Addressing the Impact of Poverty on Health

The 46.5 million Americans who live in poverty are measurably less healthy and have far worse health outcomes than the rest of the population. Less certain is how much of these negative health outcomes are directly caused by poverty and how much is caused by other factors.

America would be better off if everyone were healthy, regardless of income — especially since government programs cover some of these costs directly. How should we think about the role and impact of poverty within the larger question of health?

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Meet the Challenge Team

The Challenge Team Members are leaders in their fields and reflect multi-disciplinary, passionate and thoughtful perspectives for the Challenge they represent.
Challenge Team members participate in the discussion held by the Great Challenges community, and will be creating responses to questions submitted by the community on the discussion tab.

  - look for this icon throughout the Great Challenges discussions. It is used to identify comments posted by the Challenge Team members.

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Robert Atkins, PhD, RN
Associate Professor, Nursing/Childhood Studies, Rutgers University Camden
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Robert (Bob) Atkins is the Associate Dean for Academic Affairs in the School of Nursing and an Associate professor with a joint appointment in Nursing and Childhood Studies at Rutgers University Camden. Bob has a Bachelor’s degree in Political Science and American Civilizations from Brown University and in Nursing from the University of Pennsylvania. After completing his nursing degree, Bob moved to the city of Camden where he worked as a school nurse at East Camden Middle School and co-founded the Camden STARR Program, a non-profit youth development program dedicated to improving the life chances of youth living in Camden. Bob’s work in Camden motivated him to pursue a Ph.D. in Health Studies at Temple University, which he completed in 2004. 

Dr. Atkins’ research with nationally representative longitudinal survey data and qualitative data collected in Camden explores the effects of urban poverty on child and adolescent health and development. Atkins’ current work explores questions about the health and development of youth living in high-poverty neighborhoods, which include: What social and institutional processes mediate the relationship of high-poverty neighborhoods to the health and well being of youth living in those neighborhoods? What do youth in high-poverty neighborhoods do to promote, maintain, or restore their own health?

My perspective on poverty and health has been shaped by my experiences in Camden -- one of America’s poorest cities -- as a school nurse, researcher, and the founder of a non-profit youth development program. I have found that insufficient resources (e.g., access to care, health literacy) often mean that subacute health problems like unhealthy diet receive a lower priority than making sure children are safe from neighborhood violence and putting food on the table. Attending to subacute health problems is vital as a growing body of evidence suggests that childhood and adolescent health and health behaviors greatly influence adult morbidity and mortality.

Robert Atkins, PhD, RN
Associate Professor, Nursing/Childhood Studies, Rutgers University Camden
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Gary Slutkin MD
Founder, CureViolence
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Gary Slutkin, M.D. founded Cure Violence, formerly CeaseFire a public health approach to violence prevention, after more than a decade with the World Health Organization fighting infectious disease in Africa and Asia. Dr. Slutkin applied the same science-based strategies developed to control tuberculosis, cholera and AIDS to stop the spread of violence. In its first year, Cure Violence reduced shootings by 67%. Since those initial results, subsequent research has shown that Cure Violence successfully reduces shootings and killings. A 2008 study by the U.S. Department of Justice reported significant drops in violence in Chicago’s most volatile neighborhoods, including a 100 percent reduction in retaliatory murders. A 2012 study from Johns Hopkins Bloomberg School of Public Health shows a replication of the program in Baltimore cut homicides in half and changed youth attitudes and behaviors away from using violence. Inspired by Dr. Slutkin’s work, the Institute of Medicine and U.S. Conference of Mayors recently affirmed the need to approach violence as an epidemic control public health issue. Currently, Cure Violence has 50 partner sites in 15 U.S. cities, including Baltimore, Chicago, Kansas City, New Orleans, New York City, Philadelphia and 5 countries. 

Violence has a price tag. When shootings are common in a neighborhood progress on jobs, housing and schools are blocked. Communities with high violence rates struggle economically evidenced by shuttered storefronts and abandoned buildings. Businesses are afraid to invest. Insurance rates are high and the potential for success is low. Reducing violence can lead to increased tax revenues, improved housing values and business growth. Violent behavior also has harmful economic consequences for individuals. Those convicted of a felony are often barred from jobs, housing and public assistance preventing them from contributing to their communities.

