Investigation of The Link Between Poverty and Hypertension

Hypertension is a chronic disease that disproportionately affects those of a lower social economic status (SES) in the United States. There are several contributing factors, or risk factors, that can exacerbate the already biological disposition to the disease. Such risk factors are considered social disparities in the context of this review. The concept of how a social disparity can relate to health outcomes is not a new concept, but it is difficult one to prove. In this case, the argument will be that poverty leads to hypertension through the channels of disparities. These disparities include the wealth, status, education, and nutrition. This literature review intends to connect poverty and its manifestations to hypertension.

Lack of Wealth and Hypertension

Wealth or social economic status is by far the strongest indicator of health. SES refers to the standing in the stratification system which is measured by education, occupation, employment, income, and wealth. The wealthier you are, more often than not, the healthier you are. This can be due to an array of factors, such as access to care, quality of care that you received, and the neighborhood that you live in Moreover, there is an apparent abundance of health disparities and risk factors that plague those of a lower SES such as higher rates of smoking, lower exercise, poorer diet, and excess weight (Pampel, 2010). Lastly, what is alluded to as social disparities of health are referred to as the manifestations of poverty such are neighborhood, lack of status, restricted education, and food insecurity. Hence, being categorized as a person of low SES (low income or poor) influences health by way of diet, health behaviors, and stress.

Lack of status and Stress

The lack of status or social position can give way to implicit bias which are induce chronic stress. Chronic stress can directly affect the heart by lessening the elasticity in large arterial vessels and creating higher blood pressure reactivity or hypertension. Moreover, stress can further lead to unhealthy behaviors as a means of coping. Pampel et. Al 2010 noted that smoking, overeating, and inactivity represent forms of pleasure and relaxation that help to regulate mood among the disadvantaged. Furthermore, racial stress from implicit bias increases cortisol levels from chronic stress. Race related vigilance comes are a result of racial/ethnic discrimination as a result of acute experiences with unfair treatment due to race (Hicken, 2014).

Neighborhood

According to Morenoff “social contexts”, or neighborhoods, in which people live may substantially contribute to social disparities in hypertension. This is can be seen through the higher prevalence, lesser awareness, quality of treatment, and the lack of control of hypertension. (Morenoff, 2007). Higher levels of neighborhood affluence are related to lower odds of being hypertensive Household food insecurity was also associated with low educational attainment, low household income, lack of health insurance, and tobacco use. Fast-food restaurants are more prevalent in low-medium neighborhoods and become less prevalent in highest-wealth neighborhoods. As wealth increases, the number of bars decreases.

Food Insecurity

Food insecurity is a byproduct of poverty. Thus, food insecurity or a restricted access to healthy foods can be attributed to a high risk of hypertension. This is illustrated through studies that have looked at low economic neighborhoods and their access to healthy food options being lessened, hence the reason we see a higher intake of unhealthy foods. The availability of food stores can influence people’s foods choices. Morland and Wing looked at neighborhood characteristics and their associated with food stores (or food access). Specifically, the locations of food stores and food services places are associated with and the racial make-up of the neighborhood. There are over 3 times as many supermarkets in the wealthier neighborhoods compared to the lowest-wealth areas. Additionally, wealthier neighborhoods contain fewer small grocery and convenient stores compared to lowest-wealth neighborhoods. Morland and Wing likewise suggest that residents whom live in neighborhoods that suffer from food insecurity have a greater difficulty obtaining healthy food. This can be attributed to either have no private transportation to reach the stores with healthier food options at supermarkets. Consequently making it difficult for residents of low-wealth and predominantly black neighborhoods at a lesser advantage to achieve a healthy diet thus exacerbating their risk for hypertension.

Intake of Unhealthy Foods

The intake of unhealthy foods can be a byproduct of food insecurity. Adults living in food-insecure households report being unable to afford balanced meals, worrying about the adequacy of their food supply, running out of food, and cutting the size of their meals, or skipping meals (Seligman, 2009). Energy dense foods, including refined grains, added sugars, and added saturated/trans fats, tend to be devoid of nutritional quality and less expensive calorie-for-calorie than alternatives which are foods that are abundant in impoverished corner stores (Moreland, 2002). U.S. Adults living in food-insecure households consume fewer weekly serving of fruits, vegetables, and dairy and lower levels of micronutrients. These dietary patterns are linked to the development of chronic disease including hypertension. In adjusted analyses, adults from food-insecure households has a 21% higher risk of clinical hypertension than adults from food-secure households. The high sodium and low potassium content of highly processed foods, common in the diets of food-insecure adults, may increase risk of developing hypertension.

