Written Statement for the Record

Submitted to the United States Senate Committee on Health, Education, Labor and Pensions, Subcommittee on Primary Care and Aging on September 13, 2011

Gwendolyn Puryear Keita, PhD, Executive Director of the Public Interest Directorate, American Psychological Association

Chairman Sanders and Ranking Member Paul, on behalf of the 154,000 members and affiliates of the American Psychological Association (APA), I want to thank you for providing us the opportunity to comment on the serious issue of poverty. APA supports and advocates for increased access to high-quality, affordable health and mental health care for all persons, regardless of income. Poverty can be associated with several mental health issues, and an assessment of the mental health implications on low socioeconomic status (SES) individuals should be seriously considered when evaluating potential responses to this issue.

APA is the largest scientific and professional organization representing psychology in the United States and is the world's largest association of psychologists. Comprised of researchers, educators, clinicians, consultants, and graduate students, APA works to advance psychology as a science, a profession, and a means of promoting health, education, and human welfare.

APA’s Committee on Socioeconomic Status (CSES) was formed to identify and act as a catalyst in the APA’s efforts to address issues of SES and promote appropriate attention to SES in psychological research and practice. CSES collects information and documentation concerning SES; promotes scientific understanding of the roles of poverty and SES in health, education, and human welfare; and develops approaches to the application of psychology that take into account the effects of SES on psychological development and well-being.

The psychological effects of poverty are numerous and far-reaching. For example, research has demonstrated that rates of attempted suicide, cigarette smoking, and engaging in episodic heavy drinking are significantly higher among lower SES individuals1. Lower SES is also associated with higher levels of emotional and behavioral difficulties such as anxiety, depression, attention-deficit/ hyperactivity disorder, and conduct disorders. 2 Levels of aggression, 3 hostility, perceived threat, and perceived discrimination for youth 4are also heightened among poorer individuals. Studies have also found a higher incidence of Alzheimer’s disease later in life among lower SES individuals. 5 Taken together, these findings speak to the strength and pervasiveness of the link between poverty and negative psychological health outcomes.

APA members from varied and diverse perspectives are working to explain the mechanisms by which SES affects mental and psychological health. One pathway is through health behaviors such as smoking, poor diet, and lack of exercise. The prevalence of these behavioral risk factors, which significantly predict premature mortality, increases as SES decreases. Researchers are beginning to consider the potential environmental determinants of these behaviors (e.g., availability of recreational areas to exercise, cost of and access to low-fat foods, targeting of cigarette advertising).6 Another means by which SES affects health is through differential exposure to stress. Lower SES brings with it greater exposure to both acute and chronic stress, which in turn predict morbidity and mortality. 7Stressful environments may foster maladaptive emotional and behavioral responses, including hopelessness, anger, and aggression. 8,9

SES also affects family stability, including parenting practices and resulting developmental outcomes for children. 10 The myriad stressors that affect lower income parents may foster a harsh parenting style, in which parents react more quickly and punitively to child misbehavior. 11

Other factors that contribute to the impact of SES on childhood development involve resources, such as adequate nutrition, access to health care and housing, 12 and exposure to cognitively stimulating materials and environments. 13

Poverty also negatively affects social perceptions and interactions. Research examining the discriminatory treatment of low SES individuals in interpersonal interactions reveals the stigma and considerable social distancing experienced by those perceived to be "lower class." Moreover, the covariation of SES with other factors, such as race/ethnicity, gender, disability, and age, places additional social burdens upon poor individuals who are also members of other disadvantaged groups (e.g., racial/ethnic minorities, women, the elderly).

In addition to the stigma and discrimination experienced at the individual level, research on institutional classism highlights the pervasiveness of negative attitudes toward social institutions and programs perceived as targeting the disadvantaged – particularly those aimed at assisting poor people of color, poor women, or both. The stereotype of the "welfare queen" provides a good example of how class, gender, and race may intersect in the popular media and public imagination.14 Unfortunately, these images undermine support for policies designed to differentially benefit the poor and reduce disparities. 15

Given the number and magnitude of the effects of poverty on mental health and psychological well-being, the APA remains committed to supporting research, policies, and programs that address this important issue. APA supports the expansion of the Temporary Assistance for Needy Families (TANF) program, job training and reemployment programs, and additional research on the psychological effects of unemployment, in an effort to prevent long-term unemployment and poverty.

