Academic journal article American Journal of Health Education

A Poverty Simulation to Inform Public Health Practice

Academic journal article American Journal of Health Education

A Poverty Simulation to Inform Public Health Practice

Article excerpt

Background: Poverty is a pervasive condition linked to a myriad of health conditions and severe health outcomes. Public health professionals are at the forefront of addressing poverty-related issues and require education that enhances their understanding and cultural competence. Purpose: The purpose of this research was to evaluate the impacts of a poverty simulation for students and practitioners of public health regarding their attitudes toward people living in poverty and awareness of the barriers they face. Methods: A pre- and postsurvey containing Likert scale and qualitative questions was administered to 91 participants. Paired t tests were run to assess changes from pretraining to posttraining and qualitative data were analyzed and overarching themes were identified. Results: Overall, participants indicated increased empathy, understanding, and knowledge of the barriers faced by low-income populations and increased confidence in their ability to identify issues contributing to poverty and positively impact those living in poverty. Discussion: The results presented here demonstrate the need for effective training and education on the realities of poverty and the receptiveness of participants to such trainings. Translation to Health Education Practice: Simulations enable a depth of understanding unachieved by traditional didactic education and are appropriate for educating students and professionals alike.

BACKGROUND

Poverty and Health

It has been estimated that over one half of Americans (58.5%) will spend at least one year below the poverty line at some point between ages 25 and 75. (1) In 2010, the poverty level for a family of 4 was $22,314. (2) Due to the recent economic downturn, rates of poverty are on the rise. According to the Census Bureau, the poverty rate rose from 14.3% (43.6 million) in 2009 to 15.1% (46.2 million) in 2010. In 2010, the poverty rate in the state of Georgia (18.7%) was the third highest in the nation and at its highest point since 1983. (3)

In the United States, poverty has been linked to increased risk of uncontrolled hypertension, (4) cardiovascular disease, (5) stroke, (6) as well as poor mental health and health related quality of life. (7,8) Childhood poverty has been linked to worse health outcomes in adulthood, often regardless of adult levels of income or education. (9-11)

Importantly, a core principle of public health is social justice, under which "all persons are entitled equally to key ends such as health protection or minimum standards of income," (12(p6)) yet examinations of health disparities point largely to inequitable societies as their root cause. Currently, in the United States, public health insurance programs upon which the most vulnerable populations depend are under threat of further budget cuts and cost-shifting. Therefore, it is a salient time to enhance awareness among public health students and professionals about the challenges faced by people living in poverty, which place them at greater risk for disease and disability and render them far less likely to receive the care they need.

Though most public health students and professionals understand that there is a link between deprivation and poor health, many have not lived in poverty themselves or worked directly with low-income populations. Therefore, creating a deeper level of understanding and awareness among this group is important for better informing public policies and practices that affect underserved populations.

Poverty Simulations

In an effort to increase understanding and reduce the stigmatization of those living in poverty, the "Welcome to the State of Poverty" simulation was developed by the Reform Organization of Welfare (ROWEL) in 1995 and later copyrighted by the Missouri Association for Community Action in 2002. (13) The poverty simulation is a learning tool designed to increase understanding of the barriers faced by low-income populations, including institutionalized power structures, public policy, time constraints, lack of resources, and facing multiple challenges at one time. …

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