Poverty and Public Health

Since 2000, Americans have been getting poorer, and national rates of severe poverty have climbed sharply, according to a study published in the October issue of the American Journal of Preventive Medicine. The researchers reported that the growth in the poverty rate is due largely to a rise in severe poverty and that "moderate" poverty has grown little.

The percentage of Americans living in severe poverty - earning less than half of the poverty threshold - grew by 20% between 2000 and 2004, and the proportion in higher income tiers fell. The researchers reported that the number of Americans living in severe poverty increased by 3.6 million between 2000 and 2004.


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"These trends have disturbing implications for society and public health," said Steven H. Woolf, MD, MPH, Professor of Family Medicine, Epidemiology and Community Health, Virginia Commonwealth University, and lead author of the study. The researchers found that the only category of Americans to increase in size were those whose earnings were at least $8,000 below the poverty threshold, who grew by approximately 50% between 2000 and 2004. All other income tiers decreased during these years. The poverty threshold in 2004 for a family of four was $19,307.

"The rise in severe poverty is striking children the hardest," said Woolf. His study found that children under age 5 are twice as likely to be living in severe poverty as the rest of the population. "In 2004, one of three Americans with incomes less than 50% of the poverty threshold - 5.6 million people - was a child." Severe poverty is also dramatically worse among African Americans and Hispanics, and minority children therefore face the greatest risk. The researchers reported that children account for 45% of Hispanic and African Americans living in severe poverty.

The authors discuss the broad societal implications of the increase in poverty. Likely health consequences include a higher prevalence of chronic illnesses, more frequent and severe disease complications, and increased demands and costs for healthcare services. Adverse effects on children carry long-term implications.

"This is not just a problem for the poor," Woolf added. "Except for a small class of highly affluent Americans, income for the entire U.S. population has fallen since 2000." The researchers describe a "sinkhole effect," in which "families and individuals in the middle and upper classes appear to be migrating to lower income tiers that bring them closer to the poverty threshold." U.S. household income, adjusted for inflation, fell by 3.6% between 2000 and 2004. Woolf says that the sinkhole effect and the upsurge in poverty could deeply affect society and calls for the reexamination of policies enacted in recent years to foster economic progress.