Exploring Economic Instability as a Social Determinant of Health

This essay delves into the significant impact of economic instability as a social determinant of health, particularly focusing on families living under the poverty line in the United States. It examines key issues such as employment, where job stress and precarious working conditions contribute to physical and psychological health problems, and food insecurity, which leads to malnutrition and chronic diseases. The essay further explores housing instability, highlighting its association with violence, substance abuse, and poor health outcomes. It also addresses the broader issue of poverty and its far-reaching effects on health. The paper concludes with recommendations aimed at mitigating the negative impact of economic instability on health, emphasizing the need for comprehensive and targeted interventions to improve the well-being of vulnerable populations. Desklib provides a platform to access similar essays and study resources.

Running head: SOCIAL DETERMINANTS OF HEALTH
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Social Determinants of Health
Author:
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Contents
Introduction......................................................................................................................................3
Economic Instability........................................................................................................................4
Employment.................................................................................................................................5
Food insecurity.............................................................................................................................6
Housing instability.......................................................................................................................8
Poverty.........................................................................................................................................9
Recommendations to mitigate the negative impact of economic instability.................................10
Conclusion.....................................................................................................................................12
References......................................................................................................................................13

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Introduction
Health is the one of the top trendy topics of all time. Whether one is in the grass root level or at
international agencies, one would find it discussed there. Health is defined by World Health
Organisation as “state of complete physical, mental and social well-being and not merely the
absence of disease or infirmity” (WHO, 2006). It is an important sector as it impacts both the
economy and livelihood of the people. One of the reasons that make health such a key issue is
that it is affected by a number of factors making it a vulnerable sector. These factors are known
as determinants of health. The determinants range from personal, social, economic and
environmental factors and they are what distinguish those who are healthy from the unhealthy.
Determinants of health fall into the following categories: policymaking, social, health services,
personal behaviour and physiological factors (HealthyPeople.gov, n.d) (CDC, 2014).
Out of the five categories listed above, social determinants of health do receive a lot of attention.
So what are social determinants of health? These describe the environment where one lives,
learns, works and plays. They do affect the general well being of a person and the population as
they affect their functioning and health outcomes (HealthyPeople.gov, n.d). Social determinants
of health are categorized into education, economic stability, and neighbourhood and built
environment, health and health care and social and community context (HealthyPeople.gov,
2010).
Social determinants of health affect health as they do affect the other determinants. The level of
education and the economic stability of a population have been associated with better
implementation strategies of policies geared towards healthcare as information and resources are

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available. Social determinants also affect the personal behaviour of a person as it is linked with
one’s lifestyle. Aside from this, social determinants of health complement each other whereby
one determinant can influence another determinant. For example education correlates with
economic stability in that people with higher education levels have better socioeconomic status
which brings about better health. These are both protective factors that help in the prevention of
diseases and psychological distress.
It is agreed that the social determinants do affect specific populations, but how exactly do they
do this? There are three ways in which this happens. These are differences in exposure,
vulnerability and consequences (Fusco, Akerman, Drezett, & de Souza e Silva, 2016). Difference
in exposure explains why a certain population group will be more affected by health risks than
others while difference in vulnerability explains why certain population groups are afflicted with
health problems and not others. Lastly, difference in consequences explains the different health
outcomes among different population groups (Fusco, Akerman, Drezett, & de Souza e Silva,
2016). This paper shall focus more on economic instability and its effect among the families
living under the poverty line in the US.
Economic Instability
Economic stability is a term that talks about the economic level of an individual and population.
It brings about the sense of one being able to live comfortable and also someone who lives above
the poverty line. Under this factor there are key issues that are considered. These include
employment, food insecurity, housing instability and poverty (HealthyPeople.gov, 2010).
Economic instability is a key factor as it not only affects the individuals as it dictates their health

