John Elflein
Research expert covering health and health care
Income and health in the U.S. - Statistics & Facts
Although the United States is one of the wealthiest countries in the world, health disparities remain prevalent across the country. These disparities take form in various ways but most commonly involve geography, race and ethnicity, and wealth or income inequality. As the wealth gap in the United States continues to grow the link between income and health has become a more relevant and pressing issue. Although the poverty rate in the U.S. has generally decreased over the last decade, around 11.5 percent of people living in the United States lived below the national poverty line in 2023. Those with lower incomes or who are living in poverty are at higher risk for chronic diseases, mental illness, and mortality, and experience lower rates of health insurance and access to medical care than wealthier individuals. A survey of U.S. adults from 2022 found that while only 14 percent of those with an annual income of 100,000 U.S. dollars or more rated their physical or emotional wellbeing as fair or poor, around 41 percent of those with an annual income of less than 40,000 U.S. dollars stated their physical or emotional wellbeing was fair or poor. The reasons why people with lower incomes experience worse health outcomes are multifaceted and include behavioral and environmental factors as well as institutional and clinical influences.
Chronic health conditions among low-income individuals
Those from low-income households or who are living in poverty in the United States experience higher rates of chronic conditions including heart disease, stroke, diabetes, obesity, asthma, and depression. Behavioral and environmental factors both contribute to these disparities. For example, rates of smoking are much higher among low-income individuals, increasing their risk of developing various health conditions. Environment can be a contributing factor to these higher smoking rates as poorer neighborhoods have a high density of tobacco retailers, and low-income people have more limited access to cessation services and have historically been targeted by the tobacco industry through marketing. Obesity is another health risk factor that is more common among low-income earners that has environmental causes, such as a more limited access to fresh foods, a high density of fast-food restaurants, and living spaces with fewer parks and green spaces for physical exercise. In 2022, around 38 percent of adults with an annual income of less than 15,000 U.S. dollars were obese, compared to 34 percent of those who earned 75,000 U.S. dollars or more per year. Moreover, the environment in which people in poverty live often has higher rates of water pollution, poor air quality, noise pollution, and toxic and hazardous waste that can all contribute to physical and mental health conditions.Health insurance and health care access
In addition to being at increased risk of chronic health conditions, those living in poverty or with low incomes are also more likely to not have health insurance, with almost a quarter of those earning less than 100 percent of the FPL living without health insurance in 2022. Even among employed adults, low-income workers are less likely to receive health benefits from their employer with rates of health insurance significantly lower among this group. As a result, individuals from low-income families are more likely to forgo medical care and to report being unable to afford prescribed medicine or drugs.Race, poverty, and health
In the United States, it is impossible to discuss health and income disparities without mentioning the involvement of race. In 2022, around 25 percent of American Indian and Alaska Natives were living below the poverty line, along with 17 percent of Black Americans and 17 percent of Hispanic Americans. In comparison, around nine percent of white, non-Hispanics were living in poverty at that time. Minority groups such as these continue to experience disparities in education and economic opportunities that increase the chance of financial hardship and poverty as well as the health conditions and lack of health care access that accompany poverty and financial insecurity. For example, Black Americans suffer from higher rates of obesity and cardiovascular problems than their white counterparts and are less likely to have health insurance. In 2022, around 21 percent of Hispanics and 10 percent of Blacks in the United States did not have health insurance, compared to six percent of whites. Among working aged adults, this contrast is even more stark, with 23 percent of Hispanics and 11 percent of Blacks without insurance, compared to seven percent of whites. Perhaps one of the clearest examples of racial and ethnic health disparities in the United States is seen in the fact that the life expectancy at birth for white Americans is almost five years higher than that of Black Americans and almost 10 years higher than the life expectancy for American Indian and Alaska Natives.
