Trends in the Health of the Poor and Near Poor: Have the Poor and Near Poor Been Catching Up to the Non Poor in the Last 25 Years?
- Presenter:
Chair: Curtis Florence; Discussant: David Becker Mon June 5, 2006 15:30-17:00 Room 309
Objective: We investigate how health status and the relationship between health status and income have changed over time.
Methodology: First, we document patterns of health status among children, prime-age adults, and adults over 65 using the National Health Interview Survey for selected years between 1978 and 2003. We measure income using three categories of poverty: poor for below 100% of poverty, near poor for between 100 and 200% of poverty, and non poor for above 200% of poverty. At the same time, we utilize three measures of health: self-reported fair or poor health, limitations in work, school, or home activities due to health problems, and a health-related quality of life index equal to one if individuals report both limitations and in fair or poor health. We track changes in health status by poverty status for all three age groups over the 25 year period. Next, we perform multivariate regression of the likelihood of having poor health for all three measures. Besides our investigation into the relationship between income and health, our probit model includes control variables for age, sex, race, ethnicity, education, and region.
Results: As expected, we find that poor health status and poverty are closely linked. For every age group and every heath indicator, the health of the poor is worse than that of the near poor or non poor. Adults show some slight improvement in health over time, using both measures. However, the gains appear greatest among the non poor, suggesting an increase in health disparities as income disparities increase. Health status as measured by health limitations has declined for all children from 1978 to 2003, though the greatest rate of increase was among the near poor children. In the probit estimates, we find poverty to have strong correlation with poorer health status and clear statistical evidence of the increasing association between income and health for nearly all age groups and all three measures of health.
Conclusions: The evidence suggests that poverty and near poverty play an increasingly important role in determining health status. The increase in income inequality when combined with the increase in reported disparities in limitations for children may have long run negative consequences for future earnings inequality and more fundamental measures of well-being. In conjunction with programs specifically directed to provide health insurance to the poor and near poor, public policies targeted at reducing poverty could have long term consequences on health.
Implications: We make a case that ill health is a separate and very important aspect of poverty that needs to be continuously monitored and reported in the same way that the number of uninsured are monitored and reported and the number of poor themselves are monitored and reported. Only when health status, SES, and access to care can be easily and systematically compared will we be in a position to say whether the poor and near poor are receiving adequate health care or are approaching the non poor in terms of access and health status.
