Health Equity

AMA: Low-wage work exacerbates health inequities

Jennifer Lubell , Contributing News Writer

One in 10 Americans lives in poverty. Most are employed, but still struggle to afford the necessities to stay healthy. Social determinants of health—which include education, housing, wealth, income and employment—“are impacted by larger, powerful systems that lead to discrimination, exploitation, marginalization, exclusion and isolation,” according to a report whose recommendations were adopted at the 2022 AMA Annual Meeting in Chicago.

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“There is widespread consensus that populations with low incomes have worse health outcomes,” says the report, issued by the AMA Council on Medical Service. “This exacerbates health inequities because women and people of color (many of whom provide for families) are more likely to earn low wages. Black and Hispanic individuals and families specifically are disproportionately represented among minimum-wage workers.”

Wage, income and health research suggests that policies to boost the take-home pay of low-income populations would improve their health status and lower health care costs, the council report says.

“Simply put, decreasing poverty improves health,” said AMA Trustee David H. Aizuss, MD. “The COVID-19 pandemic created a concurrent public health and economic crisis that exposed and exacerbated access to care and other social inequities.

“Not only has the pandemic disproportionally impacted minoritized and marginalized communities, but economic insecurity, housing insecurity and food insecurity have disproportionately burdened communities of color and other historically marginalized populations—all highlighting in stark relief the fact that people with low incomes have worse health outcomes,” said Dr. Aizuss, a board-certified ophthalmologist living in Calabasas, California.

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“Too many people are working full-time jobs—sometimes more than one job—and are unable to rise above poverty wages,” Dr. Aizuss added. “That must change.”

Whether to do that by raising the minimum wage has stoked political and economic debate.

Some policymakers have called for local or regional adjustments to the federal minimum wage, but this wouldn’t account for the varying costs of living across the U.S., the council report says. Wages also don’t always reflect the skill or risk of work.

Thirty states and the District of Columbia have enacted laws that set minimum wage above the federal minimum. Any value set to minimum wage will erode with time, the council report acknowledges. “There are significant complexities and unintended consequences inherent in selecting an index for perpetual minimum wage adjustment,” the report says.

Given the report’s findings, the AMA House of Delegates (HOD) adopted policy stating that “poverty is detrimental to health.”

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Delegates also adopted policy affirming that federal, state or local policies regarding minimum wage should:

  • Include plans for adjusting the minimum wage level in the future and an explanation of how these adjustments keep pace with inflation.
  • Be consistent with the AMA’s commitment to speak against policies that create greater health inequities and be a voice for our most vulnerable populations who will suffer the most under such policies, further widening the gaps that exist in health and wellness in our nation. 
  • Be consistent with the AMA’s principle that the highest attainable standard of health, in all its dimensions, is a basic human right and that optimizing the social determinants of health is an ethical obligation of a civil society.
  • Include an explanation of how variations in geographical cost of living have been considered.

Read about the other highlights from the 2022 AMA Annual Meeting.