Public Health

Cross-post

The health and well-being of people are intimately tied to the conditions of life in their communities—conditions that structure opportunities and pathways for lifelong and even inter-generational well-being. Philanthropic efforts to improve community health must attend to the many systems that shape life conditions by focusing not only on whom, what, or where to fund, but equally importantly, on how to fund. The Urban Institute’s recent comprehensive review of health-focused community development investments made by the Robert Wood Johnson Foundation between 2013 and 2019 yielded a wide range of insights about how philanthropic investments can drive enduring systems change needed to improve community health, well-being, and equity across the nation.

Cross-post

Darrick Hamilton, the Henry Cohen Professor of Economics and Urban Policy at The New School, has gained national recognition for shaping policy solutions to close the racial wealth gap, which refers to how hundreds of years of structural racism have deprived Black families of resources that accumulate and transfer from one generation to the next. The typical White family has 10 times the wealth of the typical Black family and seven times the wealth of the typical Latinx family. This stark and persistent racial wealth gap has harmed generations, driven disparities and appears to be growing, even after controlling for household characteristics and long-term education and income gains by Black people.

Commentary

The COVID-19 pandemic has exacerbated racial, ethnic, and gender disparities that have existed since long before the current public health crisis. With declining infection rates and increasing vaccination rates, the United States seems to be on a path to recovery. But a full recovery from the health and economic fallout of the pandemic will require adequately supporting our most vulnerable communities. A new analysis confirms disparate health and economic effects by race, ethnicity, and gender and inadequate public policy responses in the wake of the pandemic and offers actionable solutions for a more equitable recovery.

Assessment of Perceptions of the Public Charge Rule Among Low-Income Adults in Texas

A recent expansion of the federal “public charge” rule allows the government to deny immigrants permanent residency based on their income or health status or if they participate in programs that did not previously trigger the rule, such as Medicaid or the Supplemental Nutritional Assistance Program [SNAP]. Critics contend that this will dissuade individuals from participating in programs or obtaining medical care. In this JAMA Network Open paper, Benjamin D. Sommers, Heidi Allen, Aditi Bhanja, Robert J. Blendon, John Orav, and Arnold M. Epstein examine perceptions of the new public charge rule and its potential impacts on public program participation and medical care among low-income adults in Texas.

Commentary

Even as the COVID-19 pandemic raged, state legislators continued to quietly pass laws that consolidate power in state capitals and take away local governments’ authority to protect public health. Oklahoma is the latest example.

Does Private Insurance Provide More Medical Care?

Ten years after the passing of the Affordable Care Act—the most comprehensive health care reform of the past half-century—most of the previously uninsured continue to lack coverage. Policymakers and members of the public have expressed growing support for expanding the role of public financing of health care. The “public option” and “Medicare for All” have emerged as important contenders for health policy reform. Both policies are rooted in widening access to the lower prices of the public system to make health care more affordable for all.

Commentary

To find out whether California's 2016 repeal of non-medical exemptions was associated with an increase in uptake of vaccines required for school entry, P4A researchers at George Washington University evaluated California’s new policy and tracked vaccination rates from 2012 to 2017. While vaccination coverage rose, the policy came with unintended consequences.

The Effects of State Pre-emption of Local Smoking Restrictions on Health Disparities

Public health practitioners and tobacco control advocates agree that pre-emption (a higher level of government stripping lower levels of government of their authority over a specific subject matter) has an adverse impact on tobacco control efforts. Pre-emptive state laws may prohibit local tobacco control measures, such as restrictions on marketing and promotion of tobacco products, licensure of tobacco products, smoking in public or private sites, and on youth access to tobacco products.

Local Initiatives, State Pre-emption, and Public Health

State pre-emption is an emerging and highly contentious policy movement with potentially significant consequences on population health. Yet robust analyses to examine whether pre-emption affects health have yet to be conducted. Furthermore, pre-emption’s effect on geographic inequities in health has been largely neglected in policy debates. But it is becoming increasingly clear that state pre-emption laws could reshape the spatial distribution of health, with profound consequences for health care delivery systems and state and local budgets.