Chronic Illness and Quality of Health: Association of Income and Health

This article explores the association between income and chronic illness and quality of health. It discusses the prevalence of chronic illnesses among low-income individuals, the impact of food insecurity and childhood poverty, and the challenges of managing chronic illnesses for low-income families.

CHRONIC ILLNESS AND QUALITY OF HEALTH 1
Association of Income and Health
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CHRONIC ILLNESS AND QUALITY OF HEALTH
Is Income Associated With Chronic Illness And Quality Of Health?
Introduction
Sound health is significant because it influences how people feel and their daily
interactions. Most Australians aged above 15 years report that they have sound health, but
this could mean differently for different populations (Chang et al. 2015). Health is not just the
absence of illness but reflects the lifestyle, socioeconomic factors, environmental factors,
genetic as and cultural influences. Australia’s health 2016 deciphers health from various
standpoints such as the chronic illnesses that are most prevalent in Australia and the
particular socioeconomic inequalities that affect various groups within the population
(DeLaune, 2013). The latter also provides an overview of the Australian health system and
describes the services that are meant to minimize the occurrence of chronic illnesses in
Australia.
The report showed that Australia’s life expectancy was one of the highest globally
and that incidences of cardiovascular illnesses had dropped significantly. Despite this, more
than 11 million Australians had been diagnosed with at least one chronic illness in 2014-15.
The report further showed that the Australians that lived in remote and rural areas had poorer
health and life longevity as compared to those living in the suburb areas. In this paper, it is
argued that low-income individuals are more likely to experience chronic illness and poor
quality of health, as they are more exposed to common risk factors owing to their
socioeconomic status. This can be indicated by the prevalence of chronic illnesses among
low-income individuals who experience poor food security, are more exposed to risks of
child poverty and other social determinants of health, and are not likely to adhere to
medication regimen because of associated costs.
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Discussion
Chronic diseases are commonly regarded as ‘diseases of affluence,’ as they have
traditionally been associated with wealthy and elderly people (Somrongthong et al., 2016;
Suhrcke et al., 2006). For that reason, there is a popular belief that chronic illnesses like
cardiovascular diseases, chronic respiratory diseases, diabetes mellitus, cancers,
cerebrovascular diseases, and mental illnesses only affect individuals from high-income
families. Contrary to such expectations, chronic illnesses are not only prevalent among the
affluent people. Such chronic and gradually progressive diseases have today become
increasingly prevalent in consequence of considerable changes in lifestyles owing to the large
variations of income levels between individuals in the low income and upper-income groups.
Such observable patterns have appeared to disregard oversimplified conclusions.
Figure 1.3.3: Leading causes of death, by sex, Australia 2013
Various studies have indicated that chronic diseases and associated risk factors inflict
a significant burden on low-income individuals. Globally, chronic diseases are reported to
have consisted of 71.3 percent, or about 40 million, of all deaths that occurred between 1980
and 2015 (Okediji et al., 2017). In relation to this indication, a 2017 report by the World
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Health Organization (WHO) indicates that 80 percent of mortalities that arise from chronic
diseases were reported in low-income and middle-income countries (LMICs) (Okediji et al.,
2017). Chronic diseases make up the largest proportion of total deaths in many developing
regions of the world, apart from sub-Saharan Africa.
Although the incidence of risk factors for chronic illnesses may vary from one
country to the next, studies have indicated that the degree of their severity is high in countries
that are not particularly affluent, particularly the low-income and middle-income countries
(Suhrcke et al., 2006). In the contemporary society, low-income status is associated with
chronic illness and poor quality of health. Low-income individuals are at greater risks of
chronic illnesses than high-income individuals as they are more exposed to risk factors like
smoking or lack of exercise.
Low-income status is associated with poor food insecurity, which may, in turn,
increase exposure to a chronic illness and poor quality of health. Food insecurity is an
inability of an individual to afford nutritious food to live a healthy and active life (Seligman,
Laraia, Kushel, 2010). There is a growing awareness in the healthcare sector that social
determinants of health lead to health disparities and or health outcomes (Food Research &
Action Center, 2017). A relevant example of a social determinant of health in this regard
includes food insecurity; low-income families may not sustainably afford a healthy diet.