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seeking behaviours through accessibility, availability and affordability of health services. It also
affects the government and international agencies through policy planning and implementation.
Employment
Employment is an important aspect in a nation as it helps build its economy. Being employed is
both a predisposing factor and a protective factor. Having a job is a predisposing factor due to
the increased stress that is brought about by the organization, management and relationship with
others at the workplace (World Health Organisation, 2003). One’s schedule, roles and
responsibilities, relationship with both the management and the colleagues has a great impact on
the level of stress one encounters. Job stress is defined as ‘the harmful physical and emotional
response that occurs when the requirements of the job do not match the capabilities, resources or
needs of the worker‘ (US National Institute for Occupational Safety & Health (NIOSH), 1998).
The level of control over one’s job is also an important factor that has been associated with stress
and health problems. Those who have less control over their jobs are associated with health
problems like lower back pain, heart diseases and increased sickness absence (World Health
Organisation, 2003). This has been assessed through the consideration of one’s work demands
versus the control. Those with high work demands and low control are more predisposed to
health problems as compared to those with high work demands and high control (World Health
Organisation, 2003). Aside from the physical health problems stated above, this is also
associated with psychological problems like depression, anxiety and burnout (US National
Institute for Occupational Safety & Health (NIOSH), 1998). Maladaptive behaviours like
smoking and alcohol abuse is also associated with them. These are known to predispose one to
non communicable diseases like diabetes, hypertension, cancer etc. In the United States, 40% of
the workers are very or extremely stressed due to their job. This has led to them reporting neck

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pain, back pain, depression, burnout and anxiety as the health problems that they experience due
to this stress. This might have been caused by the increase in the number of hours they work and
that it is not uncommon for one to have more than one job (US National Institute for
Occupational Safety & Health (NIOSH), 1998). Those who live below the poverty line are
forced to work more than one job so as to make their earnings. This has led to people working
more than 40 hours a week. This figure can go up to 51 or more hours a week and 30 % of those
who work these hours are extremely stressed (Statista, 2017). Working more than 50 hours also
affects their health outcomes in that they rarely have time to eat a decent meal and have enough
rest. This leads to burnout.
The positive aspect of employment comes about in that it helps to raise the socioeconomic status
of a person. Employment is a good factor for good individual and population health (University
of Tampere, 2016). Employment and good quality of work brings about food security through
the accessibility and affordability of food, stable housing in good and safe neighbourhood, good
education, insurance covers and accessibility and affordability of health services. This helps
reduce stress that is associated with food insecurity, instable housing and inaccessibility of health
services as one gets regular wages and improves social status (University of Tampere, 2016). In
the United States, In the United States, it was found that work is associated with better physical
and mental wellbeing as it is associated with financial benefits like medical covers, increased
household income and accessibility to food, safe housing and healthcare and psychological
benefits as it brings about ‘self esteem, self worth, identity and purpose’ (Staudinger, Finkelstein,
Calvo, & Sivaramakrishnan, 2016) (Goodman, 2015).

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Food insecurity
Food insecurity is defined by FAO as “A situation that exists when people lack secure access to
sufficient amounts of safe and nutritious food for normal growth and development and an active
and healthy life” (Napoli, De Muro, & Mazziotta, 2011). This has been associated with
unemployment and poverty whereby people are not able to purchase foods. It has also been
highly associated with health problems. Healthy diets and in adequate supply are important for
the general well being of a person. Shortage or excess consumption of food can cause
malnutrition with shortage causing under nutrition and excess consumption leading to obesity.
Obesity came to be after urbanization through better housing and good sanitation and this led to
the shift from communicable diseases to non communicable diseases like diabetes, cancer,
hypertension etc.
Globally, 815 million people go hungry (Pudar, 2017). This is the reason why food security is
receiving a lot of attention. In the United States, approximately 50 million people face food
insecurity (Gundersen & Ziliak, 2015). Food insecurity leads to malnourishment. In children,
under nutrition poses the risk of underdevelopment leading to impaired cognitive and physical
performance and low immunity leading to an increase in infections (Pudar, 2017). Aside from
under nutrition, obesity is on the gain especially in adults with a standing of 640.9 million people
(Pudar, 2017). The effects of obesity are far reaching. It is one of the main predisposing factors
to non communicable diseases such as hypertension, diabetes, cardiovascular diseases etc.
Economic and social classes do bring about health disparities. The main difference is the source
of nutrients consumed. While the rich consume high energy foods, fats and sugars, the poor
consume processed foods which are cheaper as compared to fresh foods. This has led to obesity

