Relationship between Poverty and Health - Research Paper Example

Poverty and health The aim of the paper is to analyze the impact of poverty on health of the people in New York. The approach adopted is both qualitative and quantitative in nature. While qualitative research is undertaken through the primary survey of the 100 participants collected via stratified sampling, the quantitative research is carried out based on the secondary data sources. The results would show that the correlation between per capita income and health indicators like life expectancy rate, mortality rate etc are strong. Qualitative observation also finds a positive relation between individual income level and the health of people. Introduction Poverty has been an issue of both social and economic concern since long. The people suffering from poverty usually suffer from restrained health care facilities, mortality among the infants and adults, higher incidence of diseases. For the poor people it is often observed that a large family depends on a single’s person’s income. In such cases health is a crucial factors to be taken care of. If the earning member suffers from health issue the other members will be “trapped in a downward spiral of lost income and high healthcare costs” (WHO, 2003, p.14). Therefore, for most poor people prevention is better than cure. Investment in health sector is a significant investment of the poor or less developed countries. The idea is to come out of the cycle of poverty. Good health conditions ensure a fit and healthy labor force, which increases productivity. In order to meet the requirements the less developed nations need adequate financial resources to purchase drugs, mange the healthcare system and to attain the Millennium Development Goals (MDGs) – “reducing child deaths, maternal mortality, and the spread of HIV/AIDS, malaria and tuberculosis”. (WHO, 2003, p.13) Similar problem of finance is observed at an individual level. The study is undertaken to look the relation between the per-capita income level and health related parameters like mortality rate (age adjusted), infant mortality rates and life expectancy ratio on one hand and other behavioral and individual choice oriented indicators. Literature review As research on poverty and related consequences progresses, it is noted that poverty rates and health are related to each other. Conditions related to poverty have been worsening. According to Rice,” The modest salary increase is not enough to counter what Woolfs study calls a "sinkhole effect" on income, a disparity shifting middle- and upper-class families closer to the poverty level.” (Rice, 2006) Poverty has a severe effect on health as the National Coalition on Health Care reports that the standard family expense on health case insurance is approximately lying between $2700 and $3200 as estimate din 2006. The people who are financially weak rather strive to maintain the basic necessities of life like food, shelter and increasing energy cost. A major part of the population remains uninsured especially due to non-affordability. The research by CDC highlights the correlation between reduced salaries and degrading health condition – “as salaries drop, individuals tend to be more stressed, and generally lead less-healthy lifestyles.” (Rice, 2006) Mental health too, is therefore related with poverty (Gunnell, Peters, Kammerling and Brooks, 1995). Mostly the children, especially those without health insurance, have felt the impact. Such children are prone to heart ailments and asthma. (Rice, 2006) McCally, Haines, Fein, Addington, Lawrence and Cassel (1998) observe that a strong association exists between socioeconomic status and health. Their study leads to health oriented and policy implications. It calls for the attention of physicians. The researchers define absolute poverty as the total crisis of the necessary resources meant for survival. Therefore this condition is connected with poor health condition. Apart from this relative poverty is also taken as an influencing factor on health. Relative poverty is defined as the poverty in comparison with the availability of resources in the society. The authors employ a method of calculating the Robin Hood index or the Pietra Ratio to measure inequality of income. This index is defined as “percentage of total income that would have to be transferred from groups above the mean to groups below the mean to equalize income distribution” (McCally, Haines, Fein, Addington, Lawrence and Cassel 1998). Next the age-adjusted moratlity rate is taken and correlation between the two variables is calculated. This reveals a significant and storng correlation between the moraltity rates and income inequality. Among the vairous appraches towards enhavingt he health care system epseically to assist the poor population, the main objective is to satisfy the basic needs of people like food and shelter. Adoption of healty way of living is to be facilitated along with improving the accessability towards suitable and efficient health care services. It is therefore the repsonisbility of the physicians to understand and realize the effects of poverty on health and impact the policymakers all levels to lighten the burden that poverty lays on health. Helmert, Mielck and Shea (2005) studied the characteristics of the heath dimensions in West Germany and their association with poverty. The authors collected the data from the National and Regional Health Surveys carried out for the year range 1984 to 1992 in West Germany. The authors define poverty in terms of household income lying at 50 percent below the mean income for Germany. A sample of 25544 men and 2519 women in the age group of 25-69 were taken for the study. Using multiple logistic regression analysis the association was studied between poverty and each of the following health parameters – “individual health behavior, subjective assessment of health status, cardiovascular disease risk factors and self reported prevalence of lifetime chronic diseases” (Helmert, Mielck and Shea 2005, p. 276). The findings revealed unfavorable or less than favorable outcomes for the population section lying below the