The less someone earns, the greater the barrier to accessing healthcare services. Accessing affordable healthcare represents a challenge to low-income populations. This same challenge hinders the ability to make healthy choices in general. While not a traditional environmental risk, I would contend that social determinants of health are social as well as environmental.
Low-income and disadvantaged populations struggle with prevention in two ways. First, low-income populations face challenges in accessing affordable health care options. Before for the Affordable Care Act (ACA), affordable preventive care was not readily available. Next, low-income populations often work more than one job and/or get paid on an hourly basis. Taking time for preventive care reduces income making it more difficult to cover personal expenses. In other words, the loss of income and the cost of care create a barrier to low-income populations accessing health care including preventive care.
According to the University of Wisconsin Public Health Institute, or UWPHI, (2012), four things impact health outcomes (as measured by mortality, the length of life, and morbidity, the quality of life): health behaviors, clinical care, social and economic factors, and physical environment (10%). UWPHI (2012) analyzed county health ranking data across more than 1,800 counties in the United States, attributing the majority (40%) of the impact to social and economic factors. Using this model as foundation, socioeconomic status can negatively impacts all populations. There are correlations between availability of nutritious food and neighborhood socioeconomics. For example, when looking at the issue of food deserts in low-income neighborhoods on health (with a correlation to obesity), Block, Scribner & DeSalvo (2004) determined a concentration of low-cost, fast food restaurants in low-income neighborhoods.
Block, J., Scribner, R., & DeSalva, K. (2004, January 1). Fast Fod, race/ethnicity and income: A geographic analysis. American Journal of Preventive Medicine .
Centers for Medicare and Medicaid Services. (2014, January 1). Affordable Care Act. Retrieved January 7, 2014, from Centers for Medicare and Medicaid Services: http://www.medicaid.gov/affordablecareact/affordable-care-act.html
Cohen, L., Chavez, V., & Chehimi, S. (2010). Prevention is Primary, Strategies for Community Well Being. San Francisco, CA: Jossey-Bass.
Kindig, D., & Stoddard, G. (2003). What is Population Health? American Journal of Public Health , 93 (3), 380-383.
Lynch, J., & Kaplan, G. (2000). Socioeconomic Position. Social Epidemiology , 13-35.
United States Department of Health and Human Services. (2012, January 1). Environmental Justice Strategy. Retrieved February 13, 2014, from United State Department of Health and Human Servcies: http://www.hhs.gov/environmentaljustice/strategy.html
University of Wisconsin, Public Health Institute. (2012, January 1). County Health Rankings and Roadmaps – Our Approach. Retrieved January 7, 2014, from County Health Rankings: http://www.countyhealthrankings.org/Our-Approach