Creating Healthier, More Equitable Communities

Ten years after the passing of the Affordable Care Act—the most comprehensive health care reform of the past half-century—most of the previously uninsured continue to lack coverage. Policymakers and members of the public have expressed growing support for expanding the role of public financing of health care. The “public option” and “Medicare for All” have emerged as important contenders for health policy reform. Both policies are rooted in widening access to the lower prices of the public system to make health care more affordable for all.

From 2013-2015, more than 3 million U.S. workers became unemployed and nearly a third were unable to return to work by 2018. Unexpected job losses can be devastating for individuals and families. However, a job loss and a sudden gap in health coverage creates an added layer of financial distress for households with costly medical needs. These households must absorb the costs of their health care needs or risk experiencing negative health effects.

Approximately 16 percent of children in the U.S. live in families with incomes below the federal poverty threshold, potentially creating negative long-term effects that are experienced over the life-course. The Supplemental Security Income (SSI) program provides cash assistance to low-income children with disabilities, expanding family budgets and potentially allowing low-income parents to better protect the health of vulnerable children. However, few studies have evaluated the impact of this policy.

People who receive vouchers or other forms of federal or local housing assistance are not protected from discrimination by federal fair housing or civil rights laws, and in most places, landlords can legally refuse to rent to voucher holders. Researchers will assess whether and under what conditions state and local protections reduce landlord discrimination and improve the rate at which voucher holders are successful at finding housing.

Greater scheduling predictability may reduce parental stress and increase child care stability, job stability, and income. Researchers will use qualitative and quantitative methods to evaluate the implementation of the Oregon law and analyze the impacts on family and child health outcomes.

Birth outcomes, including infant mortality and low birth weight, are shockingly poor in the U.S. Researchers will assess whether the ACA increased intended pregnancies, reduced prepregnancy smoking, and affected contraception and birth outcomes among women covered by Medicaid--and whether these changes reduced disparities across racial and ethnic groups.

Public health practitioners and tobacco control advocates agree that pre-emption (a higher level of government stripping lower levels of government of their authority over a specific subject matter) has an adverse impact on tobacco control efforts. Pre-emptive state laws may prohibit local tobacco control measures, such as restrictions on marketing and promotion of tobacco products, licensure of tobacco products, smoking in public or private sites, and on youth access to tobacco products.

State pre-emption is an emerging and highly contentious policy movement with potentially significant consequences on population health. Yet robust analyses to examine whether pre-emption affects health have yet to be conducted. Furthermore, pre-emption’s effect on geographic inequities in health has been largely neglected in policy debates. But it is becoming increasingly clear that state pre-emption laws could reshape the spatial distribution of health, with profound consequences for health care delivery systems and state and local budgets.

Local governments are often on the forefront of enacting innovative public health policy, and local control over public health issues is especially vital to address social inequities. Pre-emption removes the ability of local governments to enact these laws and may hinder public health policy adoption and diffusion within a state and across the country.

Municipal laws and policies affect the social, economic, and legal conditions of civic and private lives of immigrants in profound ways, including both direct access to health services, as well as broader social determinants, such as employment, housing, education, transportation, and law enforcement.

Amid a growing national conversation on equity and social justice, city and county governments are using tools to identify racial and ethnic disparities in their communities. These insights can then inform the development and implementation of laws and policies designed to minimize disparities and maximize positive impacts on racial and ethnic minorities.

Despite efforts to rigorously analyze various effects of changes to minimum wages, the research community has largely neglected the link to child development. Changes in the minimum wage may have consequences that go far beyond employment and earnings, but there is almost nothing known about these potential effects.

Using data from National Longitudinal Survey of Youth and other publicly available datasets, the research team will investigate: