The Long-Term Effects of Welfare Reform on Life Course Health

点击翻译按钮获取中文摘要

Project Summary/Abstract There are over 11 million children living in poverty in the United States. There are also substantial racial disparities in childhood poverty. In 2019, 8.3 percent of White children and 7.3 percent of Asian children were living in poverty, while 20.9 percent of Hispanic children and 26.4 percent of Black children were living in poverty. Adults who experienced childhood poverty are more likely to have worse health outcomes compared to adults who did not experience childhood poverty, including 50% lower odds of reporting good general health and 71% higher odds of having heart disease. Childhood poverty’s impact on subsequent adult health is well- documented, but few studies examine the long-term effect of economic policies on this relationship. Welfare reform represented a major shift in the 1990s in how the United States distributed cash benefits to Americans needing financial support. About 25 years have passed since states began to implement changes to welfare, shifting from a less restrictive and more generous form of welfare distribution through the Aid to Families with Dependent Children (AFDC) program, to a more punitive and less generous form, through the Temporary Assistance to Needy Families (TANF) program. At its height in 1994, AFDC served 9.6 million children, while TANF served only 1.6 million children in 2020, suggesting a large decrease in welfare benefits distribution. Due to the close link between financial resources and health, economic policies serve as potential interventions to promote population health and decrease socioeconomic (SES) health disparities. Studies on welfare reform have found important implications of this policy change on short-term health outcomes, including reduced access to health insurance and decreased health care utilization. These findings suggest potentially negative long-term health outcomes due to welfare reform, though research in this area is limited. Studies on long-term effects of other safety-net policies, such as the Food Stamp Program, have found that more benefits are associated with better long-term health. We propose to fill this gap in studies on the long-term health effects of welfare reform with this project. First, we assess the state-level variation in the relationship between childhood SES and self-rated health, chronic conditions, and psychological distress in adulthood to understand how state context may lead to larger or smaller health disparities rooted in childhood SES. Based on findings from other studies that examine state-level variation in adult health disparities, we expect to find state-level variation, and for this variation to be driven by adults whose families were lower-SES. Second, we quantify the effect of welfare reform on the relationship between childhood SES and self-rated health, chronic conditions, and psychological distress in adulthood. Lastly, due to evidence of racial discrimination in welfare administration, we estimate the extent to which the long-term health effects of welfare reform differ based on race and ethnicity. We hypothesize that welfare reform will have negative long-term health effects for the low-SES sample, and for those effects to be particularly detrimental for individuals who are Hispanic and/or Black.