Rethinking Poverty Measurements and the Implications on Health

Background: Epidemiological studies on health inequities continue to document how neighborhood context, especially concentrated poverty, influences health. However, neighborhood research is typically limited to the outdated U.S. federal poverty measure that is based on 1950s consumption patterns and uniformed nationally. Given the high housing costs that vary dramatically by region and the changing market and consumer needs, the choice of poverty measure is likely to have a significant impact on the association of neighborhood poverty and health.

Methods: Data from the 2003 California Health Interview Survey, 2000 Census, and housing/rent costs in the 2003 American Community Survey and 2003 Rent Estimates are used to develop alternative poverty constructs at the county level. Sensitivity analyses are conducted using multilevel statistical models to examine the relationship between concentrated neighborhood poverty using the alternative constructs and outcomes of self-reported health status, alcohol/tobacco use, and chronic health conditions.

Results: The traditional specification of poverty using the Federal Poverty Line is associated at both the individual and neighborhood levels with multiple health outcomes. Using alternative measures of poverty that are adjusted by county-level housing costs continue to be associated at both levels, but with stronger parameter effects. The model specifications fit best with these alternative county-adjusted poverty measures.

Conclusions: Improving the way we measure poverty will lead us to a better understanding of the root causes of poor health. With growing health inequities, it is necessary to consider alternative neighborhood poverty measures and the implications in epidemiological research, public health programs, and policies.