“If you have a whole bunch of bad experiences growing up, you set up your brain in such a way that it’s your expectation that that’s what life is about,” James Perrin, president of the American Academy of Pediatrics, told me.
In a groundbreaking study in Science last year, people who were primed to think about financial problems did worse on a series of tests that involved decision-making—a sign that physical scarcity can make it difficult for our brains to free up enough space for long-term planning.
One study found that the anxiety of living in poverty is a stronger predictor of mental health problems than going to war. Food-stamp recipients cannot use their benefits to buy diapers, and last year, a team of researchers at Yale University’s School of Medicine found that mothers who couldn’t afford diapers for their babies were more likely to feel depressed and anxious.
These worries can leave their mark on children, both in the form of a more volatile childhood environment and, potentially, through the mother’s own genetic makeup: Animal studies have shown that anxieties about certain stimuli can be hereditary.
Poverty can also deplete self-control. Smoking and unhealthy eating habits are more prevalent among the poor. A just-published study in the Journal of Epidemiology and Community Health found that girls who were repeatedly exposed to poverty growing up were more likely to be overweight or obese as young women.
“Habits form early,” Daphne Hernandez, the study author and health policy professor at the University of Houston, told me. “You begin to crave those [inexpensive] foods, and making the transition to healthier foods is difficult. Even when you’re not living in poverty anymore, you may still be buying the cheaper foods.”
Hernandez found that for boys, childhood poverty wasn’t linked to adult weight problems—but that isn’t necessarily anything to celebrate. Hernandez thinks it's heavy childhood manual labor that’s protecting the boys from obesity. “If you live in poverty, you’ll enter the labor market earlier,” she said. “For girls, it’s babysitting, but for boys in impoverished communities, they’ll more than likely engage in construction work.”
All of these factors combined mean that when doctors treat poor patients, they’re facing not just one ailment, but two: the illness itself, and the economic fragility that underlies it.
“Our society in general has looked at the issue of poverty in two ways: either a social problem, or a mental-health problem,” said Nadine Burke Harris, a San Francisco pediatrician. “But it's also a serious medical problem.”
A Patchwork of Programs
Some doctors are incorporating the treatment of poverty-related obstacles into their medical routines. In addition to its bicycle program, Boston Medical Center operates a food pantry for food-insecure families.