The APA’s Office of Socioeconomic Status and Committee on Socioeconomic Status (CSES) and Public Interest Government Relations Office work separately and jointly to develop and facilitate relationships and activities to advance psychology as a major force in research, policy and advocacy related to SES. Ongoing advocacy initiatives related to SES include reducing classist attitudes and discriminatory practices; increasing access to health care, quality education and affordable housing; and promoting safe communities. APA’s policies on these critical issues are directed by the scientific understanding of the roles of poverty and SES in health, education and human welfare.

Thank you again for the opportunity to provide a statement on the negative psychological impact of poverty and the possible policy responses to this important issue. By working to combat poverty and its detrimental physical and psychological consequences, we can help improve mental and physical health, reduce disparities, and create a healthier and more productive society.

1 Newacheck, P., Hung, Y., Park, J., Brindis, C., & Irwin, Jr. C. (2003). Disparities in adolescent health and health care: Does socioeconomic status matter? Health Services Research, 38, 1235-1252.

2 Goodman, E. (1999). The role of socioeconomic status gradients in explaining differences in US adolescents’ health. American Journal of Public Health, 89(10), 1522-1528.

3 Molnar, B. E., Cerda, M., Roberts, A. L., & Buka, S. L. (2007). Effects of neighborhood resources on aggressive and delinquent behaviors among urban youths. American Journal of Public Health, 97(11), 1-8.

4 Chen, E., & Paterson, L. Q. (2006). Neighborhood, family, and subjective socioeconomic status: How do they relate to adolescent health? Health Psychology, 25(6), 704-714.

5 Fratiglioni, L., Winblad, B., & von Strauss, E. (2007). Prevention of Alzheimer’s disease and dementia. Major findings from the Kungsholmen Project. Physiology & Behavior, 92, 98-104.

6 Macintyre, S., Maciver, S., & Soomam, A. (1993). Area, class and health: Should we be focusing on places or people? Journal of Social Policy, 22, 213–234.

7 Seeman, T.E., Crimmins, E., Huang, M.H., Singer, B., Bucur, A., Gruenwald, T., et al. (2004). Cumulative biological risk and socioeconomic differences in mortality: MacArthur studies of successful aging. Social Science and Medicine, 58, 1985–1997.

8 Gallo, L. C., & Matthews, K. A. (2003). Understanding the association between socioeconomic status and physical health: Do negative emotions play a role? Psychological Bulletin, 129, 10–51.

9 Chen, E., & Matthews, K. A. (2003). Development of the cognitive appraisal and understanding of social events (CAUSE) videos. Health Psychology, 22, 106–110.

10 Trickett, P.K., Aber, J. L., Carlson, V., & Cicchetti, D. (1991). Relationship of socioeconomic status to etiology and developmental sequelae of physical child abuse. Developmental Psychology, 27, 148-158.

11 McLoyd,V. C. (1998). Socioeconomic disadvantage and child development. American Psychologist, 53, 185–204.

12 Adler, N.E., Marmot M., McEwen, B., & Stewart, J. (Eds.). (1999). Annals of the New York Academy of Sciences: Socioeconomic status and health in industrialized nations: Social, psychological, and biological pathways (Vol. 896). New York: New York Academy of Sciences.

13 Bradley, R.H., Corwyn, R.F., McAdoo, H.P., & García Coll, C. (2001). Home environments of children in the United States: Part 1.Variations by age, ethnicity, and poverty status. Child Development, 72, 1844–1857.

14 Gilliam, F.D. (1999).The "welfare queen" experiment: How viewers react to images of African-American women on welfare. Nieman Reports, 53, 49–52.

15 Katz, M.B. (1989). The undeserving poor: From the war on poverty to the war on welfare. New York: Pantheon Books.

For more information, please contact Krysta Jones, MA, in the APA Public Interest Government Relations Office at (202) 336-5931.