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The Greatest Public Health Threat Is Poverty

April 24, 2020
by Megan Smith and Joanne Goldblum

Much of the nation is isolated, anxious, and burdened with questions like: Can I refill my prescription? Get milk for the kids? How long will the toilet paper last?

We’ve always been challenged to convey the enormity of stress and depression that accompanies poverty. Today, sadly, we have found the perfect way to explain it: What many of us are experiencing is a taste of what poverty feels like. Poverty rests in the pit of your stomach, makes you tired, and keeps you up at night; it inserts itself into relationships, and makes the problem of the prescription, the milk, the toilet paper so overwhelming that it takes significant effort to concentrate on anything else.

It is tragic that so many are experiencing this, particularly our children, as the stress of poverty is associated with poor health outcomes that last into adulthood. We need to protect them, just as we need to protect the one in five US children who lived in poverty before COVID-19. People of all ages need additional support, even as the channels that traditionally offered it are shut down. To fill that void, we first must understand why this experience is so painful.

It is distressing to be without basic needs. We collaborated on a study where we asked low-income mothers about affording diapers for their children. Industry surveys show that one in three young families experiences diaper need. We found a strong association between diaper need and maternal depression, which harms both mothers and children. The moms said that diaper need was more stressful than food insecurity. Because babies need changing frequently, these mothers were confronted with the inadequacy of their resources repeatedly, every day.

Economic poverty is often accompanied by a poverty of social capital, a network of relationships based on shared values and identities. Social capital can be described as a sense of belongingness. A middle-class person is more likely to join a choral society, faith community ,or civic improvement group. This fellowship is good for us. Volunteering has been linked to lower rates of depression; participation in a faith community, to longer life.

Coronavirus has shut down most of these groups. Many barriers already prevented participation for lower income people: work schedules, transportation, fees ,and discomfort with the dominant culture of these institutions. Poverty is lonely.

Isolation, for quarantine and other reasons, is associated with negative mental health impacts months and even years later. Few studies have looked at the impact of quarantine and physical distancing on low income families, but a Canadian study on the psychological impacts of quarantine on low income families during SARS found that low-income participants showed significantly higher amounts of PTSD and depressive symptoms during and for months after quarantine (Hawryluck, 2004).

There are steps we can take to help low-income families weather this moment:

  1. If you have a childcare provider, dog walker or other service provider who comes to your home — please consider paying them during this crisis. They likely are not eligible for unemployment benefits.
  2. If you are having groceries or cooked food delivered, please over tip! People doing this work are paid at a very low rate and are taking risks so that you do not have to. Please pay them well.
  3. Check with your local restaurants and see if they are taking collections for staff that has been laid off — and if you go to a restaurant frequently, check in with them and see if their employees are doing OK. Offer to help if you can.
  4. The National Diaper Bank Network and its more than 200 member diaper banks have seen an unprecedented uptick in requests for diapers. Local diaper banks are reporting increases of requests for diapers of up to 300%. Right now, the best way to help is to make a financial donation. If you would like to support local diaper banks please look at the National Diaper Bank Network’s member directory and find a diaper bank in your community to donate to!
  5. Foster belongingness. Belonging is a fundamental motivator that drives behavior and emotion. Social services for low-income families usually stress goods and units of service. We also need to consider intangible resources like fostering autonomy, sense of belonging and spiritual wellbeing. Offering mental health supports and brief intervention with the provision of good and services can foster connection.

Finally, when facing hardship, it can help to find meaning in it, to grow. Those of us who are more economically fortunate can cultivate empathy for people in poverty.


Megan V. Smith, DrPH, MPH, is associate professor in the Yale Child Study Center, Department of Psychiatry ,and the Yale School of Public Health (Social & Behavioral Sciences). Dr. Smith’s research is focused on the intersection of maternal mental health and poverty. Dr. Smith is the Principal Investigator of Elevate, a policy lab focused on improving the mental health of families and economic mobility.

Joanne Goldblum is CEO and founder of the National Diaper Bank Network, encompassing more than 200 member organizations that provide diapers and other basic needs to families across America. She has spent her career working with and advocating for families in poverty. In 2018, she founded the Alliance for Period Supplies.

Submitted by Jill Max on April 20, 2020