Poverty, Discrimination, and Health

  • Sharese N. Porter


Poverty and discrimination, both their overt forms and subtle micro-aggressions, are two of the most significant factors that fundamentally have a direct effect on physical, mental, and psychosocial well-being. Social conditions and socially constructed ideologies play a role in shaping interpersonal and group identities that create the type of social environment and context one is exposed. Social forces such as poverty and discrimination shape population health and can create or intensify the effect on vulnerable groups. Lack of access to resources as a result of poverty and discrimination is part of the cyclical relationship that exacerbates poor health. Perceptions of self and others influence a range of health promotion and help-seeking behaviors, healthcare delivery practices, and policies within and outside the healthcare arena. Poverty and discrimination are presented as individual determinants of health that are also closely linked to each other. Strategies that may help broaden the understanding of factors that contribute to certain health outcomes are proposed, as well as examples of approaches that may effectively address health disparities. Implications for health professionals from a population health perspective are presented.


Poverty Discrimination Socioeconomic status Health disparities Race 


  1. 1.
    United Nations Economic and Social Council, Committee on Economic, Social and Cultural Rights. Substantive issues arising in the implementation of the international covenant on economic, social and cultural rights. Poverty and the international covenant on economic, social and cultural rights. (e/C.12/2001/10), Geneva; 2001. Available from the United Nations Office of High Commissioner of Human Rights website:,
  2. 2.
    National Academy of Sciences. Measuring poverty: a new approach. “Summary and recommendations.”. Washington, DC: National Academies Press; 1995. Available from Scholar
  3. 3.
    Edwards A. Dynamics of economic well-being: poverty, 2009-2011. U.S. Department of Commerce, Economics and Statistics Administration, (Household Economics Studies, pp. 70–137); 2014. Available from the U.S. Census bureau website:
  4. 4.
    United States Census Bureau. History of the poverty measure; 2014. Available from U.S. Census Bureau website:
  5. 5.
    World Bank. Monitoring global poverty: report of the commission on global poverty. Washington, DC: World Bank; 2017. License: Creative Commons Attribution CC BY 3.0 IGO.CrossRefGoogle Scholar
  6. 6.
    United States Census Bureau. American Factfinder, American Community Survey, 2016; 2017a. Available from Accessed on 16 Jan 2018.
  7. 7.
    World Bank. Poverty and shared prosperity 2016: taking on inequality. Washington, DC: World Bank; 2016. License: Creative Commons Attribution CC BY 3.0 IGO.CrossRefGoogle Scholar
  8. 8.
    United Nations. The sustainable development goals report 2017. New York, NY: United Nations; 2017a. Available from Accessed on 16 Jan 2018.CrossRefGoogle Scholar
  9. 9.
    Semega J, Fontenot K, Kollar M. Income and Poverty in the United States: 2016. United States Census Bureau, Current Populations Report, P60-259. Washington, DC: U.S. Government Printing Office; 2017.Google Scholar
  10. 10.
    United States Census Bureau. Selected characteristics of people at specified levels of poverty in the past 12 months, 2012-2016 American Community Survey 5-Year Estimates-S1703; 2017b. Available from Accessed on 16 Jan 2018.
  11. 11.
    Smith D, Hart C, Hole D, MacKinnon P, Gillis C, Watt G, et al. Education and occupational social class: which is the more important indicator of mortality risk. J Epidemiol Community Health. 1998;52:153–60.CrossRefGoogle Scholar
  12. 12.
    Iceland J. Poverty in America: a handbook. Berkeley, CA: University of California Press; 2012.Google Scholar
  13. 13.
    Black Women’s Roundtable. Black women in the United States, 2014: progress and challenges 50 years after the war on poverty, 50 years after the civil rights act of 1964, 60 years after Brown V. Board of Education; 2014.Google Scholar
  14. 14.
    United Nations. Indigenous peoples, indigenous voices fact sheet; 2017b. Available from United Nations Permanent Forum on Indigenous Issues website:
  15. 15.
    Blakely T, Hales S, Woodward A. Poverty: assessing the distribution of health risks by socioeconomic position at national land local levels. Geneva: World Health Organization; 2004. (WHO Environmental Burden of Disease Series, No. 10).Google Scholar
  16. 16.
