I’m not a doctor, but I can tell you with certainty that the Finger Lakes region is ill.
We’ve seen the symptoms throughout our community: avoidable emergency visits, excess insurance billings, and unnecessarily high rates of chronic and often fatal diseases. We also see unequal health outcomes among people of different racial, ethnic and economic backgrounds.
Common Ground Health has explored the roots of these symptoms for more than two years through health data, personal stories and analysis of the more than 6,800 responses to our 2018 My Health Story survey.
The results point to an undeniable factor: widespread poverty. As we document in our new report “Overloaded: The Heavy Toll of Poverty on Our Region’s Health,” financial stress is to blame for much of the region’s preventable illness. It drives health inequities that cut lives short, create barriers to health self-management, and undermine wellness more than any other single cause, including all forms of cancer combined.
We’ve kept our conversations about poverty separate from our conversations about health, and that needs to change. We haven’t talked as a community about the way in which poverty deprives whole communities in our region of vigor and longevity. We haven’t discussed how poor health, both physical and mental, is an outsized contributor to poverty among our region’s residents.
Although poverty is more concentrated in urban and rural communities and among blacks and Latinos, the face of poverty in this region is not black or Latino or white, but all of the above. More than 175,000 people live at the lowest income levels in our nine-county area of the Finger Lakes region, which comprises Chemung, Livingston, Monroe, Ontario, Schuyler, Seneca, Steuben, Wayne and Yates counties. Roughly one-third of people below the poverty line reside in the suburbs and the majority of those in poverty, 55 percent, are white.
Across the region, those on the financial edge tell us that they struggle with their physical and emotional well-being every day. They are exposed to mold, lead and other toxins in substandard housing. They worry about how to make ends meet. It’s hard to be well when you are wondering how to pay for your next meal. It’s hard to manage a chronic disease when you are juggling three jobs, you can’t get transportation to your doctor’s office and you can’t find child care for the time when you would be gone.
People who live in high-poverty neighborhoods die an average of eight years earlier than those in low-poverty neighborhoods. They are 105 percent more likely to lose their teeth, 154 percent more likely to have diabetes and 224 percent more likely to be diagnosed with depression.
Survey respondents with incomes under $25,000 were more than three times as likely to report feelings of helplessness and more than four times as likely to experience significant anger as those with incomes of more than $75,000. Being poor is not just a matter of dollars and cents, it weighs down the heart and spirit.
Our survey found that when it comes to health self-management, individuals with the lowest incomes are not irresponsible, they are not misinformed, and they don’t have a different set of values. What they have is daily mental strain that comes from having too much month and not enough money.
In fact, our research shows that folks in poverty value healthy living just as much as wealthier residents. They want to make healthier choices, such as buying healthier foods, but report that healthy food is too expensive and getting transportation to buy fruits and vegetables is a challenge. Many people in poverty live in areas where their food options are limited to corner stores, gas stations and fast-food outlets. Rural residents might face a drive of 20 minutes or more to get to a grocery store.
It’s incredibly hard to be poor. We need providers, particularly in the health care system, to understand the challenges poor people face just by being overloaded. Health care providers may not see these complexities when looking at a patient. They may not realize that a low-income patient took unpaid time off work to visit a doctor, caught multiple buses and then walked blocks to arrive at a suburban specialist’s office. Faced with such barriers, many patients leave physical and mental health conditions unattended to until those conditions become a crisis that requires emergency care.
The cost of such delays adds up. The total price tag for health inequities stemming from poverty, including added health care expenses and lost economic productivity, tops $1 billion annually for the Finger Lakes region.
Our region has a proud history of public health success when we come together. Edward Mott Moore, George Goler M.D. and George Eastman, local giants in community health improvement, understood that caring for people meant addressing the root causes of poverty. In recent years, collaborations have made significant progress reducing lead poisoning and helping residents get their high blood pressure under control. This tradition of partnering across the health care ecosystem is one of the many reasons we enjoy high-quality care at some of the lowest costs in the nation.
We can build on this legacy by working together as individuals and as organizations to address the health barriers linked to extreme financial stress. Our study’s insights and hard data can provide a springboard for collaboration across geographies, sectors and perspectives.
We all deserve the chance to grow old, to embrace our grandkids, and to live a life without daily worries over how to afford nutritious food and safe housing. We know this goal is possible, because this is the life that affluent residents already enjoy. By working together, we can ensure these benefits for all.
Wade Norwood is CEO of Common Ground Health, the health research and planning organization for the Rochester-Finger Lakes region.