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Op-Ed: Listening to What ALICE Has to Say About NJ’s Working Poor

More than one-in-four NJ families — people we see and work with every day — cannot afford to meet a ‘survival budget’

Chris Kirk
Chris Kirk is director of community engagement and health improvement for Atlantic Health System.

There have been many voices involved in the conversation of how best to shape the healthcare landscape. Amid the din of debate, one name that stands out is ALICE.

Beyond the acronym created by the United Way of Northern New Jersey — asset limited, income constrained, employed — ALICE describes people you recognize in your own community. ALICE is the teacher at your kids' school and the person who prepares meals for his family. ALICE is the hundreds of people behind the scenes who make things work in our communities, from construction workers to store cashiers, to kitchen staff at your favorite restaurant, to the staff caring for you at your local hospital.

In New Jersey, these individuals often struggle to find the means to meet a modest “survival budget” within the basic domains of housing, transportation, food, childcare, and, yes, healthcare. At Atlantic Health System, what we have discovered through our community outreach and support is that ALICE has a tremendous impact on health.

Research consistently shows that socioeconomic status is one of the largest predictors of health, with income disproportionately affecting the health outcomes of those with less means. The socioeconomic level of the neighborhood where you live is a strong predictor of how long you will live. Right here in New Jersey, life expectancy at birth varies greatly from one town and neighborhood to the next, strongly correlating with the median income of those communities.

The stories of these individuals are greater than the statistics. It is the parent who must choose between quality childcare or their own healthcare. It is the pressure of multiple jobs that limit the opportunity to exercise. It’s the choice between empty calories or the mortgage payment.

These dramatic choices lead to shorter and sicker lives, and the cost on the healthcare system is tremendous.

At Atlantic Health System, the ALICE report is a key to our understanding of the needs of our communities and our patients, and demonstrates the primacy of the social determinants of health. Research on modifiable factors for population health shows that quality medical care is only 20 percent of the equation, with social and economic factors making up twice that amount, according to county health rankings from the University of Wisconsin Public Health Institute.

We are committed to providing the right care at the right quality, at the right time, at the right place, and at the right cost. The ALICE report helps us determine the services that are most needed. We are finding new ways to link those in need to community resources — from food to transportation — and developing stronger partnerships with other agencies to maximize our impact and expand our reach.

The United Way ALICE Project is intended to paint a picture of financial insecurity at state and local levels, providing organizations with data to better understand the needs of their communities, employees, and clients. The 2016 update of the ALICE report was recently released, illustrating not only the stark challenge for our communities, but showing that this challenge has only gotten harder since the original report in 2012.

More than one-third of New Jersey households struggle to survive economically and more than one in four families (26 percent) are defined as ALICE. While some modest gains have been made between 2007 and 2014 in the proportion of jobs paying more than $20 per hour, these gains have not outpaced the rate of inflation for core expenses in New Jersey, burdening ALICE individuals with an increase of 23 percent for basic expenses. The challenge of ALICE is ubiquitous. In the northern New Jersey counties that Atlantic Health System serves, more than one in four households have incomes that are below the ALICE survival budget, a number that has grown steadily since the first report.

The ALICE report is a must read for anyone focused on the health and wellbeing of our New Jersey communities. As we discuss how to design systems, pass policies, and think about what makes our communities healthy and vibrant, we will need to listen closely to the voices of ALICE.

Chris Kirk is director of community engagement and health improvement for Atlantic Health System and a member of the New Jersey Research Advisory Committee for the United Way ALICE report.

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