Socioeconomic Influences on Health
Martha D. is a 69-year-old African American woman who lives in a substandard, cold-water, third-floor walk-up apartment in a housing project with a high crime rate. She draws a small Social Security check that does not cover living expenses. Her income is supplemented by food stamps, housing assistance, and by working as a nanny for three small children for 20 hours a week. Ms. D. earns minimum wage for her job as a nanny, and accepts cash for her work to avoid any interference with her Social Security check. She uses public transportation to go to and from her job, spending $3.00 each working day on bus fare. Ms. D. helps her alcoholic single daughter, age 47, with two teenage children, especially when the daughter is experiencing a drinking binge. The children frequently stay with Ms. D. and rely on her for food, shelter, and love. Mr. D. is an alcoholic and has not been home for 2 years; however, he does occasionally call from a homeless shelter or treatment facility. Neither the daughter nor Mr. D. contribute to household expenses, but Ms. D. is very devoted to her family, especially her two grandchildren. Martha D. is 5’8″ tall and weighs 285 pounds. She has hypertension, with her blood pressure ranging from 200/90 to 250/110. She is on medication for her blood pressure, and the physician has linked her with a county home health nurse to encourage a diet and simple exercise regime for her obesity and hypertension. Ms. D. is beginning to show signs of type II diabetes and has been encouraged to lose weight and adhere to a diabetic diet. In addition, Ms. D. has some small ulcerations on her left ankle. The home health nurse visits Ms. D. and instructs her in the care of her ulcers, advising her to keep her left foot elevated as much as possible. The nurse spends considerable time explaining a 1,200-calorie diabetic diet with moderate sodium restriction to Ms. D., and talks with Ms. D. about the need to begin walking as soon as the ulcers on her foot heal. Ms. D. lets the nurse know she used to attend a weight control group and understands low-fat and diabetic diets. However, she says coming home to a nice pot of beans, fried chicken, and biscuits is her only daily pleasure. “I’ve lived 69 years on this diet, don’t wish to change, and have nothing to lose if I remain on it the rest of my life.” She also points out that it is not safe to walk in her neighborhood, so she stays inside. In addition, she indicates that she is too tired to exercise after working all day.
