The Acting Assistant Secretary for Health chaired the first cross-cutting review of
progress on Healthy People 2000 objectives for people with low income. Preparations for
the review had been made by a working group led by representatives of the Office of the
Assistant Secretary for Planning and Evaluation, the Administration for Children and
Families, and the National Center for Health Statistics of the Centers for Disease Control
and Prevention. The Director of the National Center began the presentations with data on
the health status of people with low income:
Prenatal care Among mothers 20 years of age and over, use of prenatal care in the
first trimester of pregnancy showed a clear educational gradient. In 1995, women with the
most education (13 years or more) were 1.4 times as likely to receive early prenatal care
as those with the least (less than 12 years.) White women with at least 13 years of
education were the only group to have achieved the year 2000 goal of 90 percent use of
first trimester prenatal care services (objective 14.11.)
Birthweight There is a pronounced correlation between lower educational attainment
and low-birth-weight. Data for 1995 are shown in the first graph. Black mothers have the
highest incidence of low-birth-weight at all levels of educational attainment—11.4
percent (13 years or more), 13.3 percent (12 years), and 16 percent (less than 12 years).
The year 2000 targets (Healthy People 2000 objective 14.5) are 5 percent for the
total population, 9 percent for blacks, and 6 percent for Puerto Ricans.
Food security Low-income children under age 18 are much more likely than other
children to live in households that sometimes or often do not have enough to eat. In 1994,
8 percent of children in households with incomes at or below 130 percent of poverty
sometimes or often did not have enough food, compared to less than 5 percent of all
children and less than 1 percent of children in households with incomes above 130 percent
of poverty. The prevalence of food insecurity among the poor appears to be increasing.
Doctor visits As shown in the second graph, the proportion of poor young people
under 17 years of age who had not visited a physician during the 2 previous years declined
markedly between 1964 (>30 percent) and 1995 (c.8 percent). The proportion of non-poor
without a visit also declined in those years, but to a lesser degree.
Immunizations In 1996, 77 percent of all children aged 19-35 months had received
the recommended series of vaccines. While no racial/ethnic group has yet achieved the year
2000 target of 90 percent (objective 20.11), children from families with incomes
below the poverty level received the combined series at a rate of only 69 percent, as
compared with those from families with incomes at or above the poverty level, whose rate
was 80 percent.
Health insurance During the period 1989-1995, the proportion of the population with
private health insurance coverage declined, while Medicaid coverage increased. Yet in
1995, children under age 18 from families with incomes of 100-149 percent of the poverty
level were more than 4 times as likely to be uninsured, and poor children 3.5 times as
likely to be uninsured, as those from families with incomes above twice the poverty level.
Mammography Between 1987 and 1994, mammography screening increased substantially
for all women and the rate of increase was greater for the poor than for women with higher
income, thereby narrowing the gap between the two groups. Nonetheless, only women at or
above the poverty level achieved the year 2000 target of 60 percent utilization in 1994
(objective 16.11.) Poor women achieved a utilization rate of only 43 percent in
1994.
Perceived health status In 1995, people below the poverty level were 3 times as
likely as those above twice the poverty level to report fair or poor health status. This
finding continues to perpetuate the debate about which comes first—poor health
leading to low income, or low income leading to poor health.
Activity limitation In 1995, people below the poverty level were about 2½ times as
likely to be limited in their activities due to a chronic health condition. Objective 17.2a
sets a year 2000 target to reduce to 15 percent the proportion of people with incomes of
less than $10,000 per year who have limitations in a major activity due to chronic
conditions. The proportion so limited in 1995 was 17 percent. This represents a slight
worsening trend.
Mortality Death rates show a strong inverse relationship with educational
attainment. In 1995, age-adjusted death rates among people aged 25-64 with less than a
high school education were more than twice those for people with more than a high school
education. The rates for males ranged from half-again to over twice as much as the rates
for females in each education group. For males with less than 12 years of education, the
rate was 747.4 per 100,000; for females, 373.3. For males with 12 years of education, the
rate was 607.9; for females, 292.5. For males with 13 or more years of education, the rate
was 313.3; for females, 178.5.
![[signed] John M. Eisenberg, M.D., Acting Assistant Secretary for Health](sig.jpg)
