While policy makers routinely blame soaring drug costs, unnecessary medical procedures, and rising chronic disease for health care spending, there is silence about the effects of hunger and unstable housing.
Rajiv Bhatia, MD Sep 23, 2015
After finishing my medical training, I worked at the Tom Waddell Clinic in San Francisco’s Tenderloin. The clinic was free for everyone with no questions asked. In the winter, homeless patients would drop in, telling the nurse they had pneumonia. What most wanted was a note for a week in a residential hotel.
At Tom Waddell, I learned that poverty was physical. I saw how poverty hurt and how it got under the skin. I remember a man who couldn’t get his asthma under control. He had a regular job, understood his disease and took his medications religiously. He had already figured out that his damp basement room was causing him to use up his inhalers. But, he didn’t want me to send a city housing inspector to look for habitability violations. He needed his home.
Statistically, poverty is the single biggest cause of poor health in the United States. One-third of poor working-age adults have two or more chronic conditions — double the proportion of the non-poor, and rates for avoidable stays in hospitals are highest in poor neighborhoods. These facts shouldn’t surprise anyone. If a diabetic can’t afford a prescribed diet, she is going to have trouble controlling her diabetes. If a parent is struggling to pay the rent year after year, the stress eventually makes it to the heart.