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You can tell more about a person’s health by knowing their Zip code than you can by knowing their genetics. This startling fact is due to the under-appreciated effect that being poor has on one’s health, and the way that geography is too often a proxy for poverty.

Everyone knows that people living in poverty tend to have worse health than more affluent households. We usually attribute that to bad lifestyle choices like poor diet, smoking, etc. However, in reality the single largest set of influences on a person’s health are social and economic factors, which account for roughly 40 percent of the modifiable factors that influence health.

These “social determinants of health” include income, employment, education level and community safety. They are distinct from other environmental factors like bad air quality or inadequate housing, which only account for about 10 percent of modifiable factors influencing health.

The effects can be dramatic. Neighborhoods separated by just a couple of miles can see as much as a 25-year difference in life expectancy.

Living in poverty has a direct, negative impact on people’s health. Facing constant financial difficulties leads to chronic stress. Chronic stress has, in turn, been linked to increased incidence of heart disease and diabetes. Prolonged, high levels of stress have toxic effects on children, affecting everything from their brain development to their genetics. These effects can have lifelong impacts on children’s future health and economic success, further perpetuating a cycle that can have devastating impacts on entire communities.

Hawaii has one of the highest rates of poverty (when measured properly) and the highest rate of homelessness in the nation. This should make us particularly sensitive to the threats to health presented by poverty.

The root of the problem is in the often overlooked, but painfully obvious fact about poverty: poor people don’t have enough money. A recent study by the Anne E. Casey Foundation found that 47 percent of Americans cannot handle a $400 emergency, like having to replace a car’s alternator or pay for out-of-pocket emergency medical expenses.

Being able to afford an unforeseen car repair, or an unexpected illness, can be the difference between low-income individuals seeking medical treatment and not. And low incomes impact people’s abilities to live in safe, health-promoting neighborhoods.

Hawaii is one of only a very small handful of states that tax the income of the poor. Our poor pay more in income tax than residents of every other state except for Alabama.

These facts point to an unexpected public health tool: tax policy.

We are not used to thinking about the health impacts of changes in tax policy. But, studies in recent years have found numerous health benefits—particularly for infants and mothers—associated with work-related tax credits like the Earned Income Tax Credit and the Child Tax Credit.

This, and other research, has led many state public health officials, in Wisconsin for example, to recommend expanding low-income tax credits as a way to alleviate poverty and reduce the negative impacts of social determinants of health.

Hawaii could learn from this approach. We desperately need to update and expand our system of tax credits for low- and moderate-income families. Hawaii is one of only 16 states that taxes wages and does not provide a state earned income tax credit.

Additionally, Hawaii is one of only a very small handful of states that tax the income of the poor. Our poor pay more in income tax than residents of every other state except for Alabama. Taxing the poor only serves to decrease their ability to make ends meet, and increases the stresses associated with poverty.

Taxing people in poverty increases their dependence on public services and increases our state’s public health costs. The result is that we end up in an indefensible cycle of pushing those already living in poverty even deeper into poverty while spending many millions of dollars paying for services to help them escape poverty.

Of course, tax policy is only one of the tools we have to alleviate the challenges of those living in or near poverty. However, given the depth of the problem, it will remain an important component of any realistic plan to improve their chances for a healthy life.

We ought to be able to come together over some set of commonsense reforms that can address the plight of our struggling households. The health of Hawaii’s families depends on it.