Families from low-income residents tend to have fewer resources that support good
health, such as access to nutritious foods and recreational facilities that allow them to prevent
the development of chronic diseases. Accordingly, low-income status is associated with
poverty and food insecurity, and ultimately poor health incomes. Some studies have indicated
the relationship between food insecurity and poor health outcomes (Seligman et al., 2010). In
Seligman’s et al. (2010) study, the researchers found that majority of adults surveyed who
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live in food-insecure households are incapable of affording balanced diets and worry about
the sufficiency of their food supply and risks of running out of food supply. Accordingly,
they were found to be more at risk of mental illnesses, such as long-term depression. As a
result, it is clear that low-income status is associated with chronic illness and poor quality of
health, as individuals who experience food insecurity owing to their low income-status are
more exposed to chronic illnesses like a mental disorder.
Low-income is also associated with childhood poverty, which exposes children from
poor families to a greater risk of developing a chronic illness like asthma. Studies have
established that such economic conditions pose significant threats to children’s health
(Raphael, 2011). The health risks linked to childhood poverty vary from higher incidences of
chronic illnesses to higher levels of infant mortality because of living in poor households or
neighborhoods in polluted environments. Raphael (2011) established that children from poor
quality housing were more exposed to high risk of chronic illnesses like asthma. Such a
condition may carry on in spite of later life situations. Several explanations have been
provided for this. According to Raphael (2011), children who experience deprivation because
of their social class habitually experience adverse health outcomes because of the dirty poor
households or polluted environments that they are often exposed to. Hence, it can be
concluded that low-income status is closely associated with chronic illness and poor quality
of health, as childhood poverty is associated with higher risks to chronic disease and poor
quality of health.
Low-income status is associated with economic hardship and poor lifestyles, which
are in turn closely linked to poor management of chronic illness and poor quality of health.
Patients with chronic illnesses from low-income families are less likely to afford the direct
costs associated with nursing and treating chronic illness. In their descriptive cross-sectional
study, Okediji et al. (2017) aimed to establish the economic effects of chronic diseases on
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households of individuals in Nigeria and to clarify the varied coping strategies that household
in the country use low and middle-income countries (LMICs) to overcome the negative
economic effects.
From the survey of 443 patients with different chronic diseases, Okediji et al. (2017)
established that chronic diseases were associated with high burdens on patients. This had
disastrous effects regarding making it difficult for individuals from low-income families to
manage chronic illnesses. Similarly, attendant implications such as higher medical bill can
contribute to economic impoverishment. Okediji et al. (2017) define the term economic
impoverishment, as a process of asset depletion and household income that lead to a drop in
healthy consumption levels and a rise in mortality in LMICs. As Okediji et al. (2017) further
explain, there are significant costs associated with nursing and treating chronic illness. These
include the cost of medicine and traveling to hospitals to access healthcare. Over time, such
costs can deplete a patient’s resources. Overall, the costs can be classified into direct and
indirect costs. The direct costs comprise the costs that come about from using medication,
gaining admission in the hospital, and transportation to a healthcare facility.
Conversely, indirect costs consist of the cost of loss of manpower or man-hours when
an individual with a chronic illness dies or fails to report to work (Kim et al. (2016).
Accordingly, individuals from low-income families are less likely to afford the direct costs
associated with nursing and treating chronic illness. Patients with chronic illnesses who are
unable to afford the growing healthcare expenses tend to demonstrate poor management of
chronic illness. For instance, in the region, Guyana and Haiti reported the highest mortality
rates for stroke in 2002. Studies have also indicated that 30% of premature deaths that arise
from stroke occur in the poorest 20% of the population, while only 13% of the premature
deaths occur in the richest 20%. In concluding, low-income status is a major contributor to
the development of chronic illness and exposure to the poor quality of health, as it leads to
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economic hardships, loss of earning capacity, and consequently poor management of chronic
illness.
