What is the impact of social determinants on mental health?  Social determinants have been defined as the social circumstances in which a person lives and works.  When a person has little or no income, it often results in poor physical and mental health outcomes (see graphic below).  Individuals who experience poverty, particularly in early childhood or for an extended period, are at risk for a range of adverse health and developmental outcomes throughout their life. For children, poverty is associated with lower school achievement; worse cognitive, behavioral, and attention-related outcomes; higher rates of delinquency, depressive and anxiety disorders; and higher rates of almost every psychiatric disorder in adulthood. Recent studies on adverse childhood experiences (ACEs), defined as traumatic experiences occurring before the age of 18, link childhood adversity with an increased risk for medical and psychosocial morbidity.  Individuals with more ACEs are more likely to experience negative health outcomes in childhood and adulthood. Poverty in adulthood is associated with depressive disorders, anxiety disorders, psychological distress, and suicide.

Source:  https://www.change4health.org/it-takes-a-village/social-determinants-of-health/frameworks/

According to the Center for American Progress, there were 9,886,033 people living in North Carolina in 2016.  Of this number, 1,521,880 or 15.4% were living below the poverty line (or $24,340 for a family of four).  The State ranked 38th nationally.  Poverty, however, varies by gender and race.  Children and women experience poverty at higher rates. The poverty rate for African Americans (23.5%), American Indians (25.6%), and Hispanic (27.3%) residents of NC is about double that for whites (12.0%). The chart below provides the percentage living in poverty and state ranking.

Percentage  of North Carolina Residents Living in Poverty North Carolina’s Rank among States




Working Age Women



Working Age Men



Income Inequality



Unemployment 5.1%


Hunger and Food Insecurity 15.1%


Source:  https://talkpoverty.org/state-year-report/north-carolina-2017-report/.

In addition, the Center for American Progress reported on affordable housing, stating that there were only 63.0 units for every 100 renter households with very low incomes in 2015. Very low-income households are those with incomes at or below 50% of the area median income.  NC ranked 27th among the states.  Other statistics included the percentage of people who held unemployment insurance (10.9% with a ranking of 50 among the states) and who had health insurance coverage (22.0%, with a ranking of 41st among the states).

Poverty and income in North Carolina also depend on the county in which a person lives.  For examples, Camden County’s poverty rate is 7.9% while Robeson County’s is 31.6%. Forty of North Carolina’s 100 counties have a poverty rate over 20%.  UNC School of Law has developed a map that indicates poverty rate, child poverty rate, and number of people living in poverty by county (see https://www.law.unc.edu/centers/poverty/numbers/northcarolina/).

The effects of poverty on physical and mental health have led some health professionals to propose the development and implementation of upstream interventions at the individual, family, community, and policy levels. One proposed strategy is the administration of a standardized screening tool, which would assess housing instability, food insecurity, transportation problems, utility help needs, interpersonal safety, financial strain, employment, family and community support, education, physical activity, substance use, mental health, and disabilities (https://innovation.cms.gov/Files/worksheets/ahcm-screeningtool.pdf).  Responses would result in referrals to appropriate services and resources offered by community and state agencies.

Because low income individuals lack access to evidence-based, high-fidelity mental health treatments, it is critical to focus attention on public policies that place greater value on giving everyone an equal chance at living a fulfilling and healthy life.  Advocacy for better housing, more income equality, better access to care, fairer immigration policies, and a stronger social safety net needs to result in public policies that improve mental health for everyone.  Project Everyone recognizes the need to end poverty as it is included as one of the 17 global goals needed to create a fairer world by 2030 (https://www.globalgoals.org).

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