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. Following protests during the summer of 2020 in response to continued anti-Black violence, we saw a renewed interest in identifying and dismantling the structural racism inherent in existing policy and practice, but not much has changed. The importance of strengthening the evidence base to inform current and future policy conversations about how to inclusively and effectively address these twin pandemics—COVID-19 and structural racism—has never been clearer.

The Policies for Action (P4A) program, now in its seventh year, continues investigating laws and policies and their abilities to help build a Culture of Health and dismantle systemic racism. In addition to the broad and diverse community of policy researchers generating critical findings, P4A is supported by members of a National Advisory Committee committed to advancing health, well-being, and equity by researching and sharing insights on income and wealth, employment and workplace policy and much more. In 2021, P4A funded 21 investigator-initiated grants totaling more than $5 million. The new cohort of grantees is leading projects investigating the effects of public policy on racial equity and racial justice, including topics like guaranteed income, incarceration policy, reparations and subminimum wage. These new research teams’ work will be critical, given the current public health crisis and the undeniable need to address policies and systems that disproportionately negatively affect racialized communities while creating advantages for others.

In 2021, P4A researchers produced 43 publications, and P4A research appeared in 15 peer-reviewed journals, including the American Journal of Preventive MedicineAnnals of Epidemiology, Health Affairs, JAMA, and the Journal of Policy Analysis and Management. P4A researchers participated in 10 panel presentations at interdisciplinary conferences, including those operated by AcademyHealth; the American Society of Law, Medicine & Ethics; the Association for Public Policy Analysis and Management; and the Population Association of America. Additionally, influential media outlets including CBS, MSN, the New York Times, NPR, and The 19th cited P4A research.

This research spanned topics critical to population health, well-being and equity across many sectors.

  • An inclusive pandemic recovery for all. Investigators from several P4A-funded interdisciplinary teams examined the implications of the pandemic for access to health care, income and employment, paid leave access and racial disparities in the US. An analysis of this body of research confirmed disparate health and economic effects and offered actionable solutions for a more equitable recovery.
  • Effects of the Affordable Care Act on preconception and postpartum insurance rates. Investigators at the Urban Institute examined data for new mothers with Medicaid-covered prenatal care and found that 17.3 percent of women with Medicaid-covered prenatal care in states that have expanded Medicaid were uninsured before conception, compared with 38.1 percent of women in states that have not expanded Medicaid. They also found that 21.9 percent of new mothers with Medicaid-covered prenatal care became uninsured two to six months postpartum. Researcher Emily Johnston further discussed their findings and recommendations for closing gaps in access to care on Health Affairs’ podcast A Health Podyssey.
  • Gaps in receipt of the child tax credit among families in California. Researchers at the California Policy Lab investigated receipt of the expanded federal child tax credit (CTC) and found that almost half of all California children at risk of not receiving the CTC are either part of families headed by undocumented adults or by an adult who would usually not file their own tax return because they could be claimed as a dependent.
  • Governmental use of racial equity tools. Researchers at the Saint Louis University School of Law investigated which jurisdictions are using racial equity tools and how they are using them. They found that more than 107 jurisdictions in the US have used racial equity tools, and some have prioritized and enacted laws to address systemic racism and social determinants of health.
  • Impacts of municipal spending on severe maternal morbidity in New Jersey. Researchers at Rutgers University investigated the variation in rates of severe maternal morbidity (SMM) across municipalities in New Jersey and found municipal expenditures on transportation, health, housing, libraries and fire and ambulance were associated with lower SMM rates, and expenditures on police were associated with higher rates.
  • Medicaid as a buffer for unemployment-related losses of health insurance. Researchers from the University of Kentucky examined whether broadened access to Medicaid through the Affordable Care Act helped prevent declines in health insurance coverage and health care access related to losses of employment during the Great Recession. The team found states with Medicaid programs that were more readily able to absorb people affected by economic downturns or mass layoffs had lower rates of unmet medical needs caused by financial constraints.
  • Racial and ethnic inequities in paid parental leave access. Investigators from the University of California, Berkeley, examined differences in access to government- and employer-paid leave and found non-Hispanic Black and Hispanic women in the San Francisco Bay Area were less likely to have paid leave, and when they did have paid leave, they were paid less.

See all P4A research released in 2021.

Engaging changemakers and communities in the year ahead

With 2022 underway, we are approaching our work with two goals in mind: ensuring P4A’s critical findings reach changemakers at every level and the work of our researchers adequately engages the communities being studied throughout the research process. Later this year, in alignment with our work to achieve health equity by addressing all factors that influence opportunities for well-being, we will issue a new call for proposals focusing on income and wealth equity in the US.

We seek not only to build the evidence base to inform key discussions about addressing the pandemic and the inequities caused by structural racism in all facets of life, but to remain responsible stewards who are mindful of how we engage in this work. And we will continue to support and amplify the voices of researchers and academics from historically marginalized backgrounds The continued challenges posed by the twin pandemics call for timely, evidence-based and effective solutions, and P4A is committed to doing the work to inform these conversations and help improve quality of life for those who need it.

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