It is estimated that medical care accounts for only 20 percent of modifiable health outcomes, while social determinants drive the remaining 80 percent. The acknowledgment of the social determinants of health has encouraged a focus on upstream strategies aimed at improving health outcomes for everyone in the US. Yet, the social determinants model has continued to hold structural racism as a single determinant rather than recognizing it as a root cause that shapes inequities across all of the social determinants, including education, economic instability, and neighborhood environment. As a result, policy strategies have often failed to address the existing laws that underpin inequities. In the past two years, however, local governments have begun to lead the way in explicitly recognizing that racism is a public health crisis that requires policy actions beyond those taken to date. 

This project will evaluate the impact of resolutions declaring racism a public health crisis on subsequent policy development and implementation, asking: 

1. How has the resolution declaring racism a public health crisis impacted local policy development and implementation in Milwaukee County, WI?  

2. What enabling factors and barriers have staff in leadership positions across government agencies within Milwaukee County experienced as they have sought to fulfill the policy vision outlined in the resolution?  

3. Nationally, to what extent have local and state health departments in jurisdictions with these resolutions engaged in further policy action to address structural racism?  

Findings will determine the impact of resolutions and help shape the direction of future policy and advocacy work, as well as provide lessons for how governments can work to ensure their resolutions have the best chance of successfully improving racial equity in their jurisdiction. 

The U.S. is one of three industrialized countries without universal access to paid sick leave. Thirty-five percent of all full-time employees lack this coverage. Among low-income and part-time employees, uninsurance rates exceed 80 percent. In addition to concerns about inequality, worker well-being, and productivity, a lack of paid sick leave also contributes to the spread of disease, when ill workers are forced to choose between their health and their job.

This study will evaluate the impact of state-level sick pay mandates on coverage rates, other non-mandated fringe benefits, and the spread of infectious diseases. Researchers will focus on Connecticut, California, Massachusetts, Oregon, and Vermont—the only states that have mandated paid sick leave, all within the last five years.

Using data from the National Compensation Survey (NCS), Google Flu data, and state-provided data on rates of influenza-like illness (ILI), the researchers will be able to estimate the causal effects of the mandates on coverage rates, non-mandated fringe benefits, and the spread of disease. Because little to nothing is known about the impact of these recently implemented state-level mandates, this project will provide important insights for academics, policymakers and the public.

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.

“Complete Streets” policies enable safe access for pedestrians, bicyclists, transit users, and motorists of all ages and abilities, yet little empirical evidence has documented their impact on the community and health and well-being.

This study will investigate, through an equity lens, whether Complete Streets policies lead to changes in:

• The built environment (e.g. traffic calming; bicycle/pedestrian facilities),
• The economic environment (e.g. retail activity),
• The social environment (e.g. perceived safety, social cohesion), and
• Health/health behaviors (e.g. physical activity).

The study will use existing and original data, including objectively measured physical activity. Research will be conducted in partnership with community partners to leverage collective expertise and existing data collection efforts, to engage residents as research partners, and ensure results and research products are designed and disseminated to benefit the community and foster health equity. Resident perception of the policy and infrastructure changes will also be assessed.

Complete Streets policies have the potential to impact equity by creating activity-friendly environments in communities experiencing large social, economic, and health inequities. This study seeks to determine if the policies can and do achieve that potential.

Childhood vaccines play a major role in minimizing the incidence of vaccine-preventable disease. While all states accommodate medical vaccine exemptions, certain states also allow for waivers on the basis of religious or philosophical objections.

This study will investigate if and how changes in states' vaccination exemption laws affect subsequent vaccination coverage rates. The researchers will focus on measles-mumps-rubella (MMR), diphtheria-tetanus-pertussis (DTP), and DTP-MMR combined with the Polio vaccine (the 4:3:1 series), as well as chickenpox (varicella), Polio, Hepatitis B, and Pneumococcal (PCV). 

Data on the evolution of exemption laws will be combined with the National Immunization Survey in the period 2008-2018 to establish the degree to which vaccine uptake is affected by non-medical exemptions as a whole. The study will also explore the existence of differing types of non-medical exemptions and the different attributes controlling existing exemption laws.

The overarching purpose of the research is to understand whether existing vaccination policies and regulations are compatible with the public health objectives of improving immunization coverage and population health.

In January 2020, the Supreme Court allowed the Department of Homeland Security to implement a new rule regarding the definition of “public charge.”  The rule directs the federal government to use participation in public programs (including Medicaid, the Supplemental Nutritional Assistance Program (SNAP), and subsidized housing), overall health status, and income as criteria to determine whether legal immigrants are able to gain permanent residency.  Some have voiced concerns that this policy will dissuade individuals from participating in these programs or obtaining needed medical care, and that this “chilling effect” may impact people outside the policy’s intended scope (such as citizens with immigrant relatives).  

To examine these important and timely issues, our team is collecting primary data from two distinct populations to explore awareness of the public charge rule, sources of information about the rule, and how the rule may affect decisions on obtaining medical care and participating in public programs. In one project, we are conducting a telephone survey of low-income adults in Texas, and in the other project, we are conducting in-person interviews with patients at community health centers in Massachusetts, in order to better understand how this new policy is affecting care for vulnerable populations.