 

Getting Token Healthcare Due to Inability to Afford Better 

When the poor finally find the courage to head to an American hospital, or when they collapse and are taken to hospital against their will, they will still not get the right medical services due to their pecuniary needs (Norman, 2018). US law on health care institution management is explicitly clear that every patient who is wheeled into a medical facility in need of emergency care must be handled irrespective of their financial or insurance status. What the same law does to specify is how the hospitals who take care of such patients will recover the cost of such emergency treatment. Further, the law is ambiguous about what amounts to emergency treatment and, therefore, the bare minimum that a hospital should do for uninsured patients with no money. The poor who are wheeled to most hospitals will sometimes get stuck in triage as the administration and professionals try to decide what to do as the patient is not insured (Ahmed et al., 2015). In many cases, an ethical dilemma will arise for professionals such as doctors and nurses who, based on their professional oaths would love to do whatever it takes to treat their patients, but are limited by intuitional rules. In some cases, even a diagnosis alone can cost a hospital tens of thousands of dollars (Terje, 2016). An accident patient, for example, may need repeated magnetic resonance imaging (MRI) scans to confirm or rule out the nature of injuries suffered and determine the way forward. At the same time, any activity undertaken on a patient in the hospital creates risks for future liabilities for negligence. Few hospital administrators want to assume risk by taking care of patients who might never be able to pay their medical bills. Some hospitals have even been reported to do the minimum necessary to stabilize poor patients, then abandon them in the nearest community hospitals or bus stops (Norman, 2018). Some patients who may have recovered, die or suffer life-long damage simply because they were too poor to afford proper treatment. 

Poor Relationship with Health Service Providers 

Modern healthcare is relational in nature, a concept that has inter alia led to the advent of personal physicians. Most people have an active relationship with at least one healthcare professional who monitors their holistic or specific wellbeing. A child, for example, will have a pediatrician and dentist, seen regularly to ensure good health (Chung et al., 2016). Women, on the other hand, will have a gynecologist with regular visits for reproductive health purposes. These relationships ensure an understanding between the patient and the professional and also an ability for the professional to get ahead of any condition in good time, leading to easier treatment with a higher propensity for success. The fact that most of the poor cannot afford to visit the hospital when they are sick implies that they cannot have regular check-ups (Chung et al., 2016). They thus lack a close relationship between themselves and healthcare professionals to the detriment of their holistic health. The poor will, when unwell visit community hospitals where professionals are overworked and have higher ratios of professionals to patients. The overload compromises the ability to create a healthy relationship with the professionals thus the poor patients do not get their health monitored regularly. 

Inability to Afford Further Treatment 

The initial encounter with healthcare professionals as defined above is, to most patients only a start of the long journey towards recovery. The long journey is ridden with clinical and allied expenses, to the disadvantage of the poor. Even in the unlikely event that a poor patient gets the best possible clinical care at the advent of a disease, injury or ailment, what happens after is critical to the health of the patient. The patient will inter alia need pharmacological intervention, sometimes for extended periods, and in some cases even for life (Kangovi et al., 2014). For example, a person who gets an organ transplant may need to take expensive immunosuppressant medications to prevent organ rejection. Similarly, patients with HIV, diabetes, and cardiovascular disorders may need to take medication for the rest of their lives in order to control the respective conditions. Being able to afford such medication is beyond the scope of the poor. 

Some of the insured poor will also see the scopes of their covers lapse while they still need health care services. Most medication will also need to be accompanied by good nutrition (Kangovi et al., 2014). As indicated earlier, good food in America is expensive hence most poor people cannot afford it. Some ailments will also require ambulatory care including expensive equipment to be used at home. Expensive forms of transport such as ambulances may also be necessary for regularly scheduled hospital visits, which are also expensive in themselves. A chronic ailment has the ability to impoverish most financially secure Americans while for the poor, it completely ruins their lives and those of their loved ones, before resulting in an early, painful, and desperate death, in some cases through suicide (Kangovi et al., 2014). 

Conclusion 

The only viable conclusion that can be drawn from the above is that the poor in America, who amount to about 50 million people are an island of probable poor health, in a sea of the abundance of good health. It is perhaps the same reasons that make most Americans so healthy that cause poor Americans to suffer from poor health. The healthcare system in America is among the best in the world, with the best-trained professionals, the best medicines, and the most advanced equipment. The superior quality comes at an exponentially high cost that the poor cannot afford. Indeed, it is only the cream of the American social stratum that can afford proper health care without any health insurance covers. Unfortunately, the poor are in many cases too poor to even afford insurance premiums for a health cover. The available welfare based health covers such as Medicare and Medicaid are not available to all the poor and are also limited in their scope. This makes proper healthcare services beyond the pecuniary purview of poor Americans. These poor Americans who cannot afford proper healthcare also happen to need it more than richer Americans. As outlined above, the foods that the poor eat, the jobs available to them, where they live and their behavioral tendencies all increase their propensity for health-related problems. The combination of a greater need for healthcare services and the inability to afford it has resulted in an overall poor health for the American poor. 

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