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being associated with the rich and under nutrition being associated with people of low
socioeconomic status (World Health Organisation, 2003).
In the United States, the duration of food insecurity is chronic which means that it is present for
long periods of time and more frequencies (Seligman, 2016). Food insecurity affects people
across the lifespan. Children afflicted by food insecurity are associated with lowered emotional
and cognitive development which significantly affects their academic performance. They are also
associated with physiological problems like iron deficiency anaemia and mental conditions like
depression and anxiety (Seligman, 2016). Food insecurity affects pregnant women to a large
extent. Poor feeding may lead to issues with maintaining and delivery of the baby. This is
brought about by iron deficiency anaemia, depression and too much weight gain. Children
delivered from such mothers are at risk of low birth weight that affects proper development of
the child. (Seligman, 2016). Just like other places globally, food security among the adults in the
United States is associated with chronic conditions like diabetes, hypertension, cancer and heart
diseases (Seligman, 2016)
Housing instability
Housing instability is defined as the inability to pay rent and spending more than half of one’s
income housing (Kushel, Gupta, Gee, & Haas, 2006). It is evidenced in multiple moves, living
with others, eviction, foreclosure/being behind on mortgage and homelessness (Horowski,
Burgard, Seefeldt, & Zelner, 2012). One major factor that brings about housing instability is
poverty in that one cannot afford one of the basic needs; shelter. In a study carried out by Kushel,
Gupta, Gee, & Haas, 2006, it revealed that the prevalence for housing instability is 26.3% and
(4/5) of the respondents live either on or below the poverty line. Housing instability is associated
with poor health outcomes due to one postponing seeking health in efforts to find or provide

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housing. This is reflected by not seeking health when sick and not purchasing medication
(Kushel, Gupta, Gee, & Haas, 2006).
Housing instability is associated with unstable security. Most people end up living in
environments that lack security and are prone to violence. This leads to violence related injuries
and deaths. This is the case in many slums where robbery, murder, rape are prone as compared to
gated communities. Aside from this, housing instability is associated with intimate partner
violence (Rollins, et al., 2011). In the United States, housing instability is associated with the
use of acute care services and an increase reporting to the emergency department. This is
believed to be due to the violence and injuries associated with poor housing and unsafe
neighbourhoods (Kushel, Gupta, Gee, & Haas, 2006).
Alcohol and drug abuse, anxiety and depression are highly associated with housing instability.
The alcohol and drug abuse is believed to be highly correlated with the increase of violence and
a major predisposing factor to intimate partner violence. There are increased levels of drug and
alcohol abuse among these people as it serves as coping mechanism. Alcohol and drug abuse
does predispose them to health problems like cancer, cardiovascular disorders and hypertension.
Housing instability causes psychological distress and disorders. Common psychological
symptoms are anxiety, depression, and loss of self esteem, self worth, identity and purpose
(Horowski, Burgard, Seefeldt, & Zelner, 2012). This predisposes them to stress induced or
exacerbated illnesses like hypertension, diabetes, arthritis etc.
Poverty
Poverty and health are highly interlinked in that poverty does cause poor health outcomes
whereas poor health outcomes lead to poverty (Health Poverty Action, n.d). Poverty is defined as