    Wilkinson R, Pickett K. The spirit level, why greater equality makes societies stronger. New York, NY: Bloomsbury Press; 2009.Google Scholar
  17. 17.
    Salmasi L, Celidoni M. Investigating the poverty-obesity paradox in Europe. Econ Hum Biol. 2017;26:70–85.CrossRefGoogle Scholar
  18. 18.
    Rohde N, Tang K, Osberg L. Self-reinforcing dynamics of economic insecurity and obesity. Appl Econ. 2017;49(17):1668–78.CrossRefGoogle Scholar
  19. 19.
    Nguyen B, Powell L. Supplemental Nutrition Assistance Program participation and sugar sweetened beverage consumption overall and by score. Prev Med. 2015;81:82–6.CrossRefGoogle Scholar
  20. 20.
    Centers for Disease Control and Prevention. Health, United States, 2016; 2017. Available from CDC website:
  21. 21.
    World Health Organization. Health topics; 2017. Available from World Health Organization website:
  22. 22.
    Yao N, Matthews S, Hillemeier M. White infant mortality in Appalachian states, 1976-1980 and 1996-2000: changing patterns and persistent disparities. J Rural Health. 2012;28:174–82.CrossRefGoogle Scholar
  23. 23.
    Matthews TJ, Mac Dorman M, Thoma M. Infant mortality statistics from the 2013 Period Linked Birth/Infant Death Data Set. Natl Vital Stat Rep. 2015;64(9):1. Division of Vital Statistics, CDC. Available from CDC website: Scholar
  24. 24.
    World Health Organization. World Health Statistics 2015. Geneva, Switzerland; 2015. Available from World Health Organization website:
  25. 25.
    Centers for Disease Control and Prevention. Reproductive health, pregnancy mortality surveillance system; 2017. Available from Accessed on 30 Apr 2018.
  26. 26.
    Centers for Disease Control and Prevention. Reproductive health, infant mortality; 2018. Available from Accessed on 30 Apr 2018.
  27. 27.
    Momtaz Y, Harron S, Hamid T, Ibrahim R, Masud J. Does food insufficiency in childhood contribute to dementia in later life? Clin Interv Aging. 2015;10:49–53.PubMedGoogle Scholar
  28. 28.
    UNICEF. Nutrition: overview; 2013. Available from UNICEF website:
  29. 29.
    UNICEF. Millennium development goals: improving maternal health; 2015. Available from UNICEF website:
  30. 30.
    McEwen BS, Seeman T. Protective and damaging effects of mediators of stress: elaborating and testing the concepts of allostasis and allostatic load. Ann N Y Acad Sci. 1999;896:30–47.CrossRefGoogle Scholar
  31. 31.
    Robinette J, Charles S, Almeida D, Gruenwald T. Neighborhood features and physiological risk: an examination of allostatic load. Health Place. 2016;41:110–8.CrossRefGoogle Scholar
  32. 32.
    Santiago C, Wadsworth M, Stump J. Socioeconomic status, neighborhood disadvantage, and poverty related stress: prospective effects on psychological syndromes among diverse low-income families. J Econ Psychol. 2011;32:218–30.CrossRefGoogle Scholar
  33. 33.
    Hair N, Hanson J, Wolfe B, Pollak S. Association of child poverty, brain development, and academic achievement. JAMA Pediatr. 2015;169(9):822–9.CrossRefGoogle Scholar
  34. 34.
    Jones C. Levels of racism: a theoretic framework and a gardener’s tale. Am J Public Health. 2000;90:1212–5.CrossRefGoogle Scholar
  35. 35.
    Molina K, James D. Discrimination, internalized racism, and depression: a comparative analysis of African American and Afro-Caribbean adults in the U.S. (2006). Group Process Intergroup Relat. 2006;19(4):439–61.CrossRefGoogle Scholar
  36. 36.
    Neumark D, Burn I, Button P. Age discrimination and hiring of older workers. Federal Reserve Bank of San Francisco Economic Letter, no. 2017-06); 2017. Available from
  37. 37.
    Pew Research Center. Global Restrictions on Religion rise modestly in 2015, reversing downward trend; 2017. Available from Pew Research Center website:
  38. 38.
