It’s hardly news that poorer people have worse health on average – but teasing apart the link of income and health is harder. The income-health gradient could be because people lose income when they have health problems, or it could be due to common causes (e.g. education) rather than income itself. In fact, the relationship is more complex than you might guess; and having recently stumbled over three wonderful studies that help unpick this, I thought I’d share them with you and see what you thought.
Short-run effects: payday deaths
Probably my favourite of these studies is a lovely paper in press by Evans and Moore, using US data. Their reasoning is that if we want to know the SHORT-RUN impact of income and health, we can look at the first day of the month when most people get paid or receive welfare payments, and see if people are more or less likely to die on payday. The results are staggering.
In the chart below, you can see how murder rates vary across the month. The relate daily mortality risk is about 10% higher on payday than it is for the rest of the month, and a little bit higher for 4 days after payday.
What’s particularly striking is that this is only found for causes of death that are related to drink in the short-term. So for example, if we look at leukemia deaths in the chart below, we see absolutely no change over the month at all.
In other words, people drink more on payday, and this raises the chances of them dying. Otherwise there’s no short-run impact of payday on health.
Long-run effects: lottery winnings
Does this mean that higher incomes are actually bad for health? Well, not so fast. The deaths-by-payday charts are good for showing the very short-run impacts of income on health, but they don’t show what happens to a change in permanent income, nor do they show the longer-run impacts. The best way of getting at the causal impact of income here is to look at lottery winnings, which (unlike most sources of income) are completely random within any particular lottery.
In the UK, a paper by Apouey & Clark 2009 looks at the impact of lottery winnings on health. Like Evans and Moore, they find that this source of extra income leads to more smoking and drinking (perhaps unsurprisingly, if you think about how you personally would spend a lottery winning (or me anyway), and also the fact that people who play the lottery are going to have a different attitude to risk than other people).
The net effect of these two patterns in Apouey & Clark is that there’s no effect of lottery winnings on self-reported general health – but while self-reported health can be useful, it also has lots of problems as a measure. A more objective measure of general health is mortality, and for this we have to turn to some Swedish data analysed by Lindahl 2005 (free version here). Lindahl finds that about £1,000 worth of lottery winnings reduce the probability of dying by 2-3% over the next five years. With this design, it’s pretty unarguable that this shows a genuine causal impact of income.
Back full circle
So this takes us right back to where we started – poor people have worse health, and this is (at least partly) because lower incomes genuinely cause worse health. But through these three very nicely-designed studies, we get a glimpse into the complexity of this pattern across different aspects of health over different time periods – and it’s this that I thought made them particularly worth sharing.
Understanding the context of community development is important for health policy. David’s article with Nancy Andrews is essential reading, because it provides a short history of the major funding organizations that support subsidized housing and other amenities. Previous partnerships have been formed, but these have largely been to address specific diseases or populations, rather than to engage with the holistic health and wellbeing of a community. Braunstein and Lavizza-Mourey’s article provides the example of the Seattle King County Healthy Homes Project, which sponsored the remediation of structural lead and injury hazards in housing projects. Nationally, there have also been initiatives focused on reducing lead levels in low-income communities as well as allergens that cause asthma. More recent initiatives have also focused on promoting access to fresh fruits and vegetables in “food deserts,” areas that are not served by grocery stores. The next logical step is to form more place-based initiatives, a movement that is partially supported by funding in the Affordable Care Act.
The overall impression I was left with is that community housing-public health partnerships are being formed, but there are many logistical and financing challenges that still need to be resolved. As this field develops, I think new kinds of organizational structures that cut across public and private entities and different authorities will need to be formed. This is a challenge, but not an insurmountable one. I wanted to raise a few questions that I think will need to be answered in the coming years.
Does it matter if community development does not bend the cost curve?
It would be a slam-dunk to show that community development strategies reduced medical costs. If health insurers or employers discovered that improving poor neighborhoods reduced their medical spending, they might be willing to take action purely out of self-interest. This would be nice, but I’m skeptical. Consider that while most preventative care does improve health on average, it does not lower health care costs. We know less about the cost savings of public health interventions, but it is difficult to find many “low hanging fruit” – even when we make people much healthier, we usually have to spend more on the margin. The data from community development initiatives might disprove this assumption, but realistically it is important that community developers do not oversell the cost-savings potential of place-based interventions. I think it would be more important to emphasize that improved health matters for its own sake, especially in places where neighborhoods make people sick and less productive. Economic benefits matter—a point that David Williams and James Marks emphasize in their article – but they are not economic benefits that accrue in any measurable way to federal and state organizations.
What do joint health-community initiatives look like in “underwater” neighborhoods?
