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Making Americans Healthier

Social and Economic Policy as Health Policy

Robert F. Schoeni, James S. House, George A. Kaplan, Harold Pollack

Publication Year: 2008

The United States spends billions of dollars annually on social and economic policies aimed at improving the lives of its citizens, but the health consequences associated with these policies are rarely considered. In Making Americans Healthier, a group of multidisciplinary experts shows how social and economic policies seemingly unrelated to medical well-being have dramatic consequences for the health of the American people. Most previous research concerning problems with health and healthcare in the United States has focused narrowly on issues of medical care and insurance coverage, but Making Americans Healthier demonstrates the important health consequences that policymakers overlook in traditional cost-benefit evaluations of social policy. The contributors examine six critical policy areas: civil rights, education, income support, employment, welfare, and neighborhood and housing. Among the important findings in this book, David Cutler and Adriana Lleras-Muney document the robust relationship between educational attainment and health, and estimate that the health benefits of education may exceed even the well-documented financial returns of education. Pamela Herd, James House, and Robert Schoeni discover notable health benefits associated with the Supplemental Security Income Program, which provides financial support for elderly and disabled Americans. George Kaplan, Nalini Ranjit, and Sarah Burgard document a large and unanticipated improvement in the health of African-American women following the enactment of civil rights legislation in the 1960s. Making Americans Healthier presents ground-breaking evidence that the health impact of many social policies is substantial. The important findings in this book pave the way for promising new avenues for intervention and convincingly demonstrate that ultimately social and economic policy is health policy.

Published by: Russell Sage Foundation

Series: National Poverty Center Series on Poverty and Public Policy

Title Page, Copyright

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About the Authors

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pp. vii-x

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pp. xi-ivx

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

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pp. 15-16

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Chapter 1. The Health Effects of Social and Economic Policy: The Promise and Challenge for Research and Policy

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pp. 3-26

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

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pp. 27-28

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Chapter 2. Education and Health:Evaluating Theories and Evidence

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pp. 29-60

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...

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Chapter 3. Health Effects of Human Development Policies

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pp. 61-94

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

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pp. 95-96

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Chapter 4. Income Support Policies and Health Among the Elderly

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pp. 97-121

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...

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Chapter 5. Did the Introduction of Food Stamps Affect Birth Outcomes in California?

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pp. 122-142

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

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pp. 143-144

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Chapter 6. Lifting Gates, Lengthening Lives: Did Civil Rights Policies Improve the Health of African American Women in the1960s and 1970s?

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pp. 145-170

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

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pp. 171-172

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Chapter 7. Macroeconomic Conditions, Health, and Government Policy

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pp. 173-200

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”...

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Chapter 8. The New Employment Contract and Worker Health in the United States

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pp. 201-228

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

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pp. 229-230

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Chapter 9. Welfare Reform and Indirect Impacts on Health

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pp. 231-280

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...

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Chapter 10. The Effects of Welfare and Child Support Policies on Maternal Health and Well-Being

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pp. 281-306

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

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pp. 307-308

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Chapter 11. Residential Environments and Obesity:What Can We Learn About Policy Interventions from Observational Studies?

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pp. 309-343

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...

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Chapter 12. Are Some Neighborhoods Better for Child Health than Others?

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pp. 344-376

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

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pp. 377-378

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Chapter 13. Social and Economic Policies as Health Policy: Moving Toward a New Approach to Improving Health in America

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pp. 379-390

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...


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pp. 391-398

E-ISBN-13: 9781610444873
Print-ISBN-13: 9780871547477

Page Count: 416
Publication Year: 2008

Series Title: National Poverty Center Series on Poverty and Public Policy

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Subject Headings

  • Economic policy -- Health aspects -- United States.
  • Public health -- Social aspects -- United States.
  • Public health -- Economic aspects -- United States.
  • Social policy -- Health aspects -- United States.
  • Medical policy -- United States.
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