When we began the Health & Wealth Network at Prosperity Now, we wanted to center financial well-being as a core component of health. However, we never imagined that a public health crisis would tragically bring this conversation to the forefront. The current pandemic threatens the overall health of communities and puts the financial well-being of families at the center of the conversation. What we are witnessing is the cascading effects that come when key social determinants of health (SDOH) are not being met, as the COVID-19 crisis plunges millions of Americans into financial turmoil. The pandemic has been particularly devastating for low-income earners and communities of color, as they were at a disadvantage before the pandemic and economic crisis began.

The health crisis is impacting household financial security, and creating adverse health outcomes for those already experiencing economic inequalities - underscoring the cyclical nature of the shared determinants of health and wealth. Prior to the pandemic, despite being employed and having income, many Americans faced a reality where they struggled to meet daily expenses due to low wages and not enough assets. Now with at least 30 million people facing unemployment and losing their job security, we are seeing how critical financial stability is to overall health and well-being.

Income and Job Security

The most immediate concern for families right now is earning income, so that they can continue to pay for housing, food, bills, and other living expenses. While current federal assistance will provide emergency aid to every taxpayer plus extra unemployment aid, many workers remain vulnerable to financial and health challenges. For example, many jobs that are deemed “essential” are often held by low-income workers like grocery, fast food, food production and other service industry workers. These professionals are typically low-wage earners who lack significant safety protections. Most of these jobs lack benefits like paid sick leave, or comprehensive health insurance. If these workers become ill, it could devastate their health and finances. Additionally, if they are unable to take sick leave, they can spread the virus to others. Furthermore, most cities and states are presently under Shelter at Home orders. This means it will be nearly impossible to find a new job for those who are unable to work from home, or those who are not able to work in positions considered essential.

Housing

The crisis in income and financial stability carries over into other social determinants of health. With unemployment continuing to rise, many families are left wondering how they will continue to afford to pay for their housing. The shortfall of the current aid package is that for many, it only covers one month’s rent or mortgage expenses. Our most recent Scorecard data found that 28% of homeowners and 50% of renters were classified as “cost-burdened.” The housing expenses of these individuals exceed 30% of household income, causing them to be at risk of foreclosure or homelessness if they suffer a decline in income. A decade of high rates of gentrification across the country has caused housing costs to rise significantly in cities like New York, San Francisco, Los Angeles, and Washington D.C., which are now the hotspots of the pandemic that have been deeply impacted economically. While some places have issued eviction prevention ordinances, many people are still at-risk of losing their homes. Congress must expand federal housing assistance programs, including the Housing Choice Voucher program; work with the Administration to implement an as-needed mortgage relief program (for example, a more robust Hardest Hit Program); and ensure all residents have access to relief regardless to how their homes are financed.

Food Security

Food security is another social determinant at stake for families who no longer have income or a stable job. As schools across the country have been forced to close, low-income students have lost their most consistent source of food. The National School Lunch Program reports providing low-cost or free lunches to 29.7 million children daily, meaning children risk losing after-school snacks along with two nutritious meals per day that may not be  available at home. School closures and rising unemployment has led to an increase in families turning to food banks and pantries. Feeding America projects an additional 17.1 million people will experience food insecurity – an increase of 46% prior to the pandemic. The organization also reports that for each meal provided through their network, the largest hunger-relief organization in the US, the Supplemental Nutrition Assistance Program can provide nine. Food banks have had to meet increasingly higher demand for food as the crisis continues. Soon, they will be unable to meet the need.

Increased Vulnerability

This crisis has shown us that when one social determinant of health is not met, such as employment, food and housing, the rest of them also suffer thus increasing the potential for those who were already vulnerable to face more adverse consequences. As we explore how the crisis is impacting those who were already financially vulnerable, we see similar impacts on the health side, underscoring the deep connections between economic inequalities and health.

The widespread impact of COVID-19 crisis has exposed the deep inequities and biases in our systems. Researchers are demonstrating in maps overlaying the SDOH, such as access to food, transportation, along with other community resources, to determine which communities are at greater risk for contracting the virus. The maps also show which places (at the census block level) are at risk for having worse outcomes if an outbreak occurs. Moreover, we are seeing that predominantly Black cities, like New Orleans, have higher rates of poverty, health inequity, and multigenerational family cohabitation for Black residents - all of which puts them at greater risk of having worse outcomes in this outbreak. This is compounded by decades of discrimination in policies and healthcare that have left African Americans at an increased risk of dying from coronavirus and its effects. The bottom line is that the inequality in health outcomes, which can be linked back to social determinants of health, puts lower-income communities and specific racial groups at a higher risk for contracting the virus. 

At Prosperity Now, we will continue to monitor the impact of this health and economic crisis on the most vulnerable while advocating for policies around housing, safety net supports, racial wealth equity, and asset accumulation. We will also continue our support of programs on the ground, such as medical financial partnerships, that seek to build health and wealth simultaneously. We hope that this Network can continue to be a place to raise up solutions that states, cities and programs are using to address the connection between health and wealth.

Stay tuned for more in this series!