Due to high energy prices and high inflation, more and more citizens are getting into trouble. In addition to lower incomes, according to Nibud, households with an income above the average are increasingly unable to make ends meet. But there are not only financial consequences. A lack of money and insecurity also have a major impact on the health of citizens. A stress-sensitive approach can reduce the impact of stress due to a lack of money. But much more is needed. It is high time for a structural approach to poverty that also listens to the experiences of citizens themselves.
The signals are legion. Nibud has established that one in three households is currently short of money at the end of the month. Aedes and the energy companies have seen the number of people with payment arrears increase again in recent months. According to Nibud, people initially look for solutions through creative cutbacks. But in the long term they cannot sustain this and this leads to the disappearance of financial buffers and mounting debts. But people are not only becoming financially vulnerable. There is a direct relationship between insufficient income and financial problems and poor health.
Health effect
Lack of money and insecurity in general have a direct effect on health. In 2021, according to Nivel, 8% of the Dutch population will have refrained from visiting a general practitioner, specialist or treatment with medicines because of the costs. Insecurity and a lack of money also mean that there is often a lack of money for a healthy lifestyle (healthy food, participation in sports and other social activities).
People are only concerned with the primary needs; there is no room to think about the long term
Survival mode
Difficulty getting by leads to stress. A lot of and long-term stress can lead to unhealthy behavior in people due to smoking, alcohol or substance use. But stress also affects people’s behavior in other ways; our brain goes into a survival mode under the influence of long-term stress, so that people are only concerned with the primary needs and there is literally no room to think about the long term. The Scientific Council for Government Policy (WRR) shows in the report Weten is not yet showing that chronic stress limits people’s ‘ability to act’ and causes people to sometimes make unwise choices.
Mental health problems
Poverty and insecurity increase the risk of psychological problems. According to Plantinga, people with the lowest 25% of incomes are more than one and a half times more likely to have a mood disorder or anxiety disorder than people with the highest 25% of incomes. Insecurity leads to a greater risk of depression, psychosis, mood disorders, suicide or suicidal ideation, alcohol or drug addiction. Other research confirms the link between mental health and debt. Finally, poverty and insecurity also lead to a reduced self-esteem.
Job loss
There is also a relationship between health, income and work. If stress complaints as a result of financial problems lead to frequent absenteeism, this can lead to job loss. People with poorer health are less likely to go to work. The lack of work affects not only the income position, but also well-being in general. Working reduces the risk of depression, provides structure, more self-esteem and more appreciation from the social environment.
Life expectancy
Ultimately, the health differences are reflected in life expectancy. The average life expectancy at birth for the lowest incomes is currently 77 years, compared to 84.5 years for the highest incomes. The difference in years of good perceived health is even greater. Children from more affluent families live more than 18 years longer in relatively good health than children from poor families.
Monica’s story
Monica is 64 years old and in 2019 she completed the training to become an expert by experience in poverty and social exclusion.
Monica grew up eleventh in a family of twelve children. Her parents had low-paying jobs and needed all their energy to make ends meet. As a result, no attention was paid to the emotional and personal development of the children. Looking back, Monica indicates that she didn’t have much of a problem with the lack of money, but the biggest problem was to keep going in society. She was insecure about what was expected to work, how things worked, how to behave.
She always felt ‘less’. She noticed at a young age that she is different and developed feelings of shame; as a result, she began to avoid social contacts outside her own network. From society, this social exclusion is further fueled by the judgments people have about families with a low social status. It underlines and reinforces the feelings of fear and distrust towards society and the feeling that you will never be able to meet the demands that society makes of you. This results in a lot of stress and a fundamental mistrust of society.
So you don’t seek help from authorities; you ask for help in your own network from people who have a similar background. As a result, you sometimes get incorrect information; for example, that your children will be taken away when you go to the neighborhood team. And what should you ask for help for? Our family had little money, but poverty was a third world thing where people starve to death.’ Asking for help has therefore never occurred to Monica.
Monica indicates that more attention should be paid to the skills that people in poverty do have, such as solidarity with your network. Take care of each other. Keep going and don’t give up easily. Survive under difficult conditions. Take responsibility for your family and children. Work hard! And feel almost flawlessly whether something is sincere or not.
Stories of other people
In the publication Faces of an Uncertain Life, 14 people talk about their lives in precariousness. Stress and health problems play an important role in almost all of these stories.
As described above, stress due to chronic lack of money has a major influence on people’s behavior, in particular on people’s ability to make the right choices, to be self-reliant and to find solutions. Stress-sensitive assistance aims to reduce the experienced stress and in any case not to contribute to an increase in the stress level.
The stress-sensitive approach
Stress affects thinking ability. People live by the day and develop a kind of tunnel vision. Chronic stress leads to people showing shame and avoidance behaviour, feeling lonely and isolated, having difficulty processing information, becoming suspicious and having difficulty converting positive intentions into actions. They lose grip on their lives and no longer see any perspective.
The stress-sensitive approach tries to give people the space to strive for solutions by giving them peace and space to think, giving them back control over their lives and offering perspective. For this approach it is important that care providers can put themselves in the shoes of the person with a request for help.
Elements that care providers can use are:
- Support. For example, by sending a neutrally formulated reminder for an appointment.
- Recognition. Understand how people are put together and see and name it.
- Removing time pressure, for example through a debt freeze or repayment break
- Giving people control over what really matters to them. Giving people the feeling that they can choose for themselves
- Developing a positive vision of the future, for example by setting attainable goals and by celebrating successes achieved.
- Building a relationship of trust, without that the counselor will never find out the real cause of the stress
Read more about implementing a stress-sensitive approach on Movisie.nl.
Underlying factors
Monica’s story shows that in situations of long-term financial stress, more factors play a role than just the financial picture. A truly stress-sensitive approach not only takes into account the limited ability to do and think, but also takes into account the underlying feelings of shame, low self-esteem, exclusion mechanisms and the influence of the social network and utilizes people’s talents and possibilities.
Solutions?
The stress-sensitive approach can be an important tool in dealing with stress, and can therefore offer effective support to people in precariousness. But the above overview of the impact of a lack of money and insecurity on health shows that much more is needed. Ultimately, the poorer health of the large group of households that are now at risk will lead to a greater demand for care and significantly higher healthcare costs. Investments in income and poverty policy and social security will eventually lead to savings in health care costs.
In short, it is high time that we started thinking about a systematic approach to poverty and social insecurity. In our opinion, the measures that the national poverty coalition lists in its letter to the House of Representatives form a good starting point for this discussion.