Associations of Poverty and Homeless updated 8-19-2024.pdf

ASSOCIATIONS OF POVERTY AND HOMELESSNESS IN WOMEN’S HEALTH 2024 George L. Stanley Jr MD FACOG Assist. Professor OB/GYN Clerkship Director SNMA Faculty Advisor Department of OB/GYN Upstate Medical University Syracuse New York ...

ASSOCIATIONS OF POVERTY AND HOMELESSNESS IN WOMEN’S HEALTH 2024 George L. Stanley Jr MD FACOG Assist. Professor OB/GYN Clerkship Director SNMA Faculty Advisor Department of OB/GYN Upstate Medical University Syracuse New York  EDUCATIONAL OBJECTIVES Following the completion of this presentation the attendee should be able to: 1. Identify the reasons that Poverty and Homelessness are considered Social Determinants of Health 2. Re-examine how some historic and contemporary factors have ADVERSELY affected the conditions of Poverty and Homeless in Women’s Health 3. Adopt strategies that can POSITIVELY influence the conditions of Poverty and Homelessness in Women’s Health  DISCLAIMERS The language used in this presentation, specifically the terms WOMAN/WOMEN, IS NOT INTENTIONALLY meant to be non-inclusive Dr. Stanley is PASSIONATE about the material content of this presentation and some of his political, societal, or psycho-social affiliations/beliefs may be expressed. As an educator (and human being) Dr. Stanley also RESPECTS those with DIFFRENCES in their opinions REFERENCES Dr. Stanley reports no financial conflicts  WHICH OF THE FOLLOWING CONDITIONS ARE CONSIDERED SOCIAL DETERMINANTS OF HEALTH? A. Institutionalized Racism B. Police violence targeting People of Color C. Poverty/Homelessness D. Mass incarceration E. All of the above Social Determinates of Health account for 1/3 of all deaths in USA? A. True B. False FROM WHAT AND WHY DO PEOPLE BECOME SICK? Traditional biomedical explanations tend to focus on biologic/genetic factors, lifestyle, and individual health behavior as determinants of who gets sick and from what conditions Other factors also need to be considered  SOCIAL/STRUCTURAL DETERMINANTS OF HEALTH Interdisciplinary researchers have demonstrated that the conditions in the environment in which people are born, live, work, and age play equally as important a role in shaping health outcomes These factors are referred to as the social/structural determinants of health Environmental conditions, both physical and social, that influence health outcomes  SOCIAL DETERMINANTS OF HEALTH Shaped by historical, social, political, and economic forces Help explain the relationships between environmental conditions and individual health It is well established that social determinants of health are responsible for a large proportion of health inequities in the USA  SOCIAL DETERMINANTS OF HEALTH (PHYSICAL CONDITIONS) Lack of access to safe housing, clean drinking water, nutritious food, and safe neighborhoods contribute to poor health  SOCIAL DETERMINANTS OF HEALTH (SOCIAL-POLITICAL CONDITIONS) Institutionalized racism Police violence targeting People of Color Gender inequity Discrimination against LGBTQI+ individuals Poverty Access to quality education/jobs that pay a livable wage Mass incarceration of People of Color (particularly African-Americans) Gun control ( G. Stanley MD 2018) SOCIAL AND STRUCTURAL DETERMINANTS OF HEALTH All aforementioned conditions shape behavior and biological processes that ultimately influence an individual’s health and health of communities Such social conditions also work to create cycles that perpetuate intergenerational disadvantages SOCIAL AND STRUCTURAL DETERMINANTS OF HEALTH Social and structural factors account for more than 1/3 of total deaths in the USA per year Evidence suggests that addressing social needs of individuals results in improved overall health  SOCIAL DETERMINANTS OF HEALTH POVERTY HOMELESSNESS  FACTORS THAT HAVE ADVERSELY INFLUENCED POVERTY RATES IN USA Expanding wealth gaps Inadequacies of health care coverage/rising health care costs Extensive tax cuts to the wealthy Racist/Sexist/Gender discriminatory practices Rising student debts High levels of unemployment COUNTLESS OTHER FACTORS!!!!!!!!  