Class & Demographics of Health Care in the U.S.

Instructor: Betsy Chesnutt

Betsy teaches college physics, biology, and engineering and has a Ph.D. in Biomedical Engineering

In the US, social class is the primary factor affecting your health and the quality of health care that you receive. In this lesson, learn about some of the reasons for this disparity.

The Relationship Between Class and Health in the US

Many things affect your health, including your individual genetics, your diet, where you live, and how old you are. However, one of the biggest determinants of a person's health in the United States is social class. Living in poverty has a profound negative effect on your health and even how long you will live. If you are a man who is among the wealthiest 1% of the population, then you are likely to live almost 15 years longer than a man from the poorest 1%. For women, the difference is about 10 years!

Why do these differences occur? There is a host of complex issues that play a role. First, people living in poverty often live in areas without easy access to healthy food, and their living conditions often expose them to environmental toxins like lead paint and mold. All of these can cause you to become sick at a higher rate than people who live in a more affluent part of town. In addition, if you do get sick, access to health care is highly variable as well. There are typically few doctors offices and hospitals in poor and rural areas. Even if there is a doctor nearby, you many not be able to afford to go if you don't have insurance. Nearly 70% of the total population of uninsured Americans live at or near the poverty level, so this is a problem that disproportionally affects the poor.

States with the highest proportion of uninsured residents also have the highest rates of poverty
health insurance rates by state

To get a better idea of the effect that class can have on a person's health, let's look at the case of two people with similar medical conditions who live in very different circumstances.

Managing a Chronic Disease as an Upper Middle Class Person

James and Sarah are similar in many ways. James and Sarah live in the same state, and both are 35 years old and have diabetes. However, other aspects of their lives are very different.

James lives in a medium-sized city in the US. He works at a nearby university, and his employer provides health insurance for him and his family. After work, James likes to go for long walks in a nearby neighborhood park, which is shady and green with lots of tall trees.

James has had diabetes since he was a child and he makes sure to visit his doctor regularly to monitor it. His doctor is only a few miles away and he has great insurance, so he only has to pay $20 for an office visit. He also has an insulin pump, which was paid for by his insurance, and this helps him control his blood sugar much more easily.

In addition, James is careful to eat well. Luckily, there is a grocery store about a mile from his house that sells a wide variety of fruits and vegetables, and James shops there regularly. For James, diabetes is just one small part of his life, and the high-quality health care he receives makes it likely that he will live with it for many more years without too many problems.

Although he may not even realize it, James has a lot of advantages when it comes to his health care. He has health insurance that allows him access to the services he needs to manage his disease, and his doctor is nearby. He also has easy access to healthy food, and his neighborhood has a park where he can walk for exercise. All these are things that many people take for granted, but there is a large segment of the US population that does not have these advantages.

Managing a Chronic Disease When you Live in Poverty

In a rural area about an hour from James, Sarah also lives with diabetes. Sarah works very hard as a waitress at a local restaurant and doesn't have a lot of free time. She does her best to manage her diabetes, but the nearest doctor is an hour away and she can't take the time off work to make it there very often. In addition, she can't afford health insurance, so she waits until there is an emergency to go and tries to deal with most of her medical issues by herself.

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