The outcomes noted above are problematic in and of themselves, but they may also decrease individuals’ ability to take the actions necessary to adhere to treatment, change health behaviors, and otherwise manage their illness. Individuals with greater social support are more likely to engage in health-promoting behaviors and exhibit healthy physiological functioning (IOM, 2001). In a meta-analysis of studies of predictors of positive health practices, loneliness and degree of perceived social support were found to have the largest effects (in the expected direction) on the performance of healthy behaviors (Yarcheski et al., 2004).
Multiple studies have shown that low income is a strong risk factor for disability, illness, and death. Inadequate income limits one’s ability to avoid stresses that can accompany everyday life and to purchase food, medications, transportation, and health care supplies necessary for health and health care (Kelly et al., 2006). To take just one example, lack of transportation to get to medical appointments, the pharmacy, the grocery store, health education classes, peer support meetings, and other out-of-home health resources can hinder health monitoring, illness management, and health promotion.
As discussed in Chapter 1, in 2003 nearly one in five people in the United States with chronic conditions3 lived in families that had problems paying medical bills (Tu, 2004); 63 percent of these individuals also reported problems paying for housing, transportation, and food (May and Cunningham, 2004). Among the privately insured with problems paying medical bills, 10 percent went without needed medical care, 30 percent delayed care, and 43 percent failed to fill needed prescriptions because of cost concerns (Tu, 2004). Overall, 68 percent of families with problems paying medical bills had problems paying for other necessities, such as food and shelter (May and Cunningham, 2004). Such families may trade off medical care so they can fulfill basic needs.
The 2006 National Survey of U.S. Households Affected by Cancer similarly found that 8 percent of families having a household member with cancer delayed or did not receive care because of the cost of care. Of those without health insurance, more than one in four delayed or decided not to get treatment because of its cost, and 41 percent were unable to pay for basic necessities (USA Today et al., 2006). A longitudinal study of a cohort