Gary Slutkin MD
Founder, CureViolence
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Gail Christopher, DN
Vice President of Program Strategy, W.K. Kellogg Foundation
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Dr. Gail Christopher is Vice President for Programs at the W.K. Kellogg Foundation in Battle Creek, Michigan. In this role, she serves on the executive team that provides overall direction and leadership for the Kellogg Foundation, and provides leadership for Food, Health & Well-Being, and Racial Equity programming. She is a nationally recognized leader in health policy, with particular expertise and experience in the issues related to social determinants of health, health disparities and public policy issues of concern to African Americans and other minority populations. A prolific writer and presenter, she is the author or co-author of three books, a monthly column in the Federal Times, and more than 250 articles, presentations, and publications. Prior to joining the Kellogg Foundation, Dr. Christopher was Vice President of the Joint Center for Political and Economic Studies’ Office of Health, Women and Families in Washington D.C. She holds a doctor of naprapathy degree from the Chicago National College of Naprapathy in Illinois and completed advanced study in the interdisciplinary Ph.D. program in holistic health and clinical nutrition at the Union for Experimenting Colleges and Universities at Union Graduate School of Cincinnati, Ohio.

Social determinants of health are the conditions in which people are born, grow, live, work and age. These conditions are often shaped by the entrenched patterns of residential racial segregation and resource distribution. In the US, more than half of all children of color face the burden of “double jeopardy” of both living in poverty and in low-income neighborhoods. And many carry the associated lifetime burden of health inequities - with higher rates of infant mortality, childhood obesity, diabetes and toxic stress. At the W.K. Kellogg Foundation, we envision a nation that marshals its resources to assure that all children thrive.

Gail Christopher, DN
Vice President of Program Strategy, W.K. Kellogg Foundation
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Rebecca Onie
Co-Founder & CEO, Health Leads
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Rebecca Onie co-founded Health Leads (formerly Project HEALTH) in 1996, as a sophomore at Harvard College, along with Dr. Barry Zuckerman at Boston Medical Center. From 1997-2000, Rebecca served as Executive Director of Health Leads. At Harvard Law School, she was an editor of the Harvard Law Review and research assistant for Professors Laurence Tribe and Lani Guinier. Rebecca clerked for the Honorable Diane P. Wood of the U.S. District Court of Appeals for the Seventh Circuit and was an associate at Miner, Barnhill & Galland P.C., a civil rights and community economic development firm. During this time, Rebecca co-chaired Health Leads’ Board of Directors.

In 2006, Rebecca returned as Chief Executive Officer of Health Leads, now operating in Baltimore, Boston, Chicago, New York, Providence, and Washington, D.C. Last year, Health Leads’ corps of nearly 1,000 college volunteers assisted 8,800 low-income patients and their families in accessing food, heat, and other basic resources they need to be healthy. In 2009, Rebecca was honored to receive a MacArthur “Genius” Fellowship. In 2010, O! Magazine named her to its Power List of 20 women who are “changing the world for the better.” Most recently, she was named to Forbes Magazine’s Impact 30, recognizing the worlds top 30 social entrepreneurs. Rebecca is a World Economic Forum Young Global Leader, U.S. Ashoka Fellow, and member of the Young Presidents’ Organization and the Mayo Clinic Center for Innovation External Advisory Council. She has received the John F. Kennedy New Frontier Award; the Jane Rainie Opel ’50 Young Alumna Award; and the Do Something Brick Award for Community Leadership.

Every day in America, doctors prescribe antibiotics to patients who have no food at home or are living in a car. Yet, our healthcare system -- focused on treating illness rather than promoting health-- is not designed to tackle the well-documented impact of poverty on health. In 1996 I started Health Leads, a national organization that enables physicians to write prescriptions for food, heat, or other critical resources, just as they would medication. Patients then take their prescriptions to the clinic waiting room, where our college student advocates work side by side with patients to connect them with the basic resources they need to be healthy. We envision a healthcare system that addresses all patients' basic resource needs – and, therefore, the impact of poverty on health -- as a standard part of quality care.

