Unfair and Unjust Practices and Conditions Harm People With Low Socioeconomic Status and Drive Health Disparities

Overview

Some policies and practices have led to mental and physical health risks and challenges, and related long-term health outcomes, for people with low socioeconomic status (SES).

People with low SES have been harmed by unjust practices related to the sale of commercial tobacco.A Tobacco companies have a long history of using samples and giveaways to entice people with low SES to try and use their harmful products. For example, tobacco companies have handed out free cigarettes to children in public housing complexes, homeless shelters, and soup kitchens.12 They have also included coupons for cigarettes in mailings for government food stamps.3

Other policies and practices related to the social environment also affect health and health outcomes of people with low SES. For example:

• Lower quality education is associated with lower health literacy, fewer opportunities for employment, less ability to access enough healthy food, and less access to health care, all of which negatively affect health outcomes.4 People with low SES are more likely to live in neighborhoods where most people rent (vs own their own home). K–12 schools, funded primarily through local property taxes, are subsequently under-funded.5
• City, county, state, and federal courts can impose fines, fees, and other forms of legal financial obligations on people for traffic violations and other minor offenses. For people without the means to pay, these legal debts can trigger serious and escalating consequences—from the loss of a driver's license to jail time. These court-imposed fines and fees can add stress and negatively affect health outcomes for people with low SES.67
• Rural communities with low SES can lack resources (for example, financial resources, access to services), which can serve as a barrier to support for tobacco education, prevention, and cessation.8

People with low SES have also been excluded from systems meant to protect and improve health and well-being, including health care and medical science.

• People with lower incomes have less access to health care, including affordable health care needed to address smoking-related morbidities.9 People who have unmet needs (including economic or job instability, lack of housing) are more likely to go to the emergency room, to miss medical appointments, and to have unmanaged medical conditions compared to those with met needs.1011
• Being uninsured is related to health care disparities. People who are uninsured may decide not to get needed clinical screening (which could include for tobacco use or cancer) and routine or recommended care due to out-of-pocket cost.12
• People with lower incomes are more likely to experience delayed access to health care, which can result in adverse health outcomes.1314
• People with low incomes are less likely to be included in clinical trials for new cancer treatments.15 The lack of lower income populations included in clinical trials could potentially limit knowledge of the effectiveness of treatments across all populations.

The tobacco industry targets low-income communities with marketing and advertising

Marketing plays a big role in whether people try or use commercial tobacco products. Being around commercial tobacco ads makes smoking appear more appealing and increases the chance that someone will try smoking for the first time or start using commercial tobacco products regularly.16171819

• Neighborhoods where people have lower incomes tend to have more stores selling and advertising commercial tobacco.20 In neighborhoods with a lower SES there are a significantly higher weekly unit sales of tobacco products per tobacco retail store.21 Schools that have a larger proportion of low-income students are more likely to have stores selling commercial tobacco near those schools.22
• More stores selling commercial tobacco means more advertisements for products like cigarettes, e-cigarettes, chewing tobacco, or other commercial tobacco products. People who see commercial tobacco promotions in places where these products are sold are more likely to smoke.2324 Tobacco companies target in-store marketing campaigns toward neighborhoods where most residents have low income.3
• Tobacco companies target communities with low incomes by using price promotions to increase sales, such as discounts, coupons, and special sales.25

Tobacco companies promote flavored products—like menthol—in neighborhoods where people of low SES live.

Menthol has a minty flavor that masks the harsh taste of tobacco. Menthol makes cigarette smoke feel easier to inhale and can make it harder to quit smoking.2627 To attract customers, tobacco companies target low-income communities with advertising and sales of flavored cigarettes and cigars—especially those with menthol. This can help explain why people with lower income and less education tend to smoke menthol cigarettes at a higher rate than groups with higher incomes and more education.2829

Stress can increase commercial tobacco use, and can make health problems worse

When people face many forms of stress—like financial problems, discrimination, or unsafe neighborhoods—they can be more likely to smoke.323334

The pressures of poverty help explain why the health problems caused by commercial tobacco tend to be worse for people with low SES. When people have severe or long-lasting stress, their bodies respond by raising stress hormones and keeping them raised. When this goes on for a long time, they may develop health problems like high blood pressure and type 2 diabetes.3536 Smoking cigarettes also leads to disease and disability and harms nearly every organ of the body.16