Megan A. Carney, Felicia Goodrum Sterling and Rhonda Gonzalez

As open enrollment for health insurance under the Affordable Care Act comes to a close this year, access to quality health care is a topic of much debate. But making sure that all Pima County residents have easy access to this care means focusing on a seemingly separate issue — addressing poverty and institutional discrimination.

On Nov. 30, the Healthy Pima initiative hosted a forum on community health needs. The meeting, attended by over 100 public health and social workers, drew on months of research that engaged community members in identifying the most pressing countywide health concerns. Harnessing a wide breadth and depth of knowledge, forum participants discussed how best to allocate resources for community programs and interventions.

Oddly, however, the forum did not deeply engage with two important and often overlooked risk factors for disease: poverty and inequality. Until our community finds ways to address these factors in tandem with other health problems, we will not make true progress.

Social and biomedical scientists agree that poverty and inequality in access to health care, education or job security are strong social determinants of health. A study published in the journal Biosecurity and Bioterrorism found that people living in poverty or inequality experience heightened states of anxiety and stress from job instability, financial insecurity, and policing and profiling that, in turn, put them at greater risk for chronic and infectious diseases.

In a vicious cycle, existing health disparities or inequalities further contribute to unequal disease burden and death while poverty and inequality reduce access to quality health care. Data from the National Institute of Allergy and Infectious Diseases show that this cycle disproportionately burdens communities of color and immigrant populations.

Pima County’s failure to address the relationship between poverty, inequality, and health is symptomatic of a national problem. At the federal level, for instance, the Trump administration is currently considering a policy to block paths to permanent residency or citizenship to lawful immigrants who have relied on social services, such a Medicaid, food stamps and WIC, and other government benefits designed to assist disadvantaged individuals and families.

These resources help people maintain their economic self-sufficiency; making immigrant families choose between seeking citizenship and seeking social services exacerbates the healthcare crisis and increases hunger and health disparities.

Social programs do require investment from taxpayer dollars. However, poverty and inequality pose enormous costs to society. Researchers from the Brown School at Washington University in St. Louis estimated the cost of childhood poverty in the U.S. at $1.03 trillion in 2015, about 5.4 percent of the gross domestic product. Programs aimed at sustaining nutrition, health, education, and security pay their dividends by reducing taxpayer dollars spent on care for uninsured individuals.

Health researchers and social service providers unequivocally agree that alleviating human suffering and reducing the burden of unnecessary illness and death can be achieved only if we dismantle racist policies and practices, as a study in American Behavioral Scientist illustrates.

Instead of thinking in terms of increasing food literacy and increasing access to healthy foods, for instance to address obesity, diabetes, and hypertension, what if we work toward policies that promote socioeconomic mobility, so everyone, through better access to education, jobs and health care, reduces their overall risk of infectious and chronic disease?

To make this happen, governments, social sector, nonprofit and business organizations must collaborate. While it makes sense that public health departments lead these efforts, they cannot transform the health outcomes of Pima County residents on their own. We need policies that integrate the goals of alleviating poverty and dismantling discrimination alongside undoing health disparity and inequality.

Megan A. Carney is an assistant professor in the School of Anthropology at the University of Arizona and director of the UA Center for Regional Food Studies. Felicia Goodrum Sterling is an associate professor of immunobiology at the University of Arizona. Rhonda Gonzalez is health and nutrition programs manager at the Community Food Bank of Southern Arizona. They are all public voices fellows with the OpEd Project.