Rebecca Onie
Co-Founder & CEO, Health Leads
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Sandeep Kishore, M.D., PhD
Co-chair, Young Professionals Chronic Disease Network
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Sandeep Kishore is a post-doctoral fellow at Harvard Medical School and co-chair of the Young Professionals Chronic Disease Network (YP-CDN), a global group of 400 young professionals from 50 countries committed to the equitable prevention and treatment of noncommunicable diseases. He seeks to leverage lateral thinking and trans-disciplinary approaches at universities worldwide, with the goal of preparing and cultivating the next generation of young leaders to tackle health challenges of the 21st century. In this capacity, he served as a delegate to the United Nations General Assembly in 2011.

My entrée to the field of ‘global health’ and poverty alleviation began in high school when I lost a personal mentor to cerebral malaria in India. I myself came down with a 104 degree fever and was semi-comatose. I couldn’t help but compare my life to that of my mentor. Here was the difference: I had access to the world’s best therapies and resources to recover. That early childhood experience provided the motive force for 12 years of work on malaria research and seeking cures as a medical scientist. This biomedical model, however, was challenged when I realized the changing picture of illness globally – particularly the plight of chronic, non-communicable diseases. Thee were diseases that few associated with poverty, but I saw that these health issues of the 21st century were both a cause and consequence of poverty. Moreover, I sensed that a ew paradigm for tackling the ‘causes of the causes’ of these health issues was now needed – one that tackled the social and economic determinants of health. My vision is to create a synergy between the biomedical and social determinants, reunifying prevention and cure, for a 21st century social transformation driven from the world’s university students and young professionals. 

Sandeep Kishore, M.D., PhD
Co-chair, Young Professionals Chronic Disease Network
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Christine Simiriglia
Executive Director of Pathways to Housing PA
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Chris Simiriglia established the Pathways Program in Philadelphia in September of 2008. Pathways in Philly provides permanent, supportive, scattered site housing serving 310 chronically homeless men and women recovering from severe mental illness, long term alcoholism, co-occurring disorders and a multitude of serious untreated medical conditions. The housing is bundled with Assertive Community Treatment (ACT) Services, an Integrated Healthcare Program, and Representative Payee Services all provided in a Harm Reduction Model. Pathway has had remarkable results with a population that doesn’t usually see a lot of successes.

For fifteen years prior, Chris worked with the Mental Health Association of Southeastern Pennsylvania, leaving the position of Vice President in 2008. In the early 90’s she managed the I Do Care Foundation. Prior to that, she ran the Outreach Coordination Center; was Assistant Director at the City’s Office of Services to the Homeless and Adults; and served as Assistant Director for the Philadelphia Committee for the Homeless.

 In between, Chris has done consulting work in the area of Organizational Management, (her Master's concentration.) 

Over the years, Chris has had several papers and tool kits published that relate to her work with people who are homeless and have a mental illness.

Those who emerge from the shadows of homelessness bring the disparities in our healthcare system into sharper focus. People with serious mental illness (SMI) are disproportionally represented among the chronically homeless. People with serious mental illness experience significant health disparities. Recent studies suggest that people with SMI die approximately 25 years earlier than those in the general US population. Unfortunately, this mortality gap is widening, suggesting that those with SMI have not benefited from advances in the US healthcare system. Cardiovascular conditions and other treatable and preventable chronic diseases contribute heavily to excess morbidity and mortality in this population. Additionally, the health problems of people experiencing homelessness are significant and complex. Most chronically homeless individuals have multiple disabilities including SMI, chronic medical conditions, and co-occurring substance use disorders. These unacceptable disparities persist, despite most chronically homeless people regularly interfacing with multiple systems including shelters, hospitals, mental health, drug and alcohol, criminal justice, social security and welfare. We need to find a better way coordinate care for poor people the same way we coordinate care for ourselves.

Christine Simiriglia
Executive Director of Pathways to Housing PA

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Challenge Team Perspectives

We selected 10 questions out of the many submitted by our Great Challenges Community, to be addressed by each of our Team members.
See their responses and perspectives, below.

Question 1

Low socioeconomic status increases stress and can negatively effective mental health, but lack of access and cultural barriers can stand in the way of treatment, particularly in minority communities. Are there non-traditional care models that might better serve these communities, including making people more comfortable discussing mental health concerns?
Response from Gail Christopher, DN

Responses By Team Member:

Gail Christopher, DN
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