Restricted access to healthcare

It has been suggested that those whom are in the lower SES have fewer opportunities to undergo regular preventative medical checkup and screenings. Fang 2014 proposes that among adults with hypertension, the condition was less likely to be diagnosed among persons without health insurance than among those with health insurance. In this study Among those who reported hypertension, about 20% reported access-to-care barriers and approximately 25% did not visit a doctor’s office for a routine checkup during the past year (Fang, 2014). The results of the study further showed that having primary care provider and health insurance were related to better blood pressure control. Having no insurance, having no personal doctor or health care provider, and the inability to visit a doctor because of the cost were significantly related to whether the participant had visited a doctor or healthcare provider for a routine check-up during the past year. The presence of hypertension was associated with higher medication expenditures. Fang 2014 also found that the use of antihypertensive medications was significantly lower among those with no insurance, no personal doctor or healthcare provider, and among those who reported cost barriers to visiting a doctor. Socioeconomic status including race/ethnicity, level of education, and income are all associated with the lack of health insurance. The lack of insurance can have an influence on whether or not to seek care they need for both disease prevention and management due to out of pockets expenses or other direct/indirect financial barriers.

Restricted Education and Bad Health Behaviors

Having a restriction in education is an indication of poverty and may indirectly prelude to bad health behaviors. “Odds of being hypertensive are 70 percent higher for those with less than 12 years of education compared to those with 16 or more years of education and 60 percent higher for those with 12-15 years of education compared to 16 or more years” (Morenoff, 2007). This can be due to the concept that people with lesser education having jobs that depletes opportunities for learning the harm of unhealthy behaviors thus lack the motivation to adopt healthy behaviors, a theory suggested by Pampel 2010. To add, affluent areas may have cultures that promote behavioral patterns like non-smoking that reduce levels of blood pressure (Morenoff, 2007). This fact is not apparent in neighborhoods with a predominantly low SES community. Increased exposure to advertising that promotes the enjoyment of smoking, drinking, and consuming unhealthy foods that allude to a life of more wealth plague impoverished neighborhoods. Restricted education can also influence a person health seeking or healthful behaviors. Comparing those with less than a high school degree to those with more than a college degree, college graduates are 3.6 times as likely to report that nutritional information from scientific experts is something that they value.

Conclusion

As stated before, finding a direct link from poverty to hypertension is not an easy one to prove. Instead, we must take a multifaceted approach and look at how social disparities or manifestations of poverty can lead to the exacerbation of risk factors related to hypertension, this is what this literature review attempts to illustrate.

References

• Fang, J., Yang, Q., Ayala, C., & Loustalot, F. (2014). Disparities in Access to Care Among US Adults With Self-Reported Hypertension. American Journal of Hypertension, 27(11), 1377–1386. doi: 10.1093/ajh/hpu061
• Hicken, M. T., Lee, H., Morenoff, J., House, J. S., & Williams, D. R. (2014). Racial/Ethnic Disparities in Hypertension Prevalence: Reconsidering the Role of Chronic Stress. American Journal of Public Health, 104(1), 117–123. doi: 10.2105/ajph.2013.301395
• Morland, K., Wing, S., Roux, A. D., & Poole, C. (2002). Neighborhood characteristics associated with the location of food stores and food service places. American Journal of Preventive Medicine, 22(1), 23–29. doi: 10.1016/s0749-3797(01)00403-2
• Pampel, F. C., Krueger, P. M., & Denney, J. T. (2010). Socioeconomic Disparities in Health Behaviors. Annual Review of Sociology, 36(1), 349–370. doi: 10.1146/annurev.soc.012809.102529
• Seligman, H. K., Laraia, B. A., & Kushel, M. B. (2009). Food Insecurity Is Associated with Chronic Disease among Low-Income NHANES Participants. The Journal of Nutrition, 140(2), 304–310. doi: 10.3945/jn.109.112573