“It is natural to ask whether rising gaps in income might be associated with widening gaps in health and longevity between rich and poor Americans,” Jacob Bor and colleagues noted in an article in The Lancet this spring. This association is bidirectional: If someone is poor, they have a greater likelihood of having chronic illnesses such as diabetes and cardiovascular disease and associated complications. Illness also restricts financial security, especially within communities of color. The June issue of Health Affairs, Pursuing Health Equity, draws much needed attention to the need to pursue solutions that address the interrelationship between health status and socioeconomic influences.
One unorthodox but highly effective approach to addressing health and socioeconomic disparities in the United States would be to close the racial and ethnic wealth gap in our society by improving health. We argue that such policy solutions should prioritize chronic disease prevention and management, specifically.
Chronic Disease Burden Among Communities Of Color
People of color face higher rates of diabetes, obesity, stroke, heart disease, and cancer than whites. In the case of diabetes, the risk of being diagnosed is 77 percent higher for African Americans and 66 percent higher among Hispanics, than for whites. Asian Americans, Native Hawaiians, and Pacific Islanders are at twice the risk of developing diabetes than the population overall.
In addition to higher rates of chronic illness, lower wages and insufficient insurance coverage among people of color greatly limits their access to treatment and often forces them to work while ill. Adjusting for inflation, incomes for all poor and middle-income Americans have declined over the past 15 years. As people of color are disproportionately represented within lower income levels, there is a growing wealth gap between racially and ethnically diverse households compared with white households, the size of which has not been seen since the early twentieth century. Furthermore, in 2015, for nonelderly adults, the percentage of African Americans, Hispanics, Asian Americans, and American Indian and Alaska Natives who were uninsured was one-and-a-half to two times as large as the percentage of white Americans who were uninsured.
The Costs Of Chronic Disease
Research has shown that the onset of a chronic disease reduces wages by 18 percent. Chronic illness may restrict employment and increase medical expenses and costly caregiving responsibilities, which all contribute to widening the income and wealth gaps.
On average, chronic diseases are projected to cost the United States $794 billion per year in lost productivity alone between 2016 and 2030. Relatedly, the Joint Center for Political and Economic Studies estimates that health inequities and premature death cost the US economy $309.3 billion a year. People with lower incomes have a greater likelihood of having one or more chronic illnesses, and greater morbidity means higher out-of-pocket costs. According to a RAND Health study, Americans with just one or two chronic illnesses in 2014 paid double the out-of-pocket costs compared to Americans without chronic conditions. Americans with three or more chronic illnesses paid four times as much or more. With median household income 140 percent to 171 percent less than their white peers, respectively, Hispanic and African American households have fewer resources to absorb those costs. Incomes among Hmong, Thai, Cambodian, Laotian, and Bangladeshi Americans are even lower.
Chronic disease not only affects the earning prospects of the individual affected but often also negatively impacts income for family members. Low-income Americans cannot usually afford to hire professional assistance to care for a loved one with one or more serious chronic illnesses. Thus, many family members take time off from work or leave the workforce altogether, resulting in lost wages and diminished opportunities for workplace advancement. A 2016 study by AARP found that three of every four Americans who are actively providing caregiver assistance are incurring significant out-of-pocket costs to do so—almost $7,000 annually, on average. One in every six caregivers has needed to reduce the amount of money they put into savings or toward retirement. More than half of them have had to take time off from work or reduce the number of hours they work.
Increasing upward mobility is a critical part of any plan to close the wealth gap in the United States, but mobility is difficult to attain for those who face or are more likely to face debilitating chronic illnesses. Many chronic illnesses have a direct effect on people’s ability to work, affecting their ability to contribute financially, and diminishing their strength and stamina. For people of color who already occupy too great a share of the lower-income cohorts, chronic illnesses serve as a barrier that prevents them from climbing the economic ladder or, worse, from even being able to maintain their current status.
Moving Forward
A holistic approach, one that includes a focus on the disproportionate impact of chronic disease on communities of color, needs to be applied to close the chasms between rich and poor in this country. All of the good-faith efforts to reduce poverty and promote economic development in vulnerable communities will have limited effect if we don’t also take action to address the co-occurring, high rates of chronic illnesses that undermine opportunities for economic progress for individuals, and the health status and diversity of our workforce overall.
We’ve seen promising steps forward. The National Institutes of Health launched a new research program last year to address the high chronic disease rate among people of color, as well as among people of disadvantaged socioeconomic status. Additionally, the Centers for Disease Control and Prevention’s Racial and Ethnic Approaches to Community Health program, working with community organizations, has been successful in reducing smoking rates and improving nutrition among communities of color. Moreover, work under the Department of Health and Human Services Disparities Action Plan included efforts to address important issues such as provider shortages, gaps in health data collection, access to coverage, and racial and ethnic disparities in cancer prevention and care.
Still, there is much more to be done, as great disparities in this country in wealth, income, and education remain. It is increasingly clear that poor health negatively impacts wealth, just as lack of wealth is a detriment to health. Poor health, disproportionately concentrated in communities of color, contributes significantly to economic, educational, and social barriers that are extremely difficult to overcome.
Greater investment in chronic disease prevention and management is needed today to reduce economic disparities along racial and ethnic lines and lead to a healthier, prosperous nation for all.