Creating Healthier, More Equitable Communities

In 2017, economists Anne Case and Angus Deaton coined the phrase “deaths of despair” to describe a troubling rise of Americans dying from suicide, drugs (including opioids) and alcoholism. Experts across the country are now attempting to tease apart the complex factors driving these trends, but until now, no one has examined the potentially causal effects of decreases in real minimum wages in relation to this trend or the potential benefits of rising minimum wages in counteracting other drivers of this trend, despite a strong evidence base linking income and health.

Transfers and work supports such as the Earned Income Tax Credit (EITC) increase family resources, and may enable households to make critical investments in their members’ health and human capital. Yet not all eligible households claim this tax credit, losing out on income support that can have potentially large effects on health, education, and other dimensions of well-being.

Research has shown the crucial importance of household income in shaping child health, but we have limited understanding of the actual health impacts of high profile income-related policies such as the Earned Income Tax Credit (EITC).  Furthermore, state-level initiatives in this domain are particularly active and promising for future innovation.  In this study, the research team will first investigate the multi-dimensional child health effects of state EITC expansions. 

Since 2004, California’s state disability insurance program has provided six weeks of parental leave at 55 percent pay (in addition to typically 6-8 weeks of postpartum disability leave for biological mothers, also at 55 percent pay). However, many parents—especially those of lower-income—cannot afford to take this bonding leave at only partial pay. San Francisco’s new Paid Parental Leave Ordinance (PPLO) addresses this issue by requiring San Francisco employers to supplement up to 100% pay for six weeks of parental bonding leave.

Many hourly workers, especially in the retail sector, contend with unstable and unpredictable work schedules in which the number of hours, the days of the week, and the times of day that they work vary substantially from week to week. This chronic instability is likely to negatively affect workers and could also have spillover effects for children.

While there is an extensive and growing research literature on the benefits of paid parental leave, few studies have examined the impacts of paid family leave on caring for elderly family members. Yet families that take advantage of these policies may actually be helping to lower state costs in other areas. Arora and Wolf (2018) estimate that paid family leave reduced elderly nursing home utilization by 11 percent in California relative to an empirically matched group of control states.

The Institute for Women’s Policy Research’s (IWPR) simulation model estimates the costs and benefits of paid leave for six common leave types, using data largely derived from the U.S. Department of Labor’s 2012 Family and Medical Leave (FMLA) Survey. The types include 1) own serious medical condition; 2) maternity and childbirth; 3) new child care following birth, adoption, or foster placement; 4) care for spouse; 5) care for children; and 6) care for parents.

Income is considered one of the key underlying social determinants of health. However, there has been relatively limited research on the health effects of policies designed to increase income for vulnerable families.

In 2016, the Chicago Police Department developed a pilot pre-arrest diversion strategy, the Westside Narcotics Diversion and Treatment Initiative (WNDTI), to respond to the opioid crisis in underserved Chicago neighborhoods. The goal was to encourage police officers to redirect low-level drug offenders (users and sellers) to treatment, instead of jail and prosecution. This strategy was modeled after a promising program in Seattle, the Law Enforcement Assisted Diversion (LEAD).

Springfield, Massachusetts is a mid-sized city with a large community of color population experiencing socioeconomic and health inequities. Historically there has been little infrastructure in Springfield to support active transportation and recreational walking and biking, so in 2015, Springfield City Council adopted a city-wide “Complete Streets” resolution.

In response to research on food deserts across the country, scholars and public health practitioners are encouraging limited service food stores, like discount stores, to expand their healthy food selections and accept SNAP and WIC benefits. By becoming WIC-authorized, these stores would be required to carry a certain number of healthy food items, which can improve food access in low-income communities that may lack a full-line grocery store.

Medicaid and the Supplemental Nutrition Assistance Program (SNAP) currently comprise nearly a quarter of US expenditures on children. The programs have the potential to significantly reduce health and socioeconomic disparities, yet little is known about the impact of these programs on later generations’ health and well-being.