Poverty / Financial Problem

Health inequity

Patients of low socioeconomic status often have more chronic health conditions and health behaviours that increase risk, with less local support and infrastructure available to help. Significant personal and social barriers often stand in the way of change — good communication skills and longer appointments are often needed to navigate health, housing, welfare and legal systems together.

Supporting health literacy in disadvantaged groups

Socioeconomic disadvantage and low health literacy are linked; low health literacy is associated with poorer health outcomes and lower uptake of screening/preventive care.

• Use a “teach-back” technique — ask the patient to repeat back what they’ve just been told.
• Motivational interviewing.
• Plain language, with simple written handouts.

Psychosocial issues

• Depression is almost twice as common in patients from a low SES background.
• Suicide and attempted suicide are consistently associated with markers of SES disadvantage, including limited educational achievement and homelessness.
• Income-related inequalities in psychological distress/common mental health conditions are particularly prominent in mid-life; with advancing age, socioeconomic inequity increases anxiety and depression.
• Young people with low educational attainment have the greatest likelihood of chronic depression and progression from anxiety to depression.
• Postpartum depression and poorer childbirth outcomes are associated with socioeconomic disadvantage.

Food insecurity

• ~4% of Australians cannot reliably access sufficient, safe, nutritious food. Food insecurity is both a precursor to, and a consequence of, chronic disease and poverty.
• Screening question: “In the past 12 months, were there any times you ran out of food and couldn’t afford to buy more?”
• Higher prevalence reported among asylum seekers (71%), Aboriginal and Torres Strait Islander people (22%), disadvantaged urban households (25%), and people who are unemployed (23%).
• Welfare-dependent Australian families spend ~40% of disposable income to afford a nutritious diet, vs ~20% for the average family. Overweight/ obesity rates were 20–40% higher among women experiencing food insecurity.

Homelessness (AJGP 2019)

Patients experiencing homelessness face compounding barriers to care: fear of discrimination from staff/other patients, a perceived power imbalance with doctors, lack of transport or identification documents, and financial constraints — often meaning they present only once a condition is advanced and costly to treat.

Practical model-of-care points:

• Bring services to the patient — locate care within spaces people already use (crisis accommodation, drop-in centres, mobile clinics) rather than expecting attendance at a traditional practice.
• Use preventive screening (cardiovascular risk, diabetes, depression) as a natural springboard for broader conversations; frame management plans as collaborative agreements between patient, clinician and support staff.
• Bridge to mainstream care — many patients lack a regular GP; help arrange transport/accompaniment to a first mainstream GP appointment.
• Be cautious prescribing medications with addictive potential; dispense donated medications where cost is the barrier to access; adapt BP monitoring/dietary advice to the patient’s practical circumstances; offer mental health first aid and appropriate referral.

From the RACGP Red Book and AJGP.

Unemployment

Unemployment is a recognised social determinant of health in its own right. Anxiety and affective disorders are more common in the unemployed, and unemployment is itself a marker of socioeconomic disadvantage carrying the psychosocial harms described above.

Practical considerations:

• Ask about impact on mood, self-worth, sleep, finances and relationships — unemployment is a common but under-asked contributor to a low-mood presentation.
• Patients receiving unemployment-related payments (e.g. JobSeeker) may need a Centrelink medical certificate documenting a temporary reduction in work capacity, or referral to a program of support — see Social Welfare Problem for the relevant forms and criteria.
• Consider onward referral for financial counselling, vocational/employment support services, or mental health care where indicated.