POVERTY IN UNITED STATES Poverty Threshold-a government-set estimate of the point below which a household of a given size has a pre-tax income INSUFFICIENT to meet the MINIMAL basic needs The Poverty Threshold for a family of four is ~$25,700 According to the U.S Census the poverty rate in 2018 was 11.8%, an estimated 38.1 MILLION people (World Population Review 2021)  POOREST STATES IN AMERICA 2021 1. Mississippi (19.65%-poverty rate) 2. West Virginia 3. Louisiana 4. Arkansas 5. New Mexico (World Population Review 2021) POOREST CITIES IN USA 10. Bloomington, IN 5. Detroit, MI 9. Reading, PA 4. San Marcos, TX 8. Flint, MI 3. Cleveland, OH 7. Greenville, NC 2. Jackson, MI 6. Birmingham, AB 1. Pharr, TX (US World & News Report 9-7-2023)  Data is presented as median income of the city and calculation of percentage of residents with a household income 100K were evaluated (World Population Review 2021)  POOREST CITES IN UNITED STATES 2021 (World Population Review 2021) 1. Detroit, MI 2. Cleveland, OH 3. Dayton, OH 4. Hartford, CT 5. Rochester, NY 6. Newark ,NJ 7. Jackson, MS 8. SYRACUSE, NY 9. Birmingham, AL 10. Springfield MA SYRACUSE, NEW YORK 4- 2020 CENSUS DATA Population 148,620 White (54%), Black (30%), Latinex (9.4%) Native Amer. (1%), Asian (6.5%) Median household income (in 2019 dollars) $38,276 Per capita income in past 12 months (2019 dollars) $23,090 Person in Poverty 31.0% (census.gov 2020)  POVERTY RATES IN CNY Syracuse ranks 9th in country with 31.0% overall poverty (but 5th in USA for child poverty (50.4%) BUT HIGHEST in nation for cities with populations US>100K Buffalo 18th-28.8% overall 43.4% child poverty Rochester 40th-25.3% overall 36.0 % child poverty Pharr, TX 1st 38.1% overall 49.6% child poverty (US Census Bureau’s American Community Survey 2020)  WORKING POOR BUREAU OF LABOR STATISTICS DEFINITION People who spend 27 weeks or more in labor force either working or looking for work but whose incomes still fall below federal poverty levels.  WORKING POOR 2011, 46.2 million Americans lived below the official poverty level (15 % of country). Of those ~10.4 million counted as working poor (Washington Post April 2013)  WORKING POOR Among families with at least 1 member in labor force of >27 weeks or more with children < 18 years old are FOUR TIMES more likely to live in poverty than those without children 13.3% Black, 12.9% Hispanic, 6.1% White (Washington Post, April 2013)  POVERTY AND WOMEN’S HEALTH CARE IN USA 2016 more than 16 MILLION women lived in poverty 21.4% Black women, 22.8% Native women, 18.7% Latina women, 10.7% Asian women The poverty rate for families with children headed by women is HIGER than those run by men or those headed by married couples  POVERTY AND WOMEN’S HEALTH CARE IN USA Women face higher health care costs Women are MORE LIKELY to have chronic conditions that require ongoing medical treatments Women are MORE LIKELY, on average, to use prescription drugs Throughout their reproductive lives, regardless of whether they have children, women require substantially more contact with medical providers than men their age  POVERTY AND WOMEN’S HEALTH CARE IN USA A greater share of women’s income is consumed by out- of- pocket health care costs On average, women have LOWER incomes than men (in part due to pay inequities) and are more likely to live in poverty/extreme poverty than men  MEDICAID The state-federal health insurance program for individuals with low incomes, serves as a safety net for women throughout their lifecycle The largest payer of pregnancy services, financing b/w 40-50% of ALL births in USA and family planning services, accounting for 75% of ALL public family planning expenditures In addition to providing care to individuals with lower incomes, Medicaid has played a crucial role in advancing women’s economic security by DECREASING debt/bankruptcy due to medical expenditures (ACOG Protecting and Expanding Medicaid to Improve Women’s Health June 2021)  FEMINIZATION OF POVERTY Data for the city of Syracuse and all of the 5 Central New York counties reflect the phenomenon that women disproportionately make up the face of poverty In Central New York, women ages 18-24 experience the highest levels of poverty among any age/gender group In 2018 nearly 29% of women in this age range lived below the threshold compared to 23 % men in the same range (CNY Vitals 2021)  FEMINIZATION OF POVERTY 2018 data for Syracuse 53.88% of residents living below poverty were female There were ~22,167 Female residents and 18,967 Male residents who lived BELOW the poverty line (CNY Vitals 2021)  WHAT DOES W.I.C COVER? Pregnant and postpartum women (< 6 months) and children 1 year or at least 4X in past 3 years  HOMELESSNESS (POSSIBLE ETIOLOGIES) Joblessness Inadequate social/financial support Substance abuse Mental illness Previous incarceration Loss of home (fire, eviction, natural disaster, building condemned/sold) Discrimination in housing because of ethnicity, # of children, receiving welfare, or pregnancy  HOMELESSNESS Pregnancy or pregnancy complications may lead to loss of employment and, in turn, loss of income to pay for housing.  