    Cameron D, Berkowitz B. The state of gay rights around the world. The Washington Post; 2016, June 4. Available from
  39. 39.
    Dawson L, Kates J, Rae M. Access to employer-sponsored health coverage for same-sex spouses: 2017 Update, Kaiser Family Foundation; 2017. Available from Accessed on 14 Jan 2018.
  40. 40.
    Hannon K. “The health insurance surprise facing some same-sex couples,” Forbes, Sep. 7, 2017; 2016. Available from Accessed on 14 Jan 2018.
  41. 41.
    American Psychological Association [APA]. LGBT health disparities. APA Public Interest Government Relations Office; 2013. Available from
  42. 42.
    Abraham M, Tstoglou E. Addressing domestic violence in Canada and U.S.: the uneasy co-habitation of women and the state. Curr Sociol. 2016;64(4):568–85.CrossRefGoogle Scholar
  43. 43.
    United States Department of Labor, Bureau of Labor Statistics. The Economics Daily, Women’s median earnings 82 percent of men’s in 2016; 2017. Available from Accessed on 2 Aug 2017.
  44. 44.
    International Labor Organization. Women at work trends: 2016; 2017, March 8. Available from
  45. 45.
    Almeida J, Biello B, Pedraza F, Wintner S, Viruell-Fuentes E. The association between anti-immigrant policies and perceived discrimination among Latinos in the U.S.: a multilevel analysis. SSM Populat Health. 2016;2:897–903.CrossRefGoogle Scholar
  46. 46.
    Pew Charitable Trusts. Collateral costs: incarceration’s effect on economic mobility. Washington, DC: The Pew Charitable Trusts; 2010.Google Scholar
  47. 47.
    Flake D. When any sentence is a life sentence: employment discrimination against ex-offenders, 93 Wash. U.L. Rev, Washington University Law Review; 2015. Available from
  48. 48.
    National Fair Housing Alliance. 2017 Fair housing trend report; 2017. Available from
  49. 49.
    Archibald C. Cultural tailoring for an Afro-Caribbean community: a naturalistic approach. J Cult Divers. 2011;18(4):114–9.PubMedPubMedCentralGoogle Scholar
  50. 50.
    Waters M. Black identities: West Indian immigrant dreams and American realities. Cambridge, MA: Harvard University Press; 1999.Google Scholar
  51. 51.
    Hatch SL, Gazard B, Williams DR, Frissa S, Team SCHS, Hotopf M. Discrimination and common mental disorder among migrant and ethnic groups: findings from a South East London Community sample. Soc Psychiatry Psychiatr Epidemiol. 2016;51:689–701.CrossRefGoogle Scholar
  52. 52.
    Organization for Economic Cooperation and Development (OECD). Education at a glance 2014: OECD indicators; 2014. Available from OECD website:
  53. 53.
    Hayward M, Hummer R, Sasson I. Trends and group differences in the association between educational attainment and U.S. adult mortality: implications for understanding education’s causal influence. Soc Sci Med. 2015;127:8–18.CrossRefGoogle Scholar
  54. 54.
    Luo Y, Zhang Z, Gu D. Education and mortality among older adults in China. Soc Sci Med. 2015;127:134–42.CrossRefGoogle Scholar
  55. 55.
    Smith EJ, Harper SR. Disproportionate impact of K-12 school suspension and expulsion on Black students in southern states. Philadelphia, PA: University of Pennsylvania, Center for the Study of Race and Equity in Education; 2015.Google Scholar
  56. 56.
    Duran A, Diez-Roux A, Latorre M, Jaime P. Neighborhood socioeconomic characteristics and differences in the availability of healthy food stores and restaurants in Sao Paulo, Brazil. Health Place. 2013;23:39–47.CrossRefGoogle Scholar
  57. 57.
    Shortt N, Tisch C, Pearce J, Mitchell R, Richardson E, Hill S, et al. A cross sectional analysis of the relationship between tobacco and alcohol outlet density and neighborhood deprivation. BMC Public Health. 2015;15(1):1–9.CrossRefGoogle Scholar
  58. 58.
    Talen E, Koschinsky J. The neighborhood quality of subsidized housing. J Am Plann Assoc. 2014;80(1):67–82.CrossRefGoogle Scholar
  59. 59.
