The Lack of Progress in Moving the Needle on Poverty Reaffirms the Need for Healthcare Transformation

By Eve J. Higginbotham, SM, MD

There was good news and bad news out of Washington D.C. this week.

The good news is that the number of people without health insurance dropped in 2014 by 8.8 million, however there was no significant difference in the rates of poverty between the years of 2013 and 2014.[1] The annual report released by the U.S. Census Bureau[2] indicates for the fourth year in a row that rate of poverty was not significantly different from the previous year. Overall, more than 45 million Americans live in poverty, a number that seems staggering for one of the most affluent nations in the world. The median household income in 2014 was $53,657, not significantly different from $54,462 noted in 2013. Quite strikingly, the median household income declined 6.5% compared to 2007, the year before the recession. Since 1993, the Gini index, a measure of income inequality has increased almost 6%. But what about jobs?  We have heard about the reduction in unemployment in the last year. There was an increase in the number of full time workers among men and women in 2014 compared to 2013 measuring 1.2 million and 1.6 million respectively. Perhaps this is a good sign for the future as the economy continues to recover. However women continue to make 79 cents on the dollar compared to men, a measure of how far we still have to go related to gender equality.  How does this relate to health care? Considering the social determinants of health, income is related to the health of households.  Median household income for blacks and Hispanics continue to track well below the median at $35,398 and $42,491 and the elimination of health disparities within these populations continues to be an ongoing national objective.  How do we get there?  By continuing to transform healthcare delivery, a movement already underway following the passage of the Affordable Care Act. One of our own Penn faculty and her colleagues are demonstrating the benefits of engaging community health workers and tapping into this group as a resource for improving health outcomes. A recent Perspective by Kangovi and coworkers[3] published in the New England Journal of Medicine highlights the important potential contribution community health workers have to improving health outcomes. Her work is important to national efforts to improve the health of vulnerable populations. As we consider today‚Äôs report from the US Census Bureau, let us renew our efforts to continue to transform healthcare at a time when poverty remains a recalcitrant barrier to health equity.

To learn more about the work Community Health Workers are doing at the Penn Center visit:

 http://chw.upenn.edu/


[1] .  Pear, R. Uninsured number drop as poverty rate holds steady. http://www.nytimes.com/2015/09/17/us/politics/census-bureau-poverty-rate-uninsured.html?emc=edit_na_20150916&nlid=68022320&ref=cta, Accessed 09/16/15

[2] . DeNavas-Walt, C and Proctor, B. U.S. Census Bureau, Current Population Reports, P60-252, Income and Poverty in the United States: 2014, U.S. Government Printing Office, Washington, D.C., 2015

[3] . Kangovi S, Grande D, Trinh-Shevrin, C. From Rhetoric to Reality-Community Health Workers in Post-Reform U.S. Health Care. N Engl J Med 2015; 372:2277-2279