Poverty & Health

According to the U.S. Census Bureau an estimated 14.5% of the U.S. population (45.3 million people) are living in poverty. Having limited resources creates competing priorities for meeting basic needs, and too often, health care is neglected in order to secure more immediate necessities such as housing and food. While Medicaid expansion has improved access to health care for many, the shortage of affordable housing and livable wages continues to take a toll on the health of the poorest members of our communities. The irrefutable correlation between poverty and health has precipitated new and innovative approaches to address social determinants of health in clinical practice. This page provides resources expanding on the impact of poverty on health, considerations for providing care to this population, and administrative resources related to this topic.

NHCHC Publications

  • Homelessness & Health: What’s the Connection? (2011) | National HCH Council | Many people are reduced to homelessness in a downward cycle that begins with a health problem and rapidly escalates into employment problems, financial problems, and housing problems.

Additional Resources

  • 2015 Poverty Guidelines | Office of the Assistant Secretary for Planning and Evaluation | The federal poverty guidelines are issued each year by the Department of Health and Human Services (HHS). These guidelines are one version of the poverty thresholds that are used administratively to HUD determine eligibility for various programs, including health centers.
  • UDS Mapper | American Academy of Family Physicians| The UDS mapper is an interactive tool that allows users to explore the geographic extent of the federal Health Center Program compared to medically underserved areas and demographic information, such as income levels and race.
  • Maness DL, Khan M. Care of the Homeless: An Overview. American Family Physician, 89(8): 634-40, 2014. | People experiencing homelessness face complex health concerns and have poorer health outcomes than those who are housed. This article identifies the demographics and risk factors of individuals experiencing homelessness, common health conditions, and discusses how an interdisciplinary approach can be used to address the various needs of this population.
  • Currie LB, Patterson ML, Moniruzzaman A, McCandless LC, Somers JM. Examining the relationship between health-related need and the receipt of care by participants experiencing homelessness and mental illness. BMC Health Services Research, 14:404, 2014. | The correlation between homelessness and mental illness has long been established, but how does this impact health service use? This study suggests that there may be a gap between need and utilization of services.
  • Hwang SW, Burns T. Health Interventions for people who are homeless. The Lancet, 384(9953):1541-1547, 2014. | This article provides an overview of various health interventions and care models that have proven to be effective in providing care to people experiencing homelessness, including primary care approaches, mental health care, permanent supportive housing, and medical respite care.
  • Baggett TP, Hwang SW, O’Connell JJ, Porneala BC, Stringfellow EJ, Orav EJ, Singer DE, Rigotti NA. Mortality among homeless adults in Boston: shifts in causes of death over a 15-year period. JAMA Internal Medicine, 173(3):189-95, 2013. | This study looks at the cause of death for individuals who had received services at an HCH in Boston, Massachusetts in order to identify current trends and changes over time.
  • Bharel M, Lin WCW, Zhang J, O’Connell E, Taube R, Clark RE. Health care utilization patterns of homeless individuals in Boston: preparing for Medicaid expansion under the Affordable Care Act. American Journal of Public Health, 203(S2):S311-7, 2013. | Massachusetts’ early expansion of Medicaid provided the opportunity to determine the disease burden and health care utilization for insured individuals experiencing homelessness. This study offers an idea if the impact of Medicaid expansion for this population.
  • Hwang SW, Chambers C, Chiu S, Katic M, Kiss A, Redelmeir DA, Levinson W. A comprehensive assessment of health care utilization among homeless adults under a system of universal health insurance. American Journal of Public Health, 103(S2): S294-301, 2013. | A universal health system can provide rich information and a more complete picture of individuals receiving health services. This study compares health utilization between housed and homeless individuals, looking at ambulatory care, emergency department, medical-surgical hospitalization, and psychiatric hospitalization encounters, and the resulting cost differences between groups.
  • Zlotnick C, Zerger S, Wolfe PB. Health care for the homeless: what we have learned in the past 30 years and what’s next. American Journal of Public Health, 103(S2):S199-205, 2013. | The Health care for the Homeless model has been providing targeted services for 30 years. This article provides an overview of lessons learned over the last three decades, reflecting on key strategies, barriers, and the history of HCH work, as well as implications for the future.
  • Baggett TP, Singer DE Rao SR, O’Connell JJ, Bharel M, Rigotti NA. Food insufficiency and health services utilization in a national sample of homeless adults. Journal of General Internal Medicine, 26(6):627-34, 2011. | Many people experiencing homelessness must also contend with food insecurity. This study explores the relationship between lack of accessible food and use of acute health services.