    Hall M, Greenman E. Housing and neighborhood quality among undocumented Mexican and Central American immigrants. Soc Sci Res. 2013;42:1712–25.CrossRefGoogle Scholar
  60. 60.
    Hussein M, Diez-Roux AV, Field R. Neighborhood socioeconomic status and primary health care. J Urban Health. 2016;93(6):1027–45.CrossRefGoogle Scholar
  61. 61.
    Uchino B. Social support and health: a review of physiological processes potentially underlying links to disease outcomes. J Behav Med. 2006;29(4):377–87.CrossRefGoogle Scholar
  62. 62.
    Geronimus A, Hicken M, Keene D, Bound J. “Weathering” and age patterns of allostatic load scores among Blacks and Whites in the United States. Am J Public Health. 2006;96:826–33.CrossRefGoogle Scholar
  63. 63.
    Hoyt D’Anna L, Ponce N, Siegel J. Racial and ethnic health disparities: evidence of discrimination’s effects across SEP spectrum. Ethn Health. 2010;15(2):121–43.CrossRefGoogle Scholar
  64. 64.
    Krieger N. Theories for social epidemiology in the 21st century: an ecosocial perspective. Int J Epidemiol. 2001;30:668–77.CrossRefGoogle Scholar
  65. 65.
    Frost D, Lehavot K, Meyer I. Minority stress and physical health among sexual minority individuals. J Behav Med. 2013;38:1. Scholar
  66. 66.
    Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull. 2003;129:674–97.CrossRefGoogle Scholar
  67. 67.
    United States Department of Health and Human Services, Office of Minority Health. Diabetes and African Americans; 2014. Available from the Office of Minority Health website:
  68. 68.
    United States Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau. Child Health USA, 2013; 2013. Available from Maternal and Child Health Bureau website:
  69. 69.
    Seith D, Kalof C. Who are America’s poor children? Examining health disparities by race and ethnicity. National Center for Children in Poverty, Columbia University; 2011.Google Scholar
  70. 70.
    Blair C, et al. Salivary cortisol mediates effects of poverty and parenting on executive functions in early childhood. Child Dev. 2011;82(6):1970–84.CrossRefGoogle Scholar
  71. 71.
    Center on Budget and Policy Priorities. Policy basics: an introduction to TANF; 2015. Available from Accessed on 30 Apr 2018.
  72. 72.
    European Parliament. Directorate general for internal policies. Main Causes of Female Poverty, Compilation of In-Depth Analyses Workshop 30 March 2015; 2015. Available from Accessed on 30 Apr 2018.
  73. 73.
    McWhinney L, Irby D, Roberts E. Passed along: Black women reflect on the long term effects of social promotion and retention in schools. Int J Educ Reform. 2016;25(2):154.Google Scholar
  74. 74.
    United States Department of Education. Race to the Top program executive summary. Washington, DC: Author; 2009. Scholar
  75. 75.
    National Center for Education Statistics. Charter schools-Fact sheet; 2017. Available from
  76. 76.
    Glander M. Selected statistics from the public elementary and secondary education universe: school year 2014–15 (NCES 2016-076). U.S. Department of Education. Washington, DC: National Center for Education Statistics; 2016. Available from Accessed on 10 Aug 2017.Google Scholar
  77. 77.
    Ericson J, Silverman D, Berman P, Nelson B, Solomon D. Challenge and opportunity: the impact of charter schools on school districts. A report of the National Study of Charter Schools. United States Department of Education, Office of Educational Research and Improvement; 2001. Available from
  78. 78.
    Gleason P, Clark M, Tuttle CC, Dwoyer E. The evaluation of charter school impacts: final report [NCEE 2010-4029]. Washington, DC: U.S. Department of Education, Institute of Education Sciences, National Center for Education Evaluation and Regional Assistance; 2010.Google Scholar
  79. 79.
    Soderstrom M, Uusitalo R. School choice and segregation: evidence from an admission reform. Scand J Econ. 2010;112:55–76.CrossRefGoogle Scholar
  80. 80.
    Yoon E, Gulson KN. School choice in the stratilingual city of Vancouver. Br J Sociol Educ. 2010;31:703–18.CrossRefGoogle Scholar
  81. 81.
