Document Type


Publication Date

Summer 2018




Alternative financial services (AFS) such as payday lenders, pawn brokers, tax refund loans, and check cashers are more prevalent in minority and lower income neighborhoods. These are neighborhoods also found to have disparities in health, compared to more affluent neighborhoods and communities. The focus of this paper is to determine if any relationship exists between use of AFS and health disparities. Using data from a survey performed by the Federal Deposit Insurance Corporation (FDIC), we compared four banking variables to several measures of health for 85 metropolitan statistical areas (MSA) across the nation. The four banking variables all related to degrees of reliance on alternative financial services. The three health related measures were all-cause mortality, cancer mortality, and drug and alcohol related mortality. The regression analysis controlled for income, education, and relative size of the nonwhite population. We found that for all-cause mortality there is a statistically significant relationship between three of the four banking variables, in particular “Used an AFS” has a strong association with a coefficient of 0.25 and a p-value of 0.001. The conclusion of this analysis is that when use of AFS increases for an MSA, health status declines, as seen with all-cause mortality. This study adds evidence to establish a finer and often unrecognized dimension of “social determinants of health.”


Journal of Health Disparities Research and Practice Volume 11, Issue 2, Summer 2018

Digital Scholarship@UNLV © 2018

Original Publication Information

Hundley, Courtney, Richard W. Wilson and John Chenault. "Alternative Financial Services as a Social Determinant of Health in U.S. Metropolitan Statistical Areas." 2018 Journal of Health Disparities Research and Practice 11(3): 33-45.