The Hidden Cost of Almost-Poverty
There’s a working population stuck between their bills and their basic needs. The numbers link financial strain to clinical stress, illness, and suicide. Community care minimizes the damage.
Stock photo from Getty Images.
They serve your food, care for your kids, clean your hospital rooms, and stock your shelves. They’re ALICE (Asset Limited, Income Constrained, Employed), people working full-time in jobs our cities run on, but still unable to afford basics. In 2023, roughly 4 in 10 U.S. households lived below the ALICE Threshold. That’s tens of millions of families one bill away from crisis.
Last fall, I got laid off from a well-paying, full-time job. Overnight, the health insurance and dependable routines disappeared. I spent a month cramming in medical appointments and preparing to stretch savings. I also learned how loud shame can be when you can’t afford to do even the small things. This is what millions live with every month, and it hits the mind and body even harder than the wallet.
Financial strain isn’t just an unfortunate event; it tracks with measurable psychological distress among U.S. adults, and the stress response shows up in the body’s systems. This is what researchers call allostatic load, a physiologic wear-and-tear tied to chronic stress. Recent studies link higher perceived stress to higher allostatic load even after accounting for social and neighborhood factors.
The stakes are life and death, and suicide is part of that picture. The CDC reported over 49,000 suicide deaths in 2023, near a record high. Data on related circumstances shows that employment, financial, and housing problems are one in six in recent multi-state surveillance. While a financial crisis isn’t the only culprit, it piles onto existing risk.
The people who represent ALICE aren’t working marginal jobs; they’re in essential roles. These are child-care workers, home health aides, cashiers, servers, drivers, custodians. Paychecks land and are immediately drained into housing, child care, transportation, food, health care, a phone plan, and taxes, outpacing wages in many regions. Households of color are disproportionately represented in ALICE, creating a legacy of pay gaps and higher local costs where many service jobs cluster.
If you’re wondering how close “almost-poverty” really is, consider this: the Federal Reserve finds that only 63% of adults could cover a $400 emergency entirely with cash. The rest would borrow, sell something, run a balance, or go without. That fragility is the water ALICE swims in daily.
The wellness world loves mindset hacks, but mindset won’t refill an EBT card or turn the demand for rent into a suggestion. When public benefits stall, millions face immediate insecurity, which causes mutual aid lines to form. But community care can’t be an emergency-only reflex.
So what helps?
Check on your broke friend before the crisis. Don’t ask, just offer groceries, child-care backup, and rides to appointments. Small, routine support is an enormous stress reliever.
Normalize resource-sharing. Grocery gift cards, sliding-scale co-ops, rideshares, and childcare swaps are wellness by another name.
Employers: post your wages, raise them where you can, and offer predictable payment. Stability is also healthcare.
Most of us will pass through ALICE at some point: a layoff, a sick parent, a rent spike. The work, then, is to build neighborhoods where people don’t have to be lucky to be well.
If you or someone you love is struggling, you’re not alone, and help is real. Call or text 988 for the Suicide & Crisis Lifeline.
