Payday Loans and Health High Cost Lending Summit, Washington, D.C. - - PowerPoint PPT Presentation

Payday Loans and Health

High Cost Lending Summit, Washington, D.C. November 28, 2018 Elizabeth Sweet, PhD, MPH

What is an epidemiologist doing here?

Health reflects economic status

Women Men

70 75 80 85 90 Expected Age at Death 20 40 60 80 100 Household Income Percentile

Expected Age at Death vs. Household Income Percentile By Gender at Age 40

Chetty et al., 2016 JAMA

How do inequities enter the body?

Health care? Diet and Lifestyle? Smoking? STRESS

From INTERH ERHEA EART RT Stud tudy y in 5 52 2 countri ntries es, Rozans anski ki et al 200 005. 5.

Stress predicts heart attacks better than many conventional risk factors Psychosocial Stress

Clinical risk factors Healthy behaviors

Debt is stressful. Is it associated with worse health?

Type of Health Outcome Number of Studies Types of Debt Measures Mental Health (Depression, Anxiety, etc.) 12+ Total $, income ratio, mortgage delinquency, self-assessment, any debt Life Expectancy 1+ Unsecured and mortgage General Health (self-report) 5+ Debt to income ratio, credit card debt, mortgage debt, self- assessment Physical Health (biomarkers,

• besity, etc.)

4+ Same as above Evidence is building. Lots of variation in the measurement of both debt and health outcomes.

Short-term loans and health

Sweet et al., 2018

Short-term loans and health

0% 10% 20% 30% 40% 50% 60% 70%

SBP BMI Waist Circ. CRP # Phys. Symp. # Sexual Symp. Anxiety

% Difference between STL and non-STL Borrowers

Sweet et al., 2018

Compared to those who had never had a short-term loan (STL), STL borrowers had significantly higher:

• blood pressure
• body mass (obesity)
• C-reactive protein
• self-reported physical and

sexual symptoms

• anxiety

Biggest takeaway: payday loans are disease risk factors

• Effect sizes are consistent with those seen in
• ther health inequities research
• Effects on biomarkers and physical health

measures are particularly strong

• The effect on CRP is especially notable

– CRP is a measure of inflammation and cardiovascular risk – Unlike non-STL borrowers, STL borrowers’ CRP puts them in an ‘intermediate risk’ category for heart disease

Limitations of the study…

• Direction of causality not explored

– Need longitudinal data to sort this out

• Mechanism linking STL to poorer health needs

more study

– BUT psychosocial stress is the strongest theory – And is supported by qualitative data from this study…

Qualitative findings…

“I feel like I’m a bad person because I can’t pay this off.” “[I feel] horrible, like a loser, just like crap.” “[You feel] like you failed at life. I just want to cry, I feel suffocated, I feel like I can’t breath. You feel like less of a person.”

These feelings about debt were also strong, independent predictors of poor health…

What’s next?

• This study was born from a health inequities

perspective – not designed with an eye toward data that is most policy relevant

– What do policy and consumer advocates need from researchers? – What data can epidemiologists provide that will be most helpful? – What formats and/or venues are most helpful for reporting that data? – What else can we do to better facilitate dialogue, collaboration, and action?

Some references…

• Sweet E, Kuzawa C, McDade TW. Short-term Lending:

Payday Loans as Risk Factors for Anxiety, Inflammation, and Poor Health. SSM – Population Health. 5: 114-121.

• Sweet E. “Like you failed at life”: Debt, Health and

Neoliberal Subjectivity. Social Science and Medicine. 212: 86-93.

• Sweet E, Stanley F, DuBois LZ. Embodied Neoliberalism:

Epidemiology and the Lived Experience of Consumer Debt. International Journal of Health Services. 48(3): 495-511

• Sweet E, Nandi A, Adam EK, McDade TW. The High Price of

Debt: Household financial debt and its impact on mental and physical health. Social Science and Medicine, 91: 94- 100