Focus on Economic Inequality in 2013
My New Year's resolution for the U.S. health care system and population health is that there is more sustained attention to the fragile economic state of many of America’s families and households, especially as we continue to climb out of this most recent Great Recession. I say this in light of the strong empirical evidence that economic inequality continues to be inextricable linked to health disparities within our country. I also believe it is especially important at this moment in U.S. history, given the increasing calls to balance the federal budget by defunding social safety net programs— in particular those that provide social insurance to America’s most economically vulnerable populations.
A significant portion of the U.S. population is still either unemployed or underemployed. Many Americans remain deeply concerned about health care costs or the threat of financial instability due to health-related problems. The passage and implementation of the Affordable Care Act was a positive step to ensure proper health care coverage for those previously shut out of private health insurance markets, such as young adults and individuals with pre-existing health conditions. It would be naïve, however, to think that just one policy will provide the economic security U.S. households need to be productive workers and active consumers.
We need to continue to examine the relationships between economic status, resources, and health outcomes in the New Year, and especially address their contributions to racial and socioeconomic health disparities in America. I would urge researchers and policy-makers to examine wealth inequality, as income alone cannot provide a complete picture of overall social status and financial wellbeing. Wealth provides access to social status and political power, it buffers against negative income and health shocks, providing a sense of security and social class insurance.
During the latest recession, U.S. households lost significant wealth, and low-wage and unskilled workers whose wages have remained stagnant for decades saw their unemployment rates rise and remain in the double-digits for lengths of time unforeseen in many Americans’ lifetimes. These losses in wealth, however, were not experienced uniformly across the populations.
Minority households fared worse, given that they were more dependent on housing equity as a source of wealth. Between 2005 and 2009, the average White household total wealth loss was about 16 percent, compared with 66 percent for Hispanic households, 53 percent for Black and 54 percent for Asian households. Over the same period, the share of wealth held by the top 10 percent of U.S. households increased from 49 percent to 56 percent (Pew, 2011).
Households are still reeling mentally, physically, and financially from the severe losses experienced over the last few years, and a nontrivial amount may never recover. These asymmetric wealth losses combined with aging and diversification of the older population, both racially and ethnically, may negatively affect one of the true policy successes in American history— the sharp decline in poverty among the elderly.
It will therefore also be important to pay close attention to the long-term care needs of America’s growing elderly population, discontinuities in access to care, and the associated costs. The percentage of older adults aging into poverty and having to rely on their families and communities for both informal basic needs and financial caregiving is on the rise. The burden is increasing on today’s working age population, who are caring for both aging parents and children who are taking even longer to launch.
Home health care is largely provided by low-wage minority women and men, many of whom have difficulty accessing health care themselves. There should be a greater emphasis or acknowledgement of care work as an essential service, and that those who are caring for our elderly require health care also.
To summarize, prioritizing the economic and financial stability of American families and households is critical to ensuring a healthy and thriving population. If U.S. leaders are really concerned about decreasing health disparities, then now is the time to address issues of wealth inequality, low-wage worker employment and salaries, equitable health care access, and elder care.
Twenty-to-one: Wealth gaps rise to record highs between whites, blacks, and Hispanics”. Retrieved on December 20, 2012 at http://www.pewsocialtrends.org/files/2011/07/SDT-Wealth-Report_7-26-11_FINAL.pdf.