Low-income

  Population considerations

  • Access to health care. Access to quality healthcare remains a contributing factor to heart disease and stroke disparities for low-income populations (Mensah, 2005).  Poverty and lack of health insurance among low-income populations may cause a considerable decrease in utilization of health care services (Davidson, 2007).  Individuals with undiagnosed high blood pressure, high cholesterol, diabetes and obesity are at an increased risk for heart disease and stroke (Masucci, 2006).  Poverty and lack of insurance are barriers to screening (early detection) for heart disease and stroke. Thus, poverty populations experience less favorable health outcomes. (Schulman 1991)
  • Access to resources. Low-income individuals may live in environments that tend to support and even promote high risk heart disease and stroke behaviors (Gettleman, 2000).  Low income neighborhoods typically have more fast-food restaurants and fewer vendors of healthful foods than do more affluent neighborhoods. They also face obstacles to physical activity as unsafe streets, dilapidated parks, and interpersonal crime (Kumanyika, 2006).Also, lack of transportation options (e.g., personal car, public transit) may prevent individuals from obtaining health care, being physically active and purchasing healthy foods.
  • Cost of treatment. The cost of medications for managing long-term heart disease- and stroke-related conditions such as hypertension is often an obstacle for those of lower socioeconomic status, and has been linked to poorer health outcomes (Schulman, 1991). High cost was found to be a significant barrier in seeking acute stroke care among low-income ethnic and racial minority individuals (Morgenstern, 2007).
  • Priorities. Health promotion and disease prevention are often low priorities in low-income families due to financial, family and health care constraints (Gettleman, 2000).
  • Lack of time and motivation. It may be more difficult for individuals with lower paying jobs, care giving responsibilities and housekeeping duties to find time and motivation to make health care appointments, be physically active and prepare nutritious foods (Wong 2008).
  • Lack of self efficacy or chronic disease self-management skills.   The general population often lacks the skills to coordinate all the things needed to manage their health, as well as to help them keep active in their lives. This is particularly true among impoverished populations. (Lorig, Holman, Sobel, Laurent, González and Minor (2006),)

  Strategies to address considerations

  • Offer low-cost or free activities. It may be beneficial to work with community and recreational centers to offer low-cost or free interventions in the communities (e.g., sliding fee scale at health clubs, free activity classes in the community centers) (Sherwood 2000). Likewise, free or low-cost cooking classes and healthy recipes may increase skills and motivation to prepare healthy meals.
  • Enhance the environment. When working in lower income communities, it may be useful to focus on creating or improving environmental conditions to support active and healthy lifestyles (e.g., improve sidewalks, build walking trails, increase availability of fresh produce, enact smoking bans). In doing so, it may be useful to work with community partners to enhance existing resources or to create new resources. 
  • Increase transportation options. It may be useful to work with the department of transportation to enhance or modify routes, or work with local churches or other community organizations that might be able to provide vans to and from different locations. 
  • Offer worksite programs. It may be useful to work with worksites to help to inform workers about risk factors and symptoms and how to prevent heart disease and stroke. (See Settings: Work Sites.
  • Increase access to health care.  Identify ways to add to or expand current health care options in the community. Contact the Missouri Primary Care Association to locate a Federally Qualified Health Center nearby. If an FQHC is not located in your area, work with the local community health coalition to address the issues surrounding health care access for low income populations. Advocate for improvements in quality of and access to healthcare through policy changes at the state and federal level. The Missouri Primary Care Association functions as an advocacy voice for the medically underserved and explores and implements activities aimed at providing and promoting high quality, accessible, and personalized healthcare services to urban and rural populations regardless of ability to pay in the state of Missouri.

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