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inadequate amount of money needed in order to meet the three basic needs; food, shelter and
clothing (UNESCO, n.d). Poverty line is the necessary income needed to meet daily basic needs.
The international poverty line is set at 1.90$ a day. Globally, approximately 767 million people
live under the poverty line (World Bank, 2018). This large figure is what led to the declaration of
no poverty as the sustainable development goal one. In the US, 43.1 million people lived under
the poverty line (University of California, 2017). One of the major causes of poverty is
unemployment. Unemployment is associated with premature death. This is due to the impact it
has on health outcomes. It affects both the physical and psychological aspect of a person.
Psychologically it leads to high levels of stress, depression, anxiety and drug and alcohol abuse.
The drugs and alcohol are a means of coping with the stress levels experienced. These lead to or
exacerbate physical problems like diabetes, hypertension, headaches, heart diseases etc (World
Health Organisation, 2003).
These health problems come about due to a number of factors. First is the lack of accessibility
and affordability of health services and medication. This is brought about by people prioritizing
the other basic needs instead of seeking healthcare when sick. It can also manifest itself by
people lacking the money to pay for the services and medication making them not seek help at
all. Food insecurity is another factor which makes them not able to afford fresh and healthy
foods instead they settle for processed foods leading to malnourishment. As discussed earlier,
housing instability is a result of poverty. It is highly associated with maladaptive behaviour and
violence both intimate and neighbourhood. Poverty is also associated with poor sanitation and
overcrowding bringing about spread of communicable diseases like cholera and tuberculosis
(Murray, 2006)

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Recommendations to mitigate the negative impact of economic instability
From the discussion above, it is clear that economic instability is a major factor for poor health
outcomes through work related stress, food insecurity, housing instability and poverty. These
issues do bring about an increased prevalence of both psychological and physical problems like
depression, anxiety, alcohol and substance abuse, diabetes, hypertension and heart diseases just
to name a few. Because of this, it is important for the implementation of strategies that mitigate
these problems.
First in order to deal with work related stress, there is need of employers providing better
working conditions for their employees by clearly stating their roles, responsibilities, demand
and increasing the amount of rewards they receive. This will not only help in reducing stress but
will also improve the employees’ productivity. Also there is need of involving employees in
making of decisions that do affect them. This will increase their sense of control leading to
lowered stress. Another intervention can be the inclusion of stress management strategies such as
company fun day and inclusion of mental health practitioners like psychologists who will help
fellow colleagues deal with stress (World Health Organisation, 2003).
Regarding food security, there is need of policies that reduce the prices of fresh, healthy foods.
This will help people purchase healthy foods as compared to processed foods. There is also need
for creation of awareness of healthy eating habits. This information can be geared to the
community and also made children friendly (World Health Organisation, 2003). This will help to
increase the knowledge of the community. Another intervention that can be started is the use of
community gardens. This will help make fresh and healthy foods like vegetables accessible and
available at affordable prices.

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The government can enact housing subsidies so as to curb housing instability. This will help
make houses affordable helping reduce the psychological distress faced by people who cannot
afford to pay rent or buy a house. According to Quigley, Raphael, & Smolen, (2001) making
houses affordable is the most effective intervention in curbing homelessness. Assistance can be
offered to people with rent and mortgage arrears. This has proved to help in the past as only 2-
5% of families become homeless as compared to 20% that are evicted without any assistance
(Burt & Pearson, 2005). Collaboration between the private and public sector is important in
bringing about affordable housing that people can rent or buy.
Poverty is multifaceted issue. It can be solved from different angles. First, the government
should provide scholarships to people of low socioeconomic status. This helps them get formal
education which brings about better employment opportunities as compared to no education.
This will help uplift the families by increasing the household income. More job opportunities
should be provided so as to curb unemployment. This will help more people to be absorbed to
the labour market. The private and public sector can collaborate and provide skills training like
tailoring, carpentry, and construction etc for those who did not receive formal education. This
will help them boost their household income and even create employment for others.
Conclusion
Health is a vulnerable sector as it is affected by a number of factors which are policymaking,
social, health services, personal behaviour and physiological factors. Among these factors, social
determinants of health are considered as they affect both the society and the individual.
Economic instability is among the issues under social determinants of health. The impacts of
economic instability on health outcomes are seen very clearly among families that live under the