Low-income is associated with poor adherence to health behavior change, and
consequently poor management of chronic illness. Current chronic disease prevalence
literature has shown that management of chronic illnesses demands that a patient should
adhere to recommended health behavior change (Campbell et al., 2014; Shaw et al., 2008).
Studies have indicated a link between low income and lack of adherence and showed that
individuals with low income are less likely to adhere to the recommended treatment regimen
(Campbell et al., 2014). In their study, Campbell et al. (2014) investigated the relationship
between household income and health behavior change and established that patients with
chronic illnesses from a low-income family are less likely to adhere to behavior change
outcome because of different factors like low literacy levels and the high cost of a medication
regimen.
Population health experts have suggested that the capacity of children with chronic
illness to adhere to recommended behavior change is often inhibited by external factors
called social determinants of health (SDH) like socioeconomic status (Shaw et al., 2008).
While socioeconomic status is a variable that involves a number of the SDH like income,
immigration status, ethnicity, social class, and education level, socioeconomic status is
mostly linked to income. Touchette & Shapiro (2008) also elaborated that income is among
the most significant social determinants that affect behavior change.
A related study by Mishra et al. (2011) attempted to investigate the reasons behind
patients’ non-adherence to recommended behavior change and established that a majority of
the reasons that participants provided included the costs that come with behavior change and
low-income levels, which lead to lower literacy levels and the procedural complexities.
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According to Mishra et al. (2011), a majority of behavior change models recommended for
treatment or management of chronic illnesses is associated with significant procedural
complexities of drug regimens, which also come with additional costs to patients. The use of
lifestyle-based health promotion interventions is affected by the capacity of patients to adhere
to prescribed behavior changes.
Poor adherence to prescribed behaviors recommended in lifestyle interventions is
prevalent, chiefly in the long-term. Therefore, the “adherence problem” embodies a major
challenge to the efficacy of medications. Regrettably, non-adherence to prescribed behavioral
change and medication regimens tends to be prevalent among patients with chronic illnesses
from poor families. A study by Middleton, Anton, and Perri (2013) reported higher rates of
non-adherence to be as high as 80 percent. Behavioral therapy studies have also indicated that
a majority of patients with chronic illnesses who experience difficulty in adhering to
recommended healthy behavior, with the premature drop-out rate being as high as 60 percent
tended to be prevalent among individuals from low-income families.
The “adherence problem” embodies a significant challenge across medicine and
public health, particularly in respect to situations where research demonstrates that people
who fail to adhere to health interventions tend to witness substantially fewer health benefits
(Middleton et al., 2013). For this reason, it becomes apparent that low-income status is
associated with chronic illness and quality of health, as individuals with low income tend to
demonstrate poor adherence to health behavior change and report poor quality of health.
Conclusion
In conclusion low-income individuals are more likely to experience chronic illness
and poor quality of health, as they are more exposed to common risk factors owing to their
socioeconomic status. This is indicated by the prevalence of chronic illnesses among low-
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income individuals who experience poor food security, are more exposed to risks of child
poverty and other social determinants of health, and are not likely to adhere to medication
regimen because of associated costs. In the contemporary society, low-income status is
associated with chronic illness and poor quality of health. Low-income individuals are at
greater risks of chronic illnesses than high-income individuals as they are more exposed to
risk factors like smoking or lack of exercise.
Low-income status is associated with poor food insecurity, which may, in turn,
increase exposure to a chronic illness and poor quality of health. As a result, it is clear that
low-income status is associated with chronic illness and poor quality of health, as individuals
who experience food insecurity owing to their low income-status are more exposed to chronic
illnesses like a mental disorder. Also, low-income is associated with childhood poverty,
which exposes children from poor families to a greater risk of developing a chronic illness
like asthma. Low-income is also associated with poor adherence to health behavior change,
and consequently poor management of chronic illness. For this reason, non-adherence to
prescribed behavioral change and medication regimens tends to be prevalent among patients
with chronic illnesses from poor families.
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