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Prior to the COVID-19 pandemic, progress was made in reducing rates of unemployment and improving rates of high school graduation and per capita income. However, wide disparities persisted across these and other measures including rates of poverty and food insecurity.

Poverty

Poverty is strongly associated with poor health outcomes, such as chronic disease, mental health challenges, infant mortality and premature mortality.1 Households with incomes below the federal poverty level often struggle to meet basic housing, food and health care needs—a challenge that significantly contributed to increased exposure and susceptibility to COVID-19.
Prior to the COVID-19 pandemic, notable disparities persisted in poverty rates by educational attainment, gender, geography and race and ethnicity. In 2015-2019, households headed by those with less than a high school education (30.7%) had almost a six times higher rate of poverty than households headed by college graduates (5.2%). Households headed by American Indian/Alaska Native (25.0%), Black (22.8%) and Hispanic (19.5%) adults had more than a two times higher rate of poverty than white-headed households (9.8%). Female-headed households (16.4%) had a 1.7 times higher rate of poverty than households headed by males (9.7%).
Poverty rates were also higher in households in non-metropolitan areas (15.5%) than metropolitan areas (12.5%).

Child Poverty

Nationally, 18.6% of children lived in households below the federal poverty level in 2015-2019. Between 2005-2009 and 2015-2019, the percentage of Hispanic, Black and Asian/Pacific Islander children living in households below the federal poverty level declined, whereas the percentage of white children living in poverty slightly increased. Despite these changes, in 2015-2019, American Indian/Alaska Native (32.5%), Black (33.2%) and Hispanic (26.7%) children continued to face poverty rates that were more than two times higher than white (11.3%) and Asian/Pacific Islander (11.1%) children.
Deep racial and ethnic disparities in child poverty rates were also evident within and across states. For example, within South Dakota—the state with the highest disparities—American Indian/Alaska Native (56.8%) children had nearly an eight times higher rate of living in poverty than white (7.3%) children. In Hawaii—the state with the lowest disparities—Hispanic (17.3%) children had nearly a two times higher rate of living in poverty than white (9.3%) children.
Across states, child poverty rates varied more than tenfold by race and ethnicity. In 2015-2019, American Indian/Alaska Native children in South Dakota (56.8%) had the highest rate of child poverty nationally—a rate 10.5 times higher than white children in Connecticut who had the lowest rate (5.4%).

Less than a High School Education

Educational attainment is a strong predictor of health. Americans with higher levels of education have better job opportunities, earnings, and resources to live longer, healthier lives than those with less education. Lower educational attainment is associated with greater prevalence of many chronic conditions, mental and behavioral health challenges and premature death.
Between 2005-2009 and 2015-2019, significant progress was made in reducing the percentage of adults ages 25 and older with less than a high school education across all subpopulation groups. Of note, significant progress was achieved in reducing rates and disparities of less than a high school education between non-metropolitan and metropolitan areas.
While progress was also made to improve education rates by race and ethnicity, Hispanic adults continued to face the highest rates of having less than a high school education. In 2015-2019, Hispanic adults (31.9%) had a four times higher rate of having less than a high school education than white adults (7.2%), who had the lowest rate in the nation.
In fact, Hispanic adults across 43 states and the District of Columbia had the highest rates of less than a high school education compared to all other racial and ethnic groups. Arkansas had the highest rate, where 42.8% of Hispanic adults were without a high school education, compared to 8.6% of Hispanic adults in Maine, where the rate was lowest.


Food Insecurity

Food insecurity is measured as the percentage of households unable to provide adequate food for one or more household members due to lack of resources. It is associated with chronic diseases such as obesity, diabetes and hypertension as well as mental health conditions such as anxiety and depression, especially among low-income populations.2, 3, 4

Even prior to the COVID-19 pandemic, notable disparities existed in food insecurity rates, with gaps further widening between 2003-2007 and 2015-2019 as some subpopulation groups experienced significant increases in food insecurity rates. For example, during this time period, food insecurity rates increased 39% for American Indian/Alaska Native households from 19.7% to 26.7%. By 2015-2019, American Indian/Alaska Native (26.7%) households had a five times higher rate of food insecurity than Asian/Pacific Islander (5.6%) households.
Disparities in food insecurity were also significant by education. In 2015-2019, households headed by those with less than a high school education (24.8%) had nearly a six times higher rate of food insecurity than households headed by college graduates (4.4%). Since 2003-2007, food insecurity rates increased at every education level – including 15% in households headed by those with less than a high school education, and 19% in households headed by college graduates.
There were notable disparities in food insecurity rates within and across states too.

Per Capita Income

Per capita income is the mean income calculated for every individual in a group (often a household). Income is a strong predictor of health, and lower levels of income are associated with poorer health outcomes across the life course.
All subpopulation groups experienced an increase in per capita income between 2005-2009 and 2015-2019. Despite this progress, disparities persisted by education, gender, geography and race and ethnicity. Of note, in 2015-2019, females ($26,156) had a per capita income that was $15,857 lower than males ($42,013).
Gender-based disparities in per capita income were wide across states. Connecticut had the highest disparity, where per capita income varied in absolute terms by $22,162 between females ($33,505) and males ($55,667). Mississippi had the lowest disparity, where per capita income varied by $10,714—however both males ($29,905) and females ($19,191) in Mississippi had far lower per capita incomes than their counterparts nationally.

Income Inequality

Income inequality is measured as the ratio of median household income at the 80th percentile to household income at the 20th percentile. Higher ratios indicate greater income inequality. In 2019, income inequality varied considerably across states. District of Columbia (6.3) had the highest income inequality, whereas Utah had the lowest (3.7). Since 2011, income inequality declined across 18 states, whereas it increased across three states—Alaska, Wyoming and New York.

[1] Adler, N.E., et al. (1994). Socioeconomic Status and Health: The Challenge of the Gradient. American Psychologist, 49(1)15–24. doi:10.1037/0003-066X.49.1.15.
[2] Seligman, H., et al. (2010 February). Food Insecurity is Associated with Chronic Disease among Low-Income NHANES Participants. Journal of Nutrition, 140(2): 304–310. doi: 10.3945/jn.109.112573
[3] Gregory, C. and Coleman-Jensen A. (2017 July). Food Insecurity, Chronic Disease, and Health Among Working-Age Adults. Economic Research Report, 235. United States Department of Agriculture.
[4] Jones, A. (2017 August). Food Insecurity and Mental Health Status: A Global Analysis of 149 Countries. American Journal of Preventive Medicine, 53 (2): 264-273. https://doi.org/10.1016/j.amepre.2017.04.008.

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