Making Health a Shared Value

Access to contraception, receipt of quality medical care, and the ability of individuals to make their own reproductive decisions are critical elements of basic healthcare and health equity for all. The recent overturning of Roe v. Wade and related trigger laws have severely limited access to safe abortions in parts of the United States, especially for women with low incomes and women of color.

Now entering its third year, the COVID-19 pandemic continues to alter the lives of people everywhere and exacerbate racial and ethnic disparities in income, wealth and access to resources and care. The nation is also grappling with the perpetuation and consequences of hundreds of years of systemic racism.

The COVID-19 pandemic has exacerbated racial, ethnic, and gender disparities that have existed since long before the current public health crisis. With declining infection rates and increasing vaccination rates, the United States seems to be on a path to recovery. But a full recovery from the health and economic fallout of the pandemic will require adequately supporting our most vulnerable communities. A new analysis confirms disparate health and economic effects by race, ethnicity, and gender and inadequate public policy responses in the wake of the pandemic and offers actionable solutions for a more equitable recovery.

Two pandemics upended our nation this year. The novel coronavirus (COVID-19) continues to sicken, kill, and reshape the lives of people everywhere, and is also testing our nation’s healthcare, public health, education, and social protection systems like never before. The second pandemic is one that has been with us since well before our nation’s founding but has come into much sharper focus this past year. Like a virus, it has infected virtually every aspect of our society including our laws and policies, a central focus of the Policies for Action (P4A) research program: systemic racism and its attendant social, economic, and political injustices. Although this time last year, the need for sound policy research was clear – especially in light of growing inequality in health and wealth, and the conditions that drive and are shaped by these – 2020 made these needs more visible and more urgent. As P4A enters its sixth year, a strong and growing community of policy researchers across the country, supported by a stellar National Advisory Committee, are generating a host of research findings crucially needed at this moment.

It is with good reason that there has been an outpouring of support for essential workers during the COVID-19 pandemic. Essential workers have tended to the sick, responded to emergencies, and kept the food supply intact, thus permitting the rest of society to have continued access to health care and basic necessities, and to remain safe and, for the most part, comfortable. As has been reported, Black and Latino workers make up a large share of the essential workforce, and these demographic groups have experienced higher rates of COVID-19 infections and deaths. Discrimination, disparate access to health services, higher rates of chronic illness, lower incomes, and deficiencies in housing and other social determinants of health have all contributed to the higher risk of COVID-19–related illness and death among racial and ethnic minorities.

The advent of just-in-time scheduling technology and practices in the mid-1990s has led to increased schedule instability, resulting in a growing movement to address the need for predictable, stable schedules for workers paid low wages. Unstable schedules have been associated with earnings instability, increased stress and fatigue, sleep irregularity, and worse mental health outcomes for workers.  In this report, P4A researchers Amelia Coffey, Eleanor Lauderback and H. Elizabeth Peters, along with their partners at the University of Oregon’s Department of Sociology Lola Loustaunau, Larissa Petrucci, Ellen Scott and Lina Stepick, examine Oregon’s implementation of S.B. 828, the first statewide predictive scheduling law in the nation, in its first year.

Despite extensive research showing that shift work compromises employee health, jobs that require work outside the traditional daytime hours of 8:00 AM to 6:00 PM have become ubiquitous across economically developed nations. Employers enact work scheduling policies based on the needs of company stakeholders and without evidence of the effect of shift work on health care costs, even though the companies ultimately bear the majority of those costs. Researchers Megan McHugh, Dustin D. French, Mary M. Kwasny, Claude R. Maechling, and Jane L. Holl examined the additional health care costs incurred by two large manufacturing companies due to their shift work requirements in this brief published in the Journal of Occupational and Environmental Medicine.

Paid family leave policies have the potential to reduce health disparities, yet access to paid leave remains limited and unevenly distributed in the United States. The US is the only OECD country that does not provide paid leave for new parents, and just 8 states and the District of Columbia have passed partially-paid family leave policies. In a new paper, Julia Goodman of the OHSU-PSU School of Public Health, Will Dow of UC Berkeley, and Holly Elser of Stanford University examine the impact of the 2017 San Francisco Paid Parental Leave Ordinance (PPLO), the first in the US to provide parental leave with full pay. 

The earned income tax credit (EITC) is the largest US poverty alleviation program for families with children, with well-documented positive effects on recipient health. In addition to the federal EITC, over half of US states have implemented supplemental EITC programs.

Paid family and medical leave has important health benefits for parents and their children, but access to job-protected leave is limited and highly disparate in the United States. Increasingly, state and local governments have established policies such as paid leave to support parents and other caregivers. While these policies have been crucial in enabling more workers to take leave, their effects have been weakened due to only partial coverage of job protection laws. As part of their ongoing work evaluating the 2017 San Francisco Paid Parental Leave Ordinance, investigators Julia M. Goodman (Oregon Health & Science University/Portland State University) and William H. Dow (University of California, Berkeley) published an issue brief examining paid leave protections in the California Bay Area.

Jobs that require work outside the traditional daytime hours of approximately 8 AM to 6 PM have become ubiquitous across economically developed nations, but extensive research shows that shift work and long work hours may compromise employee health. Although employers recognize the potential harmful effects of shift work, many argue in favor of maintaining it, citing the nature of the work requiring a 24/7 schedule (e.g., public safety), maximization of production capacity in response to consumer demand, and in some cases, employee preference for long shifts to maximize days off and pay. In recent publications, P4A researcher Megan McHugh, doctoral student Adovich Rivera, and their colleagues from Northwestern’s Manufacturing and Health Research Program provide evidence on how shift work affects the incidence of chronic illness and overall worker well-being.

The United States is one of three OECD countries that does not provide universal access to paid sick leave for all employees. Over the past years, just 12 states have passed sick pay mandates. In a new working paper, P4A researcher Nicolas R. Ziebarth of Cornell University and colleagues Catherine Maclean and Stefan Pichler provide first-of-its-kind evidence on how state-level sick pay mandates affect coverage rates, sick leave utilization, and labor costs.