Friday, May 23, 2014

Poverty Complicates Cancer

People living in poverty take a much harder hit from cancer.

One reason cancer is harder on people living in poverty is that they are diagnosed later in their illness. They have less routine screening and less preventative care. Yes, I know there are all those “free” screening tests available, but really, if you are poor, have a couple of kids, no car and work a part-time job you are most likely having to choose between milk, Pampers and the $6-9 round trip bus fare to go to a health center (and spend the day waiting) for your “free” test.

So you cross your fingers and wait. You take your kids to the doctor but you might put off your annual physical or a Pap test or Mammogram. Forget colonoscopy—who’s going to drive you home?

So it takes a lump or some bleeding or some significant pain to get your attention and by then things have advanced.  And then, even after that things are still different if you are living in poverty.

Because Caregiving is Different for People in Poverty in CancerLand

When I hear caregiving discussed—and that’s a lot now that the Boomer Bump has descended, I hear us talking about caregiving as a separate social issue from poverty. We often picture caregiving scenarios that involve older folks with a well spouse caring for an ill spouse, or an adult child taking care of an aging parent. Occasionally we extend that picture-story to those caring for someone with cancer.

But caregiving is also a poverty issue and even those who are poverty advocates frequently ignore it. The economics of caregiving are a big part of caregiver stress for all families. Part of the blind spot is that we rarely see past the crisis that initially throws a family into caregiving. We worry with them through the cancer diagnosis, the surgery gone wrong, the ICU, the nursing home. 

But even for middle-class families or working class folks poverty begins after chemo is complete and after the ICU and after the discharge to home. In most serious illness caregiving situations both adults have lost or decreased their employment—one to illness and one to caregiving. Very few families can absorb one lost income, even fewer can lose two.

Here are some stats from the National Family caregivers Association:

Women who are family caregivers are 2.5 times more likely than non-caregivers to live in poverty and five times more likely to receive Supplemental Security Income (SSI).
Study conducted by researchers at Rice University
and data compiled from the Health and Retirement Study
funded by the National Institute of Aging and conducted by the University of Michigan, 1992-2004
Caregiving families have median incomes that are more than 15% lower than non-caregiving families. In every state the poverty rate is higher among families with members with a chronic illness or disability than among families without.
Disability and American Families: 2000, Census 2000 Special Reports, July 2005.

During the 2009 economic downturn, 1 in 5 family caregivers had to move into the same home with their loved ones to cut expenses.
Evercare Survey of the Economic Downturn and Its Impact on Family Caregiving;
National Alliance for Caregiving and Evercare. March 2009

We also forget to extend our thinking the other way. Illness doesn’t discriminate so how can families in poverty cope with the chronic impact of stroke, heart attack, or cancer—which has rapidly become a chronic disability.

People living in poverty generally can’t attend Cancer Clubs or Chemo Yoga Class and they don’t have friends to drive them to treatment a couple of times a week. In most cases the friends of people living in poverty also live in poverty so there is much less social networking to arrange those those extra meals or provide rides. Women living in poverty generally don’t have women friends with adequate vacation time to take a day off from work for wig shopping.

Our romantic ideal—and what has been my reality and maybe yours too if you’ve had cancer—is being surrounded by friends and family who help you. We had an amazing team of helpers for John—meals, rides, laundry, errands. And one of the reasons that happened is that we have a lot of friends who drive, who have time to cook, (and kitchen appliances), and who have jobs with lots of flexibility, and discretionary income.

Those of us who have had cancer—or a loved one with cancer and were able to do it the middle class way  (just consider the relief of having a car) have to be grateful for those extra blessings. And then we have to figure out what we can do to give a lift to those who don’t.

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