Material Hardship Can Cause Adverse Health Outcomes in Young Adults

An Urban Institute survey covering the first year of the coronavirus pandemic found that despite a steep drop in employment, the share of young adults reporting food insecurity or problems paying utility and medical bills actually declined compared to previous studies. 

“Measures of hardship look at very specific indicators of things like bill paying hardship, so a specific question would be like did you not pay utility bill last year because your phone was disconnected, if you had trouble with one of these, we would say you had a material hardship,” said John Iceland, a professor of sociology and demography at Penn State University. 

According to the Institute, of the nearly 9 million young adults who lost their jobs during the pandemic, most had been hourly-wage workers.  

Compared with adults whose family employment was unaffected by the pandemic, families who lost jobs during the pandemic were twice as likely to report food insecurity, and nearly three times as likely to report problems paying utility bills, and nearly four times as likely to report problems paying rent or mortgage. 

“There’s a sense in our affluent world that we don’t need to be so careful at measuring material hardship, but the COVID-19 crisis taught us it’s more prevalent than we thought,” said Colleen Heflin, professor of public administration of international affairs at Maxwell School of Syracuse University. 

“Material hardship should measure an ability to cover basic needs,” said Heflin.  

Heflin and her research colleague Dr. Ying Huang, an assistant professor of demography at the University of Texas, San Antonio based their analysis on an earlier nationally representative survey of 13,313 young adults, aged 18–34 years, who were surveyed during the Great Recession of 2007-2009.

The four health outcomes examined included self-reported health measures (whether study participants thought their health was good, fair, or poor), depression, sleeping problems, and whether the participant had suicidal thoughts in the past 12 months. 

“Stressful environment and conditions could be one of the pathways that lead to bad health,” Huang said.  

Measuring material hardship is different from measurements of poverty which only look at income levels, and not individual’s abilities to do things like go to the dentist or pay rent.  

“Poverty is an income-based measure and looking at household income and household measure for family size, it’s not adjusted for local cost of food or housing. There are many problems with the official poverty measure, it’s largely misunderstood as you can be above the poverty measure, and not have any money to afford housing,” Heflin said. 

Social programs like unemployment insurance, supplemental assistance, Medicaid, the Children’s Health Insurance Program, served about three-quarters of the adults whose families lost jobs during the pandemic, and half of families who had a member furloughed, according to Urban Institute findings.  

“Loss of employment is a big hardship, but the safety net, so far, is doing okay,” Iceland said. 

“You could say the public policies have worked, could be one interpretation, whether you’re looking at the population as a whole or population as job loss,” said Heflin.  

However, individuals who are part of these programs tend to fall out of them because of things like keeping up with routine paperwork, which means data sets on how these social programs might impact health outcomes are not entirely reliable.  

A separate research effort, the Household Pulse survey conducted by the U.S. Census Bureau, provides researchers with a data set of material hardships with different income and program participation modules.  

“It’s a nationally representative data set that provides weekly changes, for example when people receive stimulus checks, and you can see the changes over time and how that responds to policies at the state and national level,” Huang said.  

However, earlier year versions of the census survey from 2014 included modules which asked survey participants more extensive questions on material hardships, and included many more domains, such as specific question about paying utilities, whether someone went to the dentist or hospital, and the quality of their housing, such as whether there were exposed wires or cracks in the ceiling. 

“The newer version has more longitudinal data, but less depth than previous measures,” said Heflin.  

“We are in a pandemic, and most people are working from home, people are spending longer hours inside the house. It would be helpful to know if they have energy hardships. For example, when it’s really hot can people afford having air conditioning? Or during a snowstorm do people have resources to keep themselves warm? Things like that would be helpful. Unfortunately, in the national survey, we don’t have that data,” said Huang.  

Huang is currently researching material hardship and mental health, and metropolitan local segregation, and whether or not that, with income loss and material hardship, can put minorities at greater risk for health disadvantages. 

Heflin is working on research on whether older adults on the Supplemental Nutrition Assistance Program and Medicaid are having prescription drugs filled on time, and whether those recipients are medically adhering to their prescription drugs.  

While Iceland will be looking at neighbor income and material hardship, and if living in a poor neighborhood increases the likelihood of hardship. 

“A lot of issues are interrelated, and we tend to focus on simple ones we can measure, but if it doesn’t become a social fact then it’s invisible. Material hardship issues need to be studied because they drive policy,” said Heflin. 

“We really need to help people with material hardships, and local and national policies can make a difference,” said Huang.