poverty line. The effect of poverty was significantly found on obesity, myocardial infarction, and subjective contentment regarding health status. The overall findings reveal that poverty impact an individual’s health condition quite significantly. Hence due to the declining wages or lack of employment in Germany in the recent past, probability of negative health effects is on the rise. Kennedy, Kawachi and Pro-throw Stith (1996) show the impact of inequality in income (using Gini Index and Robin Hood Index as the indicators) on the cause specific mortality rates of United States. The research design involves a cross section study base done ecology and data has been collected from the households of United States. The findings show that the Robin Hood index was significantly associated with age adjusted total mortality rate. The index also affected the prevalence of infant mortality rate, heart ailments, homicide and malignant neoplasms significantly. The index was statistically associated with the cause of deaths, which are otherwise medically treatable. The relative poverty or the difference between the rich and the low-income group therefore mattered more than the absolute level of income in terms of health related impact on the population. Therefore policy implications to improve health conditions lie in addressing the income inequality factor. Summary and Hypothesis From the background study in the previous section it is clear that income has a close association with health of an individual. Therefore per capita income might be expected to correlate strongly with certain indicators of the health status of an economy like life expectancy rate, age-adjusted mortality rates and infant mortality rate. On the other hand income level of people will also determine their capacity to spend. When a person is not able to meet the basic daily necessities, health becomes a secondary priority. The aim of this paper to look at the effect of income on the health related variables. The idea is to study the impact of poverty on health of an individual. The hypothesis adopted for the paper is presented as follows: H0: Per-capita income is not associated with mortality rates H0’: Per-capita income is not associated with infant mortality rate H0’’: Per-capita income is not associated with life expectancy ratio H0’’’: Income is not closely associated with the level of health awareness of an individual When the above null hypotheses are rejected then the following alternative hypotheses are respectively accepted: H1: Per-capita income (PI) is significantly associated with mortality rates (MR) H1’: Per-capita income (PI) is significantly associated with infant mortality rate (IMR) H1’’: Per-capita income (PI) is significantly associated with life expectancy ratio (LE) Apart from this our objective is to qualitatively identify the impact of income levels on health related decisions and health consciousness of a person. This is achieved through extensive primary research. Methodology Scope of research The method applied to the research is for the purpose of investigating the impact of poverty on the health parameters of the society in New York. Research Design The methodology of this paper incorporates both qualitative and quantitative approaches. Both secondary and primary data sources are used. The paper involves a research in two stages. Secondary research: First the literature survey is conducted based on empirically conducted research based studies of other authors and scholars. This is done in order to form a clear idea about the problem studied and also look at the different methodologies applied so far. Next a regression analysis is performed with per-capita income as the independent variable and the others as dependent variables one after another. Following this quantitative analysis based on secondary research, the study follows a primary analysis to obtain first hand data from a sample selected. The following regression equations might be written based on the data collected from secondary sources: MR = a +b (PI); Corresponding null hypothesis: b=0 IMR =a1 + b1 (PI); Corresponding null hypothesis: b1=0 LE = a2 + b2 (PI) Corresponding null hypothesis: b2=0 Alternative hypotheses will imply b 0; b1 0; b2 0. Alternative hypotheses will be chosen or rejected based upon the statistical significance of the results obtained form regression analysis. Secondary data sources Next, the secondary sources like the World Bank, US Census Bureau, and Bureau of Economic Analysis (BEA) will provide the data for mortality rates, life expectancy and per-capital income for the available time span of 1999-2006. For the literature review academic journal articles and books have been used. Primary research A stratified random selection method is applied for selecting the sample for the primary research. The population collected from New York is subdivided into two groups according to their income levels. People earning less than or equal to US$11,200 annually have been taken as group 1 while those lying above this level are taken as group 2. The threshold has been defined based on our secondary research, which shows that the poverty threshold for people below 65 years of age is US$11,201 according to 2008 estimates (IPR, 2009). The age group of population selected lies between 25-65 years. Hence 50 people are selected from each stratum identified likewise (according to socio-economic terms). Conducting interviews is the next task. For this purpose designing a questionnaire in order to capture the impact of poverty on health is essential. This interview will provide qualitative information. Method of data generation A small personal level interview will be conducted for a more complete study. The stages of the survey include study of the answers, evaluation and inspection and drawing a conclusion. A personal interview is very necessary in order to obtain the individual opinion of the participants. Primary research can give the researcher admittance to the viewpoint of the people being interviewed (Cooper, 1998). The interview can ask for certain information that can be scrutinized to recognize the motive behind the answers. People