There are now major suburban areas in places like Las Vegas, Miami, and greater Los Angeles that have been ravaged by foreclosures and where many homeowners are “underwater” – unable to sell their homes because they are worth less than the outstanding mortgages. These are not necessarily the traditionally poor neighborhoods, and consequently they do not have the social services and community development resources in place to assist households. As I reviewed, Janet Currie and Erdal Tekin show that these areas are experiencing an acute health crisis. What can be done to help them? Part of the response extends to a complex banking infrastructure, which reaches beyond the limited resources of community development organizations. Once the initial crisis has been resolved, there will be a need for creative solutions to redefine these neighborhoods, luring back families and making use of the existing housing stock. An important challenge for public health-community development partnerships will be to devise ways to also increase access to health amenities in these areas.
How do we get cities and suburbs to work together?
One point that is emphasized in several of the papers (especially Arcaya and Briggs) is that using community development to promote health will require regional solutions. We are past the old paradigm of thinking about poor health and neighborhoods on the level of atomistic urban cores. Urban areas are integrated with suburbs, and low-income communities are now more dispersed than in the past. We might hope that authorities from cities and suburbs would sit down together to develop regional solutions, but there are real political obstacles. As the work of Katie Levine Einstein (a classmate) emphasizes, racially and economically fragmented communities are much less likely to forge regional collaborations to solve shared problems such as transportation. We need to know more about whether poor collaboration reflects something cultural (such as historical patterns of mistrust) or something economic (such as an inability of cities to kick in their share of the financial resources to develop infrastructure). The guiding assumption has been the latter, but we need to understand the cultural factors better.
- Community Development (communitydevelopment1.wordpress.com)
- New from Health Affairs: Community development and health (phlibraryres.wordpress.com)
- New from Health Affairs: Community development and health (jflahiff.wordpress.com)
- Aileen Balahadia to leave White Center Community Development Association, ‘an organization that has been my heart and soul…’ (whitecenternow.com)
- Alternative Models For Community Development Emerge Far From Rio’s Bright Lights (forbes.com)
- Six Geese a’ Layin: Reviews & Community Development (outspokenmedia.com)
- HUD connects community development to philanthropic dollars (scoppcanton.wordpress.com)
In recent years, there has been an unparalleled rise in the number of homeless students in the United States. Between the 2006 – 07 and 2009–10 school years, the number of homeless students increased by 38% (from 679,724 to 939,903). States with some of the most homeless students, New York (82,409) and Texas (76,095), witnessed substantial increases of 87% and 125%, respectively (figure 1). A 2010 National Association for the Education of Homeless Children and Youth (NAEHCY) and First Focus survey of state education departments and local school districts listed the top reasons for the increase in homeless students as the economic downturn (62%), greater community awareness (40%), the foreclosure crisis (38%), and the noteworthy efforts of homeless school liaisons in identifying students (33%).1 Across the U.S., homeless school liaisons have heightened outreach efforts to homeless students and have been particularly successful at identifying those living doubled up with family or friends, who are often more challenging to recognize. Hence, the majority of the overall nationwide increase between the 2006 – 07 and 2009–10 school years is due to a 59% rise in the number of those students living doubled up (table 1). In addition, economic factors stemming from the recession contributed to the overall increase, including an 11% rise in the number of students living in shelters. Despite the 38% increase from the 2006 – 07 school year, the number of students served declined two percent between 2008– 09 and 2009–10. This is due to California—the state with the most homeless students (193,796)—underreporting their numbers in 2009–10. Without considering California, the number of students served rose 12%.2.
To see the entire study click.…
- Homeless kids lag in city schools: report (nydailynews.com)
- California’s Homeless Student Population Struggles In School (huffingtonpost.com)
- Is There Still a Need? (yarnfest.wordpress.com)
If the government can find a manufacturer, the Linux operating system-based computer would be the latest in a string of “world’s cheapest” innovations to hit the market out of India, which is home to the 100,000 rupee ($2,127) compact Nano car, the 749 rupees ($16) water purifier and the $2,000 open-heart surgery.
The tablet can be used for functions like word processing, web browsing and video-conferencing. It has a solar power option too — important for India’s energy-starved hinterlands — though that add-on costs extra.
“This is our answer to MIT’s $100 computer,” human resource development minister Kapil Sibal told the Economic Times when he unveiled the device Thursday.
In 2005, Nicholas Negroponte— cofounder of the Massachusetts Institute of Technology‘s Media Lab — unveiled a prototype of a $100 laptop for children in the developing world. India rejected that as too expensive and embarked on a multiyear effort to develop a cheaper option of its own.
Negroponte’s laptop ended up costing about $200, but in May his nonprofit association, One Laptop Per Child, said it plans to launch a basic tablet computer for $99.
