Making Americans Healthier

Making Americans Healthier: Social and Economic Policy as Health Policy

Robert F. Schoeni
James S. House
George A. Kaplan
Harold Pollack
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  • Book Info
    Making Americans Healthier
    Book Description:

    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.

    eISBN: 978-1-61044-487-3
    Subjects: Health Sciences, Political Science, Economics

Table of Contents

  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-vi)
  3. About the Authors
    (pp. vii-x)
  4. Preface
    (pp. xi-xiv)
    Robert F. Schoeni, James S. House, George A. Kaplan and Harold Pollack

    • Chapter 1 The Health Effects of Social and Economic Policy: The Promise and Challenge for Research and Policy
      (pp. 3-26)
      James S. House, Robert F. Schoeni, George A. Kaplan and Harold Pollack

      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 totaling $1.9 trillion per year and large increases projected over coming decades (Chernew, Hirth, and Cutler 2003).

      Scholars, policy makers, and citizens debate the marginal value and cost-effectiveness of these expenditures. Specific advances—for...


    • Chapter 2 Education and Health: Evaluating Theories and Evidence
      (pp. 29-60)
      David M. Cutler and Adriana Lleras-Muney

      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 with some college (Lyert et al. 2001, table 26).

      Substantial attention has been paid to these “health inequalities.” Gradients in health by education are now systematically monitored in many countries (the United...

    • Chapter 3 Health Effects of Human Development Policies
      (pp. 61-94)
      Daniel P. Keating and Sharon Z. Simonton

      A growing 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 their relevance before reviewing evidence to illustrate their connection with health.

      Human development policies include leave policies; labor laws that determine work conditions,...


    • Chapter 4 Income Support Policies and Health Among the Elderly
      (pp. 97-121)
      Pamela Herd, James S. House and Robert F. Schoeni

      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 attention, alongside biomedical factors, in determining individual and population health. Although researchers and policy makers increasingly recognize the general importance of social and economic factors for health, the peer-review research literature includes very limited research on or discussion of the health effects of...

    • Chapter 5 Did the Introduction of Food Stamps Affect Birth Outcomes in California?
      (pp. 122-142)
      Janet Currie and Enrico Moretti

      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 welfare programs and improvements in infant mortality.

      While there is little doubt that improving maternal nutrition can lead to healthier babies, it...


    • Chapter 6 Lifting Gates, Lengthening Lives: Did Civil Rights Policies Improve the Health of African American Women in the 1960s and 1970s?
      (pp. 145-170)
      George A. Kaplan, Nalini Ranjit and Sarah A. Burgard

      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). Wages, income, wealth, the nature of work, investments in human capital, and the levels of resources and risks in communities are now recognized by many as arguably the most critical determinants of health (Kaplan 2001; Evans, Barer, and Marmor 1994). It seems possible that social and economic policies, in their ability to alter these determinants, might also impact health even if...


    • Chapter 7 Macroeconomic Conditions, Health, and Government Policy
      (pp. 173-200)
      Christopher J. Ruhm

      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” because they make government spending more expansionary during economic downturns and less so during booms. Other programs, such as the Earned Income Tax Credit (EITC), increase incomes during expansions when work is easier to find, and so operate in the opposite...

    • Chapter 8 The New Employment Contract and Worker Health in the United States
      (pp. 201-228)
      Richard H. Price and Sarah A. Burgard

      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, thephysical environmentof 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. Second, thedemanding nature of work activitieshas also been the topic of policy debate. The pathway from work activity to health most often implicates work stressors involving too little task...


    • Chapter 9 Welfare Reform and Indirect Impacts on Health
      (pp. 231-280)
      Marianne P. Bitler and Hilary W. Hoynes

      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 net. The roots of this reform lie in long-time concern that AFDC led to reductions in work, decreases in marriage, and increases in nonmarital births among low-income women.

      These important policy changes, known collectively...

    • Chapter 10 The Effects of Welfare and Child Support Policies on Maternal Health and Well-Being
      (pp. 281-306)
      Jean Knab, Irv Garfinkel and Sara McLanahan

      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 from nonresident fathers.

      The PRWORA provisions raised concerns within the medical community and among other advocates interested in the health and well-being of at-risk families. The changes to cash welfare and child support policies had potential direct and indirect consequences for...


    • Chapter 11 Residential Environments and Obesity: What Can We Learn About Policy Interventions from Observational Studies?
      (pp. 309-343)
      Jeffrey D. Morenoff, Ana V. Diez Roux, Ben B. Hansen and Theresa L. Osypuk

      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 factors (such as stress and social relationships that help cope with stress) that may be related to health through more complex...

    • Chapter 12 Are Some Neighborhoods Better for Child Health than Others?
      (pp. 344-376)
      Rebecca C. Fauth and Jeanne Brooks-Gunn

      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). While this assumption, on its face, seems obvious, it is incredibly difficult to substantiate from a social-science perspective. The primary reason is that families have some choice as to where they live. Consequently, when neighborhood influences are reported, individual-level variables may be accounting, wholly or...


    • Chapter 13 Social and Economic Policies as Health Policy: Moving Toward a New Approach to Improving Health in America
      (pp. 379-390)
      Harold Pollack, George A. Kaplan, James S. House and Robert F. Schoeni

      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 justifiably could have been expanded to consider still other domains: environmental, law-enforcement, agriculture, and transportation policies, as well as others. Human health is too multifaceted, its determinants too varied, and the current state of our knowledge too limited, for any one volume to capture the...

  13. Index
    (pp. 391-398)