    Olszweski-Kubilius P, Clarenbach J. Unlocking emergent talent: supporting high achievement of low-income, high-ability students. Washington, DC: National Association for Gifted Children; 2012. Available from Scholar
  82. 82.
    National Association of Home Builders. Inclusionary zoning primer. Land use and design department; 2016. Available from
  83. 83.
    Economic Research Organization at University of Hawai’i. The unintended consequences of affordable housing policy; 2013. Available from
  84. 84.
    United States Department of Agriculture-Food and Nutrition Service. 2015a. Available from the USDA Food and Nutrition Service data website:
  85. 85.
    United States Department of Agriculture-Food and Nutrition Service. 2015b. Available from the USDA Food and Nutrition Service data website:
  86. 86.
    United States Department of Agriculture-Food and Nutrition Service. Food distribution, FDD history and background; 2013. Available from the USDA Food and Nutrition Service website:
  87. 87.
    United States Department of Agriculture-Food and Nutrition Service. Women, Infant, and Children (WIC), WIC food packages-monthly maximum allowances; 2016. Available from
  88. 88.
    United States Department of Agriculture-Agricultural Marketing Service. National retail report-fruits and vegetables, advertised prices for fruits & vegetables at major retail supermarket outlets ending during the period of 10/31 to 11/12, IX(44); 2015. Available from USDA Agricultural Marketing website:
  89. 89.
    Almada L, McCarthy I, Tchernis R. What can we learn about the effects of food stamps on obesity in presence of misreporting. Am J Agric Econ. 2016;98(4):997–1017.CrossRefGoogle Scholar
  90. 90.
    Carson EA. Prisoners in 2016. United States Department of Justice, Office of Justice Programs, Bureau of Justice Statistics. Bulletin NCJ 251149, January 14, 2018; 2018.Google Scholar
  91. 91.
    Schanzenbach D, Nunn R, Bauer L, Breitwieser A, Mumford M, Nantz G. Twelve facts about Incarceration and prisoner reentry. The Hamilton Project; 2016. Available from Accessed on 14 Jan 2018.
  92. 92.
    Prison Policy Initiative. State and federal prison wage policies and sourcing information; 2017. Available from Accessed on 16 Jan 2018.
  93. 93.
    The United States Constitution. U.S. National Archives. Amendments. Available from Accessed on 30 Apr 2018.
  94. 94.
    Carter W. Class as caste: the thirteenth Amendment applicability to class-based subordination. Seattle Univ Law Rev. 2016;39(3):813–28.Google Scholar
  95. 95.
    Alexander M. The New Jim Crow: mass incarceration in the age of colorblindness. New York, NY: The New Press; 2012.Google Scholar
  96. 96.
    Mumford M, Schazenback D, Nunn R. The economics of private prisons. The Hamilton Project; 2016. Available from Accessed on 14 Jan 2018.
  97. 97.
    Federal Bureau of Prisons. Work programs; 2017. Available from
  98. 98.
    Persyn M. Mass incarceration and child trauma. Poverty Race. 2017;26(3):7–11.Google Scholar
  99. 99.
    Kim J, Park E. Impact of socioeconomic status and subjective social class on overall and health-related quality of life. BMC Public Health. 2015;15:783.CrossRefGoogle Scholar
  100. 100.
    United States Department of Housing and Urban Development. Expanding housing choices for HUD-assisted families: moving to opportunity. First biennial report to Congress, Moving to Opportunity for Fair Housing Demonstration Program; 1996.Google Scholar
  101. 101.
    Nyung Q, Acevedo-Garcia D, Schmidt N, Osypuk T. The effects of a housing mobility experiment on participants’ residential environments. Hous Pol Debate. 2017;27(3):419–48. Scholar
  102. 102.
    Centers for Disease Control and Prevention. Health in all policies; 2016. Available from
  103. 103.
    Sanbonmatsu L, et al. Moving to opportunity for fair housing demonstration program final impacts evaluation, United States Department of Housing and Urban Development, Office of Policy Development and Research Report; 2011. Available from HUD website:

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Sharese N. Porter
    • 1
  1. 1.Department of Family and Community Health SciencesRutgers University, Cooperative ExtensionNew BrunswickUSA

Personalised recommendations