Sibal turned to students and professors at India’s elite technical universities to develop the $35 tablet after receiving a “lukewarm” response from private sector players. He hopes to get the cost down to $10 eventually.
Mamta Varma, a ministry spokeswoman, said falling hardware costs and intelligent design make the price tag plausible. The tablet doesn’t have a hard disk, but instead uses a memory card, much like a mobile phone. The tablet design cuts hardware costs, and the use of open-source software also adds to savings, she said.
Varma said several global manufacturers, including at least one from Taiwan, have shown interest in making the low-cost device, but no manufacturing or distribution deals have been finalized. She declined to name any of the companies.
India plans to subsidize the cost of the tablet for its students, bringing the purchase price down to around $20.
The project is part of an ambitious education technology initiative, which also aims to bring broadband connectivity to India’s 25,000 colleges and 504 universities and make study materials available online.
So far nearly 8,500 colleges have been connected and nearly 500 Web and video-based courses have been uploaded on YouTube and other portals, the Ministry said.
Copyright 2010 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
- VIDEO: India unveils ‘world’s cheapest tablet’ (bbc.co.uk)
- India offers tablet computer to rural poor for only $35 (seattletimes.nwsource.com)
This article was co-written by Brandon Roberts and David Altstadt on behalf of the Working Poor Families Project.
The latest poverty figures paint a grim picture of the Great Recession‘s deep and persistent impact on average Americans. Last year, more Americans were poor than ever before, as the poverty rate climbed to a 17-year high.
Yet as bad as that sounds, the number of Americans who are struggling to get by is doubly worse. And, many of them are working but still can’t make a decent living.
On Tuesday, the Census Bureau announced that the nation’s official poverty rate rose to 15.1 percent in 2010, up from 14.3 percent in 2009 to reach the highest mark since 1993. An additional 2.6 million people joined the ranks of the poor, bringing the total to 46.2 million — the highest number since the government started tracking poverty in the 1950s.
A family of four earning up to $22,314 is counted as poor. But, anyone facing $4 a gallon of gas and rising costs for health insurance, food, and housing knows that you need to earn a lot more to meet your family’s basic needs without getting mired deep into debt. Many experts now agree that families must reach twice the poverty level before achieving any semblance of income security.
By this measure, in 2010, 33.9 percent of Americans — for a total of 103.6 million — could not make ends meet. This is more than twice the number of officially poor. More than four in 10 children are low income, 32.5 million in all. (The tally of Americans living below 200 percent of poverty is published in Table 6 of the Census Bureau report.)
And, while the nation’s stubbornly high unemployment has drawn attention to the millions of Americans who have lost their jobs in the economic downturn, the fact is that three out of four low-income families are gainfully employed. Despite their determination and effort, many are toiling in low-wage jobs that provide inadequate benefits and offer few opportunities for advancement.
The plight of these low-income families is worsening — challenging a fundamental assumption that, in America, work pays. In 2009, 30 percent of working families were low-income, up from 28 percent in 2007, according to Census Bureau data analyzed by the Working Poor Families Project. These families totaled 45 million people, including 22 million children, an increase of 1.7 million people from 2008. We expect that when 2010 data becomes available soon this negative trend will have continued.
Not surprisingly, the ranks of the working poor have grown at a time in which the median household income has dropped sharply. According to the Census Bureau, the average household earned $49,445 in 2010, a 6.4 percent decline since 2007.
At this critical juncture, policymakers must avoid reducing the national debt on the backs of working families. Instead, policymakers should give priority to investing public resources and enacting public policies that are directed at:
- Expanding the number of low-wage adults who enroll in education and skills development programs and successfully obtain postsecondary credentials valued in the labor market.
- Improving wages, benefits and supports for low-income working families and stimulating the creation of significantly more good jobs.
- Regularly assessing the challenges faced by America’s working families and the adequacy and success of government policies that facilitate their drive for economic advancement and security.
Pell grants, food stamps, unemployment insurance and the earned income tax credit, among other government programs, are vital for helping working families achieve economic security. We must act now to renew America’s promise that work pays.
Brandon Roberts manages the Working Poor Families Project (WPFP), and David Altstadt conducts research on the education, skill development, and employment needs of low-skilled adults.
- Economic Decline Brings Rising Poverty Rates and Growing Income Inequality (blogcritics.org)
- Understanding The Poverty Surge (andrewsullivan.thedailybeast.com)
- Poverty rate soars to one in six (geneveith.com)
- New Census Report Says 1 in 6 Americans Live in Poverty; Real Numbers Even Higher (redantliberationarmy.wordpress.com)
- Census: US poverty rate swells to nearly 1 in 6 (lonerangersilver.wordpress.com)
- Working-Age Adults Now Constitute Record Share Of U.S. Poor (jhaines6.wordpress.com)