Making Americans Healthier
Social and Economic Policy as Health Policy
Publication Year: 2008
Published by: Russell Sage Foundation
Title Page, Copyright
About the Authors
Three observations motivated the writing of this book:First, gaps in health between social and economic groups—by education, income, wealth, neighborhood, and race, for example—are massive. These gaps have persisted for decades. They are not narrowing, despite growing awareness at all levels of government and throughout the clinical and research communities that health disparities pose central challenges to American society...
Part I: Introduction
Chapter 1. The Health Effects of Social and Economic Policy: The Promise and Challenge for Research and Policy
The United States faces a growing paradox between its declining levels of population health relative to other wealthy nations—and even to some developing ones—and its burgeoning spending on health insurance and medical care. By an increasing margin each year, the United States spends a larger percentage of its gross domestic product (GDP) on health care than any other nation, with health care expenditures now...
Part II: Education Policy
Chapter 2. Education and Health:Evaluating Theories and Evidence
There is a well-known large and persistent association between education and health. This relationship has been observed in many countries and time periods, and for a wide variety of health measures.1 The differences between the more and the less educated are significant: in 1999, the age-adjusted mortality rate of high school dropouts ages twenty-eight to sixty-four was more than twice as large as the mortality rate of those...
Chapter 3. Health Effects of Human Development Policies
Agrowing body of evidence documents the substantial effects on health of social policies whose focus is not on health per se, such as those that explicitly target social policy arenas such as human development. Here we focus specifically on the health effects of early-childhood development policies. Because human development policies have typically played a minor role in policy discussions about health, it is important to define their scope and outline a general conceptual framework to support...
Part III: Income Transfer Policy
Chapter 4. Income Support Policies and Health Among the Elderly
There is increasing evidence that health care accounts for only a modest fraction of the variation in individual and population health (McGinnis, Williams-Russo, and Knickman 2002). At the same time, there are strong and well-documented associations between health and socioeconomic factors. This suggests that “non-health” factors (that is, social and economic determinants) and related policies deserve heightened...
Chapter 5. Did the Introduction of Food Stamps Affect Birth Outcomes in California?
Do welfare programs that raise the income of poor mothers affect infant mortality? Over the 1960s, United States infant mortality fell dramatically. The rate for whites fell from twenty-three to seventeen per one thousand, while the African American rate fell from forty-three to thirty-two per one thousand. These declines are coincident with the introduction of federal transfer programs including Medicaid and the Food Stamp Program (FSP). But it is not clear whether there is an actual link between...
Part IV: Civil Rights
Chapter 6. Lifting Gates, Lengthening Lives: Did Civil Rights Policies Improve the Health of African American Women in the1960s and 1970s?
Based on literally thousands of studies carried out over many decades, it is increasingly accepted that socioeconomic conditions act as important determinants of both individual health and the health of populations (Kaplan et al. 1987; Kaplan and Lynch 1997)...
Part V: Macroeconomic and Employment Policy
Chapter 7. Macroeconomic Conditions, Health, and Government Policy
Many government policies influence short- and medium-run economic performance. Some, such as the monetary and interest rate targets, are explicitly designed to stabilize the economy. Fiscal policy has the potential to play a similar role, although it is not aggressively used for this purpose in the United States. The unemployment insurance and federal income-tax systems act as “automatic stabilizers”...
Chapter 8. The New Employment Contract and Worker Health in the United States
Historically there have been three arenas of policy debate in the United States relevant to the health effects of employment for workers and their families. First, the physical environment of the workplace and its health impact has been a major arena of policy debate. The pathways from the physical environment to health include exposure to chemical and biological hazards leading to disease, as well as physical risks to safety...
Part VI: Welfare Policy
Chapter 9. Welfare Reform and Indirect Impacts on Health
Beginning in the early 1990s, many states used waivers to reform their Aid to Families with Dependent Children (AFDC) programs. This state experimentation resulted in landmark legislation that eliminated AFDC in 1996 and replaced it with Temporary Assistance for Needy Families (TANF). TANF—like the earlier AFDC program—provides cash grants to low-income families with children and is a key element of the nation’s economic safety...
Chapter 10. The Effects of Welfare and Child Support Policies on Maternal Health and Well-Being
In 1996 the U.S. Congress passed the Personal Responsibility and Work Opportunities Reconciliation Act (PRWORA), substantially reducing a family’s rights to income support. PRWORA removed the entitlement to government-provided cash assistance and increased states’ incentives to reduce welfare caseloads. At the same time it increased private responsibilities by encouraging greater work effort from mothers and more child support payments...
Part VII: Housing and Neighborhood Policy
Chapter 11. Residential Environments and Obesity:What Can We Learn About Policy Interventions from Observational Studies?
Do policy initiatives that are aimed at changing physical or social features of the residential environment have measurable impacts on health?1 It has become an increasingly popular view in the field of public health that physical and social features of the residential environment can affect health either directly (through contaminants in the air or water supply) or indirectly, by influencing behaviors related to health (such as physical activity, food intake, substance use, and utilization of medical care) or psychosocial...
Chapter 12. Are Some Neighborhoods Better for Child Health than Others?
It is believed that the neighborhoods in which children and youth live are associated with their health and well-being. The underlying premise of this belief is that living in more affluent and safe neighborhoods results in better health (as well as increases the likelihood of doing well in school and obtaining better jobs and housing)...
Part VIII: Conclusion
Chapter 13. Social and Economic Policies as Health Policy: Moving Toward a New Approach to Improving Health in America
The evidence presented in the prior twelve chapters suggests that social and economic policies substantially influence individual and population health, and it begins to draw out the many policy domains in which this occurs. These chapters consider health effects of education, income-support, civil-rights, macroeconomics and employment, welfare, and housing and neighborhood policies. This not-so-thin volume...