HOMELESSNESS For the fourth CONSECUTIVE YEAR homelessness has INCREASED worldwide January 2021 estimates that there were approximately 580,466 homeless in USA (probably VAST underestimation) Pandemic recession may increase homelessness by 49% over next 4 years Only 37 affordable and available homes exist for every 100 extremely low-income renter households (John Oliver Last Week Tonight November 1-2021)  HOMELESSNESS About 1/3 of US households are renters Renters tend to have lower incomes than homeowners The majority of renting households below the poverty line spend at least half of their incomes on housing and 25% are spending 70% of their income on shelter cost alone Black households are TWICE as likely to be evicted as White households Women of Color and particularly Black women are especially vulnerable to evictions (John Oliver Last Week Tonight June 29-2020)  HOMELESSNESS DURING THE REAGAN YEARS “WELFARE QUEENS”-single mothers raising children with the help of federal assistance Popularized by Reagan during presidential 1976 campaign Housing subsidies were SLASHED BY 75% during the Reagan years  HOMELESSNESS (Syracuse statistics) Point In Time Count- snapshot of homeless community done by volunteers nationwide Always done in late January 2017-367 single adults, 49 families (144 people), and 7 unattached youth living in shelters 2018-425 single adults, 52 families (145 people), and 19 unattached youth living in shelters (Syracuse Post Standard January 28, 2018)  HOMELESSNESS CNY 2020 Point in Time Count 1-22-2020 DECREASED POPULATION from 723 (2019) to 613 (16%)!!!! Includes Onondaga, Cayuga, and Oswego counties (Syracuse.com 2-8-2020)  HOMELESSNESS Can affect ANYONE!!! Odds of an individual in the USA becoming homeless in any given year 1/194 Women and families are fastest growing segment of the homeless population 34% of total homeless population is composed of families Of these homeless families 84% are headed by women African American families are DISPROPORTIONATELY represented (43%) of homeless families 53% of homeless women lack a high school education (ACOG Health Care for Homeless Women 2021)  HOMELESSNESS Approximately 13% of all homeless adults were veterans in 2012 LGBTQ+ individuals represent 20% of homeless youth 62% of homeless gay/transgender youth will attempt suicide Among lesbian, gay, bisexual, and transgender persons who experience domestic violence, 57% became homeless AS A DIRECT RESULT of domestic violence (ACOG Health Care for Homeless Women 2021)  Homelessness disproportionally affects women and children Women represent 80% of adults in homeless families in the United States Homeless women are at higher risk of having chronic illnesses, infectious diseases, substance abuse problems, mental illness, and being a victim of sexual or domestic violence than women who are not homeless (Up to Date 2017)  HOMELESSNESS Pregnant homeless women are typically younger than non-pregnant homeless women Frequently have a history of family disruption DOMESTIC VIOLENCE AND SEXUAL ABUSE ARE THE LEADING CAUSES OF HOMELESSNESS IN WOMEN 20-50% of all homeless women and children become homeless AS A DIRECT RESULT of trying to escape domestic violence  HOMELESSNESS AND WOMEN’S HEALTH More than 500K people in USA are experiencing homelessness and ~39% are women and girls Most minority groups experience homelessness at a rate far greater than whites Black women have been particularly at INCREASED risk of homelessness due to EVICTIONS Intimate Partner Violence (IPV) remains the LEADING cause for homelessness of women. Experts are concerned that the pandemic has sparked a silent but drastic INCREASE in IPV across the country Stay home orders and new stressors have contributed to a rise in domestic violence while simultaneously making it MORE DIFFICULT for women to safely use resources such as shelters and others (Society for Women’s Health Research 2-18-2021)  Persons who experience homelessness may be less likely to engage in the health care system due to challenging relationships with care providers, inconvenience, cost, and a perceived lack of compassion and discrimination on the part of the providers (Up to Date 2017)  HOMELESSNESS Women continue to be be at risk of violence in homeless shelters or when living on the streets Some shelters DO NOT accept pregnant women out of concern of liability due to potential complications of pregnancy or problems in shelter Domestic violence shelters are prohibited from reporting client information. Therefore, estimates likely UNDERCOUNT the number of homeless women and families seeking shelter as a result of domestic violence  HOMELESSNESS AND PREGNANCY OUTCOME Few studies Risk of adverse maternal and fetal outcomes is increased in homeless women. Due to poor access to health care, poor nutrition, lack of housing, substance abuse, exposure to violence, a high prevalence of infection and medical co-morbidities Most common complications: PRETERM DELIVERY AND LOW BIRTH WEIGHT  HOMELESSNESS AND PREGNANCY OUTCOMES Canadian study (2005) Pregnant women who were homeless or had inadequate housing had 3 fold increase risk of preterm delivery and 7 fold increase risk of birth weight