As 2020 kicks off, the Policies for Action (P4A) program is entering its fifth year with a growing community of researchers across the country and a maturing pipeline of research to support critical policy development. The need for P4A and similar policy research programs is greater than ever; there is growing demand in the health and social care sectors to better understand and address the many nonmedical determinants of population health, well-being, and equity.
Meeting this demand with grounded, actionable, evidence-driven policy research is especially important as the country continues to grapple with persistent health inequities and declining life expectancy. Many of these inequities—especially those affecting people of color and lower-income communities—are rooted in an array of policies, making P4A’s upstream policy focus critical as we work to strengthen the nation’s culture of health.
In 2019, P4A published seven working papers and five policy briefs, and P4A research appeared in seven peer-reviewed journals, including JAMA, Health Affairs, and Milbank Quarterly. P4A facilitated five panel presentations of research at interdisciplinary conferences, including those operated by the Association for Public Policy Analysis and Management, the American Society of Health Economists, and AcademyHealth. Additionally, P4A research was presented at seven key stakeholder meetings, cited in one testimony and a policy document, and mentioned 54 times in media outlets such as the Washington Post, the Hill, the Wall Street Journal, CBS News, Politico, and the New York Times.
This research spanned many cross-sector topics of vital importance to population health, well-being, and equity, including the following:
- The effects of unstable scheduling on child care. Researchers at the University of California, Berkeley, found that workers with unpredictable schedules had trouble finding care in a formal child care center. They often had to rely on a patchwork of care arrangements, including informal care. They were also more likely to leave a child with a sibling or home alone without adult supervision. This work was released to coincide with the reintroduction of the federal Schedules That Work Act, and the research was presented at policy briefings exploring the wide-ranging effects of scheduling policies.
- Addressing medical and social needs of “super-utilizer” patients. P4A researchers at the University of Michigan evaluated 46 interventions designed to address the needs of “super-utilizers,” a subset of patients with complex health and social needs that account for the majority of public health care expenditures in the United States. They found a lack of high-quality studies in the literature, making it difficult to draw conclusions about effectiveness. Their work was cited in the bipartisan Social Determinants Accelerator Act and was featured in supplementary materials for the bill.
- Minimum wage and the earned income tax credit. P4A researcher Michael Reich of the University of California, Berkeley, found that non-drug-related suicides declined significantly with higher minimum wages and earned income tax credits, especially among women. The estimates suggest that increasing both the minimum wage and earned income tax credit by 10 percent would prevent over 1,200 suicides each year. In February 2019, Reich cited this research in his testimony at a hearing of the House Education and Labor Committee called “Gradually Raising the Minimum Wage to $15: Good for Workers, Good for Business, and Good for the Economy.” This research was also featured in articles in New York Magazine, Forbes, CBS News, the Washington Post, and HuffPost, and the team’s accompanying op-ed was published by The Hill. Researchers also wrote a commentary and recorded a podcast episode for VoxEU.
- State Medicaid work requirements. P4A researchers at Harvard University released the first-ever independent investigation of Arkansas’s Medicaid work requirements. They found that the state’s Medicaid work requirements were associated with significant losses of Medicaid coverage and a rise in uninsurance rates, indicating that many people did not obtain other coverage after losing Medicaid coverage for failing to meet work requirements. The study also found no significant changes in employment; more than 95 percent of people targeted by the policy already met the requirement or should have been exempt. Following publication in the New England Journal of Medicine, the research was featured in elite media outlets; debated and discussed among advocates and policymakers on social media, including 2020 presidential candidate Bernie Sanders; and elevated through supplemental issue briefs and podcasts published by the Commonwealth Fund.
- Gentrification. Researchers at the New York University Robert F. Wagner Graduate School of Public Service found scant evidence that gentrification is associated with elevated displacement of low-income families, and those who are displaced are not moving to worse neighborhoods. Researchers also examined the health effects of children that experienced gentrification. Findings suggest that children growing up in gentrified areas had a slightly higher rate of anxiety or depression diagnoses than children who started off in low-socioeconomic-status areas that did not gentrify. The researchers also found no effects on children’s health system use or diagnoses of asthma or obesity.
Expanding the quality and reach of our work in 2020
The importance of P4A-funded research is clear. Nonetheless, we started 2020 with a strategic plan to increase the impact of the research we fund. Two top priorities are (1) ensuring our grants seek to answer questions policymakers are asking and (2) increasing our reach to diverse applicants. Both of these goals will help sharpen our work, raise new policy-related questions, provide new answers and perspectives, and increase the relevance of our work on policies that can improve the nation’s health and health equity.
This work began in 2019, with the launching of our first call for proposals to advance equity, diversity, and inclusion in policy and law research, geared specifically toward early-career researchers who have been historically disadvantaged or underrepresented in research disciplines. These grants, which will start in spring 2020, will support not only research but various mentorship and career development activities. As we move forward with our general calls for proposals, we will deliberately try to increase diversity in our grantmaking and incorporate best practices for equitable grantmaking.
And in 2020, our first open call for proposals will focus on housing policies and the many ways they shape neighborhood and community conditions and community members’ health and well-being.
With our growing pipeline of policy-oriented research and the support of our National Advisory Committee, we will find new ways to ensure P4A research reaches policymakers and key stakeholders at all levels of government, and that the policy research we support is rigorous, relevant, and responsive to the country’s needs. We look forward to learning and sharing with all of you in the year ahead.