The Logic of Policies to Address Income‐Related Health Inequity: A Problem‐Oriented Approach

Abstract

Income is a fundamental cause of health across the life course. To address income‐related health inequities, we need a set of overlapping and complementary policy approaches rather than focusing on a single policy. During their lives, individuals inhabit different roles with regard to their ability to earn wages, and at any given time, only about 50% of the US population are expected to earn wages, while the rest (e.g., children, older adults, those who are disabled, unemployed, students, and/or caregivers) are not. Three key “branch points” for designing policy approaches to address income‐related health inequity are (1) should the needed good or service be obtained on the market? (2) do policy beneficiaries currently earn income? and (3) have policy beneficiaries earned income previously? The responses to these questions suggest one of four policy approaches: social services, social enfranchisement, social insurance, or social assistance.

Gaps in the welfare state: A role-based model of poverty risk in the U.S.

“…In this examination of nationally-representative data, we found empiric support for a structural view of poverty grounded in the centrality of markets as distributive institutions in the U.S [ 23 , 26 , 27 , 49 ]. The roles one inhabits with relation to the market distribution of factor payments are strongly associated with poverty risk.…”

“…Given that earned income from paid labor is the primary method of factor income distribution in the U.S., we used variables within the ASEC to categorize individuals into ‘roles’ that relate to the reasons they would or would not be expected to engage in paid labor [ 26 , 48 ]. First, we divided individuals into three categories based on age: children (under 18 years of age), working-age adults (age 18 to 64 years), and older adults (65 years of age or greater).…”

“…An individual’s relation to the labor market can be thought of as a ‘role’ that they inhabit [ 26 ]. Characterizing these roles begins with age.…”

Food Insecurity and Social Policy: A Comparative Analysis of Welfare State Regimes in 19 Countries

“…A key set of distributive institutions are social policies, typically financed through taxation and meant to protect against material hardship, such as social insurance and means-tested "safety net" income supports. 24 These policies comprise a society's "welfare state". [25][26][27][28][29][30] Different welfare state configurations are likely to affect both the overall level of food insecurity in a society, and its distribution across segments of the population.…”

“…[31][32][33][34][35] However, this can neglect important differences in what that spending supports, the logic, or guiding principles, of various policies, and how they developed historically. Further, and perhaps most importantly, it may neglect how different policies-including social assistance, 24 social insurance, in-kind benefit provision (such as education), along with the tax system that finances them-all fit together into an overall system: a welfare state "regime". 36 An approach that may better "see the forest for the trees" is typological, creating categorizations of welfare state regimes based on their historical development, underlying logic, and interacting components.…”