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Economic stability and health

Apr 18, 2022
15 min Read
Blake Ursch
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Economic Stability and Health

Researchers at Creighton have published a study linking financial stability to better health outcomes.

“Improving Health Through Action on Economic Stability: Results of the Finances First Randomized Controlled Trial of Financial Education and Coaching in Single Mothers of Low-Income” was recently published in the American Journal of Lifestyle Medicine.

The study is the result of a collaborative effort of several Creighton health sciences programs — the School of Pharmacy and Health Professions, School of Medicine and College of Nursing — and the grant-funded Financial Hope Collaborative, housed in the Heider College of Business.

The research focused on a group of low-income single mothers in Omaha who were selected to receive financial coaching and education through the Financial Hope Collaborative, which works with low- and moderate-income families in the area to help them achieve financial stability.

The results: The women who completed the Financial Success Program “significantly reduced” their financial strain, making them more likely to quit smoking and less likely to avoid medical care due to cost.

The study — which the researchers believe is the first randomized, controlled trial examining the impact of financial education on health — is just one way in which experts at Creighton are examining the link between financial health and physical health.

Nicole Gillespie White, PharmD’10, associate professor of pharmacy practice, is one of the principal investigators of the Finances First study.

In November 2021, the University announced that it would spearhead pioneering research investigating whether better finances can lead to better health outcomes in patients with diabetes, following a $2.3 million investment from the Diabetes Care Foundation, co-founded by former Board of Trustees member Jim Greisch, BSBA’80, and chaired by former Board of Trustees member Mark Huber, BSBA’83, JD’86.

“Income is the No. 1 predictor of your health in America,” says Julie Kalkowski, founder and executive director of the Financial Hope Collaborative. “The higher your income, the better your health. The lower your income, the worse your health.”

Economic stability is one of the five major domains of the Social Determinants of Health, defined by the World Health Organization as “the nonmedical factors that influence health outcomes … the conditions in which people are born, grow, work, live and age, and the wider set of forces and systems shaping the conditions of daily life.” They are things like income and social protection, education, food insecurity, housing and working conditions.

Though numbers vary on how much of a population’s health can be directly attributed to the social determinants, most experts agree that their impact on health outcomes is significant.

“Physical and financial health are very highly interrelated,” says Nicole Gillespie White, PharmD’10, associate professor of pharmacy practice in Creighton’s School of Pharmacy and Health Professions and one of the principal investigators of the Finances First study. “When you think about access to medical care, your income level plays an important role. Just being able to afford to see your doctor, to take medications, is influenced by how much money you have.”

But a person’s financial situation impacts their health in more ways than whether they have the money to pay for doctor visits, White says. The problem goes much deeper than that.

When you think about access to medical care, your income level plays an important role. Just being able to afford to see your doctor, to take medications, is influenced by how much money you have.
— Nicole Gillespie White, PharmD’10

“For one thing, any type of stress creates problems in the body,” she says. “Stress increases inflammation in the body and dysregulates the immune system, both of which increase the risk for cardiovascular disease, diabetes and other chronic conditions.”

For another thing, continuous financial pressure erodes a person’s ability to make healthy lifestyle decisions. The concept, Kalkowski says, can be explained using what social scientists have dubbed the “limited resource model of self-control.”

The idea is that, in any given situation, a person has a limited amount of energy available to govern his or her own behavior. For example, if you haven’t slept much in the last few days because you’re worried about your bills, it’s harder to focus on just about anything, let alone concentrate on eating healthier or exercising.

People with low incomes, White says, are forced to make difficult decisions and regulate their behavior more often than those with higher incomes. Over time, this can erode self-control and lead to the adoption of unhealthy habits, such as smoking, drinking, poor diet and reduced exercise.

In the Finances First study, which took place between April 2017 through August 2020, women who were known to be making less than 200% of the 2017 U.S. Federal Poverty Guideline were randomly assigned to either receive financial counseling via the Financial Hope Collaborative’s Financial Success Program (FSP) or be assigned to a control group with no counseling.

The program, which has been around since 2009, focuses on monthly cashflow management. In the study, the single mothers selected for the program received one-on-one financial coaching and attended classes that taught them how to track their expenses, understand credit and credit reports and create a payment plan for bills and other expenses. The program was offered in both English and Spanish.

Julie Kalkowski Financial Hope Collaborative
Julie Kalkowski, left, meets with Deborah Dogba, a participant in the Financial Success Program through the Financial Hope Collaborative, housed in the Heider College of Business

“We focus on the immediate, small steps that people can do to improve their situation every month,” Kalkowski says. “That way, people begin to feel they have more control over their lives and feel that things can get better. When things start to work, it motivates you to keep moving forward.”  

Deborah Dogba entered the Financial Success Program in 2020. She joined, she said, because she was trying to boost her income and get a handle on her finances as she worked to launch her own small business.

“I was really living paycheck to paycheck, but my paycheck was invested in my business,” she says. “At the end of the day, I didn’t have a lot left.”

She says she benefitted most from the accountability the program provided through regular meetings with her financial success coach.

“The FSP brought a lot of clarity to me on my journey to financial freedom. The accountability aspect of it made it possible to achieve goals such as paying off debt,” she says. “One key component that provided a clear picture of my financial situation at that time was tracking income and expenses — budgeting.”

Since completing the program, Dogba has been able to quit her regular job and run her business consulting and publishing company, Afro Swag Media and Magazine, full-time.

The women who participated in the Financial Success Program reported greater income and ability to save than those who didn’t — a somewhat surprising outcome, given that the final year of the study took place during the COVID-19 pandemic, White says. In a subanalysis of 40 women who completed the 12-month program, participants were found to have experienced fewer job losses and an increase in median salary, along with an increase in resilience.

“When people aren’t stressed out of their minds, they perform better, and their supervisors notice,” Kalkowski says. “That leads to promotions and sometimes even a new job at a much higher salary.”

Income is the No. 1 predictor of your health in America. The higher your income, the better your health. The lower your income, the worse your health.
— Julie Kalkowski

As a result, the study showed that the women who participated in the Financial Success Program reduced their tobacco use after a 12-month period from 23.4% to 18.3%. Conversely, the women in the control group increased their use of tobacco, jumping from 19.3% to 22.2%.

The study also showed that women who participated in the program were less likely to avoid medical care due to cost after 12 months, with the percentage of those reporting they had avoided care dropping from 49% to 32.6%. The control group remained unchanged.

The Finances First study and the upcoming research funded by the Diabetes Care Foundation open the door to creating a more comprehensive picture of what health care can be, White says. So much of health care, she says, currently focuses on reactively treating physical disease instead of proactively preventing illness.

“With research increasingly tying better health outcomes to greater financial stability,” White says, “there’s the potential to create a new model that incorporates the financial element of care and gives patients the resources to build healthier lives.”