attach various meanings to different words and events and interview is very helpful to bring these things to surface. Interviews can be of various types as follows: Structured interviews: This type of interview use close-ended questions. The respondents are asked questions for which the responses will be selected from the options provided therein. Semi-structured interviews: In this case, standardized open-ended questions are asked the answers of which entirely rely on the perspective of the respondents. Unstructured interviews: This interview is conversational and the neither the questions nor the arrangement of questions are prearranged or pre-decided. The selection of the type of interview depends on the nature of the research and also the volume of the research. There is no doubt that unstructured and semi-structured interviews are all-inclusive as these allow the respondent to communicate his or her view in detail, and sometimes to share an experience. Open-ended questions have to be outlined in a proper way. It has to be to the point and should provide alternative answers to choose from to minimize the possibility of confusion that the respondent may face. Semi-structured interviews can give dependable information as the options are chosen with much accuracy and care. The researchers must keep in mind that the model questions are pre-tested to avoid perplexity. The questionnaire prepared for the current study will include both open ended and close ended questions. Hence it is both structured and semi-structured. It will be conducted over phone, face-to-face (for group1 especially), and emails as per convenience of participants. The idea is to capture their approach towards health of themselves and their family. The intention is to find out whether they have access to health insurance and if yes how much they pay for the same. The indicators of health consciousness will be accessibility to health insurance, visit to the doctor during an ailment, regularity of medicines taken in case of heart ailments, obesity/ underweight (as per age and height) and frequency of health check-ups undertaken. The same set of questions will be asked to both the income groups and then their responses will be compared to give us a qualitative impression about the impact of poverty on the status of health. Expected results The results expected from the quantitative analysis are similar to that of the research based literatures studied so far. Therefore it might be expected that the per-capita income will be significantly related to health indicators like life expectancy ratio, mortality rates and infant mortality rates. Next for the primary survey the obvious expectation is to find very little or lack of health insurance amongst people below poverty threshold. These people are not expected to visit the doctor whenever they fall sick. They tend to suffer from mal-nutrition, underweight or overweight according to their height and age. Instances of asthma, stomach related problems and heart ailments are supposed to be largely prevalent among these groups. The prevalence rate for these diseases is more for group 1 than group 2. The comparison might be made through pie charts and percentage representations. For every question related to each of these parameters the percentage of respondents between the two groups are calculated and then compared by representing in a single pie chart. This illustration will help us identify the difference clearly. Therefore the first three hypotheses listed before are the objectives related to the quantitative research part. On the other hand the other objective related to primary research is qualitatively resolved. The expected outcome is finally to obtain a clear and strong relation between poverty and health parameters. Limitations and scope of research The limitations of research pertain to the sample size chosen and the choice of location. A cross sectional analysis should have given us a clearer picture. Also a country-wise analysis involving both developed and underdeveloped nations could be studied to capture a similar effect. This is also a scope for further research where other nations could be included and comparison can be carried out cross-sectional wise. References Calculate your body mass index. (2002). National Heart, Lung and Blood Institute. Available at: http://www.nhlbisupport.com/bmi/ (accessed on August 2, 2010) Cooper H. M. (1998) Synthesizing Research, London: SAGE Gunnell, D., Peters, T., Kammerling, R. and Brooks, J. (1995) Relation between parasuicide, suicide, psychiatric admissions and socio-economic deprivation. British Medical Journal 311, 226-230 Helmert, U. Mielck, A. and S. Shea (May 2005). Poverty and Health in West Germany. Social and Preventive Medicine, 42(5), 276-285 IRP (2009). What are poverty thresholds and poverty guidelines?, available at: http://www.irp.wisc.edu/faqs/faq1.htm (accessed on August 2, 2010) Kennedy, B.P. Kawachi, I. and D. Prothrow-Stith (1996). Income distribution and mortality: cross sectional ecological study of the Robin Hood index in the United States, British Medical Journal, 312, 1004-1007. available at: http://www.bmj.com/cgi/content/full/312/7037/1004 (accessed on August 2, 2010) Leino-Arjas, P., Liira, J. Mutanen, P. Malmivaara, A. and E. Matikainen. (1999). McCally, M. Haines, A. Fein, O. Addington, W. Lawrence, R and C. K. Cassel (1998). Poverty and Ill Health: Physicians Can, and Should, Make a Difference, Annals of Internal Medicine, 129(9), 726-733. available at: http://www.annals.org/content/129/9/726.full (accessed on August 2 2010) Predictors and consequences of unemployment among construction workers: prospective cohort study, British Medical Journal, 319, 600-605. Available at: http://www.bmj.com/cgi/content/full/319/7210/600 (accessed on August 2, 2010) Rice, S. (September 2006). Poverty and poor health are intertwined, experts say, CNN, available at: http://edition.cnn.com/2006/HEALTH/08/29/poverty.health/index.html (accessed on August 2, 2010) WHO. (2003). Poverty and Health. OECD. Available at: http://whqlibdoc.who.int/publications/2003/9241562366.pdf (accessed on August 2, 2010) Read More