On this week discussion will evaluate the following scenario and discuss your insights on the situation from a scientific methods perspective as on Chapter 4 of your textbook.
ALICE is an acronym for individuals who are Asset Limited, Income Constrained and Employed (Figure 4.2). ALICE individuals may work one 40-hour per week job or several part-time jobs, with an income above their state’s federal poverty level, but do not earn enough income to afford a “bare-bones budget” or to pay for necessities such as housing, food, healthcare, childcare, and transportation as described by the United Way of Maryland (2020). They are often described as the “working poor,” because their income does not cover the cost of basic needs such as housing, food, transportation, childcare, healthcare, clothing, technology, and leisure activities. ALICE is the childcare worker, the retail cashier at the grocery store, the salesperson at the big box discount store, or the home-health aide, for example—the people in our communities that we all depend upon (United Way, 2020). Every 2 years, the United Way conducts a national-level study of financial hardship to understand and provide evidence of economic disparities and changes over time to inform policy and actions to improve conditions for ALICE households across the country. The most recent study is from 2020 and uses 2018 data (United Way, 2020). Nicole’s story that follows is a case study that uses concepts and data from the 2020 ALICE study. The case study provides an opportunity for nurses and other public health practitioners to integrate concepts from the SDOH framework to address major public health problems discussed throughout the chapter (see Figure 4.1).
Nicole’s Story
Nicole, 26 years old, is a working parent. She has two children, and she is finding it harder and harder to make ends meet for her family. Nicole makes $31,680 annually as a hotel front desk manager in a suburban county in Maryland. Her children are Samantha, 2 years old, and Jeffrey, 6 weeks old. The new baby has stretched the already-tight family budget even more. Daycare for Samantha and Jeffrey costs $1,600 month, and the rent on Samantha’s 750 square foot, two-bedroom, one-bathroom apartment was recently raised from $1,550 per month to $1,625 per month. Nicole would like to stay in this apartment because she can drop her children off at daycare on her walk to the bus stop, and there is a playground on the premises of the apartment complex. But Nicole worries that if the rent increases again she may need to think about moving. Although she was entitled to remain at home for a 6-month unpaid maternity leave, she has recently returned to work. Nicole started saving money as soon as she learned she was pregnant, because she knew she wanted to take time off after the baby was born. But the money ran out after 5 weeks, so she had to return to work earlier than she wanted to. Nicole is increasingly concerned because things like groceries, diapers, and other necessities are becoming so much more expensive.
Nicole has carefully considered her work situation. She left her previous job because she received no indication of a salary increase in the future. She had worked at her previous job for 5 years, was never late, and never took a sick day, and her annual evaluations were always positive. The only benefits her previous job and the current job offer are free dental cleanings and minor dental work for her and her family. Her current position offers 50 cents more per hour than her previous job, which helps with the household income. Nicole has been told that her family’s income is too high to qualify for help from the government, but she knows it is definitely not enough to survive without some assistance. Nicole’s husband, Wallace, works at an Amazon warehouse, where he earns $32,387 annually. Nicole and Wallace both drive for Lyft when not working their full-time jobs to help bring some much-needed extra money into their household. Nicole describes herself as the kind of person who always pays her bills, but it is becoming increasingly more difficult to stay on top of everything (United Way, 2020).
Use the information in Table 4.2 to answer the following question for this week activity in your gradebook/ exercise:
- What are the public health concerns for this family related to:
- Social and community context
- Neighborhood and built environment
- What community resources could be identified and made available to help this family?
- What local or federal policies would be important for nurses to advocate for regarding ALICE families like Nicole’s family?
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