The U.S. continues to trail other nations in recognizing the role of poverty in quality of health.
In Canada, where indigenous people in Manitoba between the ages of 10 and 25 are eight times more likely to commit suicide than non-indigenous people, a program aims to restore health as “life in balance.” It focuses on strengthening the identity, culture and language of the youths to counteract depression and other psychological disorders.
In New Zealand, the Public Health and Disability Act passed in 2000 created 21 district health boards required to respond to community health needs and reduce health inequalities.
In Iran, a national program called Meshkat Salamat battles malnutrition in rural children. The program encourages breastfeeding, and provides nutrition education, vitamin supplements and iodized salt to affected families.
The work of researchers documenting the connections between poverty and health has been influential in many countries.
“British statistics have shown, for as long as one has cared to look, that health follows a social gradient: the higher the social position, the better the health,” wrote Michael Marmot of the University College London in the introduction to “The Social Determinants of Health,” first published by the World Health Organization in 2003. Many components of British health care address such social determinants.
Ken Thompson, a Pittsburgh psychiatrist who has worked with poor and homeless populations, said the fact that the “social gradient” persisted even in countries such as England where there is a national health service showed that it was more than a matter of access.
“Everybody has access, but they found they still had discrepancies,” he said. “They found that first we need to do more to keep people from getting sick, and the second thing you do is, once people get sick you don’t want to make it hard for them to heal.”
Many countries have been blending health care and social services for decades based on research and on clinical observations that addressing problems such as contaminants in the environment, poor nutrition and unemployment would improve the health of people living in those circumstances.
The World Health Organization adopted a resolution in 2012 calling for reduction in health inequities “through action on the social determinants of health,” including:
• ensuring food security;
• enabling access to health care and affordable medicines;
• improving daily living conditions through provision of safe drinking water and sanitation;
• providing employment opportunities;
• providing social protection.
In the United States, there is no national program aimed at tackling such social determinants. With the closure of many public hospitals and decreased funding for many social service programs on state and local levels, the ravages of poverty continue to impair health.
Rocio Labrador contributed to this article.