Family Economic Security Policy Effects on Child Health: Concepts and Measures for Future Research

Introduction: Empirical evaluation of the effects of social policies on health outcomes is necessary to guide effective policymaking. In this presentation, we review the empirical literature examining the effects of a key social determinant of health, family economic security policies, on child and family health outcomes; formulate a framework to understand possible mechanisms of effect; and introduce our development of a policy surveillance system to measure changes in state laws that affect social determinants of health.

Methods: (1) We carried out a comprehensive review of the published literature on family economic security policies and health outcomes. (2) The Public Health Law Research Program of the Robert Wood Johnson Foundation has been creating and publishing legal datasets on LawAtlas. LawAtlas combines textual, interpretative legal research done by lawyers with quantitative coding of reliable and valid policy indices based on the measurement methods of empirical scientists. As part of LawAtlas, we conducted legal/policy data collection for 4 family economic security policies.

Results: (1) There is a paucity of studies examining effects of economic policies on child and family health behaviors and outcomes. There is some evidence that state-level implementation of an EITC leads to a reduction in adverse birth outcomes, possibly through the effects on increased maternal employment, prenatal care and lower maternal smoking. The literature on the health effects of minimum wage increases is sparse and mostly inconclusive. There is some disconcerting evidence indicating TANF restrictions have resulted in decreased health insurance coverage, health care access, and prenatal care and increased infant mortality. We only found 3 studies examining the effects of unemployment compensation on child and family health outcomes, and they indicate that unemployment compensation attenuates the deleterious effects of unemployment on adult and child health behaviors and outcomes. An additional concern is findings that TANF restrictions are associated with a reduction in educational opportunities for at-risk women. (2) Based on theory and review of the research to date, we developed a conceptual framework to guide future research. (3) Our policy surveillance data indicate wide distribution across states and time of numerous theoretically-relevant components of family economic security policies.

Conclusions: State policy variations offer a valuable opportunity for scientists to conduct natural experiments and contribute to evidence linking social policy effects to family and child wellbeing. Such rigorous research will help guide design of evidence-based family economic security policies to improve population health and reduce health inequities.