The recent government shutdown provided many with a small glimpse of what it might be like living from paycheck-to-paycheck. Many furloughed government workers expressed fear of not being able to pay their bills on time or provide for their families due to a delayed paycheck. Particularly striking were pictures of furloughed workers lining up to receive free meals or food from food pantries.
While these experiences are all too familiar for many of those living with limited resources, these images and stories of government workers should make us reexamine our ideas of who people in need are in this country. Safety nets once reserved for the poor or unemployed are now being used by those assumed to have stable middle class lives. An unexpected result of the government shutdown is it may have helped point to how many of those in need have been invisible.
{mosads}Evidence suggests there is a growing number of people who fall into this category, including the working poor who cannot afford health insurance or other necessities of life and college students who cannot afford food or housing. Consider the working poor.
While we have witnessed a decline in the unemployment rate (9.6 percent in 2010 to 4.4 percent in 2017), The Working Poor Families Project reports that there are more low income working families now than at the beginning of the recession in 2007. Three in 10 working families do not have the money to meet basic necessities. Racial and ethnic minority families are twice more likely to be poor or low income (44 percent) compared to non-Hispanic whites (21 percent).
Turning to food security, according to Hunger and Health one in 8 Americans were food insecure in 2017, meaning 40 million Americans lacked the financial resources for food. Food insecurity is not limited to those living below the poverty line but can affect those with insufficient wages and competing household expenses.
Consider also the college student who cannot afford food or housing. A 2017 study on food and housing insecurity among two and four-year college students found that among 30,000 two and four-year college students, approximately half are food insecure, 20 percent of 2-year students had very low levels of food security, and as many as 14 percent were homeless. Eleven to 19 percent of four-year college students reported having housing challenges.
Today’s college students are coping with rising tuition costs and financial support packages insufficient to cover the cost of food and housing. At a time when students should be devoting time and energy to learning, many are grappling with issues of food insecurity and housing. Opportunities to close the income gap via educational attainment is greatly influenced by a student’s ability to successfully complete education and secure meaningful employment. However, issues of food and housing insecurity may hamper graduation rates.
I see similar issues being played out in the clinical setting. Increasingly health-care systems are assessing and addressing the social determinants of health, the social needs that influence a patient’s ability to access health care and better comply with the recommend plan of care post discharge.
Patient challenges including food insecurity, housing insecurity, and limited health literacy skills may not be as readily apparent unless providers do a more thorough assessment of the social needs of patients entering the system. Fortunately, there’s a growing effort to include social needs assessment into clinical care within many health-care systems.
The American Hospital Association posits that by 2023, 48 percent of health-care organizations will have standardized measures to assess the social determinants of health. This is great step forward to reconstructing our views on health and those in need. Health-care providers, health-care systems, academicians, researchers and policy makers are among the many who are broadening their lenses to include a stronger focus on the social determinants of health as a critical component to improving health outcomes. The social determinants of health account for approximately 80 percent of health outcomes and are now being considered in clinical practice in addition to medical care.
My expanded vision of those in need has inspired me to become more aware of social policies that shape how people live each day and what they have access to, be it education, housing, health care, adequate wages, and even food. In order for our country to have a stronger health-care system and better medical outcomes, we must also develop the social policies that will address the needs of many hidden faces. Successfully doing so will require expanding our vision of those who are in need.
Janice Phillips RN Ph.D., is an associate professor at Rush University College of Nursing and the director of nursing research and health equity at Rush University Medical Center. She is also a Public Voices fellow with the OpEd Project.