By: Laura Samuel & Sarah Szanton
An unprecedented number of Americans are experiencing financial challenges. At least 15 percent of adults were unemployed in April. Notably, the unemployment rate is higher for Hispanic (17.6 percent) Black (16.8 percent) and Asian (15 percent) people compared to White people (12.4 percent) because of discriminatory practices that restrict educational and employment opportunities. For many families, layoffs and furloughs are compounded by unexpected expenses. As examples, some families, including a large number of Black families, have added household and medical expenses due to isolating and caring for family members who are ill from coronavirus. Many families pay more than they usually do for daily services due to interruptions in public transit, childcare, and food supply chains. These challenges contribute to financial strain.
When families struggle to make ends meet, they experience financial strain. Families facing financial strain may run out of food or medications near the end of the month when funds run low. They may not be able to afford stable, quality housing and may struggle with household crowding, pests and lack of heat.
As we face another economic recession, it is imperative that we find innovative policy solutions to support families facing financial strain.
Financial strain is an important predictor of health and health disparities. Our recent studies among a national sample of U.S. adults aged 65 and older showed that older adults who are financially strained have a higher risk of dementia and disability than their wealthier peers. Other national studies have shown that financially strained adults have more depressive symptoms, worse overall health and higher risk of death.
Financial strain is a social determinant of health that we can change.
Here’s what we can do:
Streamline the cumbersome enrollment process for public programs.
Using the Supplemental Nutrition Assistance Program as an example, we found that older adults who participate in the program are less likely to be hospitalized or admitted to a nursing home than similar low-income adults who don’t participate. However, only about 40 percent of older adults who are eligible for the program actually participate. Actionable steps include:
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- Waive document verification and interview requirements until the recession ends;
- Allow families receiving cash assistance to be automatically eligible for food assistance.
Update the minimum wage.
Although 77 million adults rely on a minimum wage, the federal minimum wage has not increased since 2009. Actionable steps include:
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- Raise the minimum wage to a livable wage based on the local cost of living;
- Eliminate the subminimum wage for workers who earn tips;
- Apply minimum wage requirements to agricultural employees.
Improve home conditions for low-income families.
Housing support can address financial strain. Low quality housing is one pathway linking financial strain to disability for older adults. Improving the home environment may improve health outcomes for low-income older adults. Actionable steps include:
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- Increase the number of low-income housing units. In our own city of Baltimore and across the nation, cities have shortages of low-income housing units and long housing wait lists.
- Allow health care payers to cover the cost of health-related home improvements for homeowners. As examples, remediation of household pests and mold may reduce asthma severity for children and simple home modifications and repairs may help an older adults experiencing health declines age safely in their home. Such modifications may be cost-prohibitive for individuals facing financial strain, but cost less than multiple emergency room visits.
Reducing financial strain can prevent costly and burdensome disease and disability and promote health equity. The policies we outline can ensure that financially strained individuals and families have the basic necessities they need during this global health crisis.
This blog is a part of the “Dialogues in Health Equity” series by the Health Equity Faculty Interest Group. They are committed to decreasing health disparities experienced by local and global communities by promoting social justice and health equity through nursing practice, research, education, and service.
Dialogues in Health Equity
- Addressing Social Determinants of Health: A Nursing Imperative to Achieve Health Equity During the COVID-19 Pandemic and Beyond
- On Being an Ally — I Don’t Know What Title To Give This
- Who’s Caring for Black Nurses? We Challenge Our Colleagues to be Allies
ABOUT THE AUTHORS
Laura Samuel, PhD, CRNP, is an assistant professor at the Johns Hopkins School of Nursing. Much of her research has sought to evaluate how low socioeconomic status leads to high chronic disease burden and accelerated aging. She is a family nurse practitioner and has provided primary care in communities. As a nurse practitioner, she regularly witnessed the myriad ways a lack of financial resources can be detrimental to health.
Sarah Szanton, PhD, ANP, FAAN is the Endowed Professor for Health Equity and Social Justice, the director for the Center for Innovative Care in Aging, and a professor at the Johns Hopkins School of Nursing. Her areas of scholarly interest and expertise include gerontology, aging in place, and racial and socioeconomic health disparities.
