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Projected health impact of the Los Angeles City living wage ordinance
  1. Brian L Cole1,
  2. Riti Shimkhada2,
  3. Hal Morgenstern3,
  4. Gerald Kominski1,
  5. Jonathan E Fielding1,
  6. Sheng Wu4
  1. 1Department of Health Services, UCLA School of Public Health, Los Angeles, USA
  2. 2Department of Epidemiology, UCLA School of Public Health
  3. 3Department of Epidemiology, University of Michigan School of Public Health, USA
  4. 4UCLA School of Public Policy and Social Research
  1. Correspondence to:
 Dr B L Cole
 Department of Health Services, UCLA School of Public Health, 650 S Young Drive, Rm 31-269 CHS, Los Angeles, CA 90095, USA;


Study objective: To estimate the relative health effects of the income and health insurance provisions of the Los Angeles City living wage ordinance.

Setting and participants: About 10 000 employees of city contractors are subject to the Los Angeles City living wage ordinance, which establishes an annually adjusted minimum wage ($7.99 per hour in July 2002) and requires employers to contribute $1.25 per hour worked towards employees’ health insurance, or, if health insurance is not provided, to add this amount to wages.

Design: As part of a comprehensive health impact assessment (HIA), we used estimates of the effects of health insurance and income on mortality from the published literature to construct a model to estimate and compare potential reductions in mortality attributable to the increases in wage and changes in health insurance status among workers covered by the Los Angeles City living wage ordinance.

Results: The model predicts that the ordinance currently reduces mortality by 1.4 deaths per year per 10 000 workers at a cost of $27.5 million per death prevented. If the ordinance were modified so that all uninsured workers received health insurance, mortality would be reduced by eight deaths per year per 10 000 workers at a cost of $3.4 million per death prevented.

Conclusions: The health insurance provisions of the ordinance have the potential to benefit the health of covered workers far more cost effectively than the wage provisions of the ordinance. This analytical model can be adapted and used in other health impact assessments of related policy actions that might affect either income or access to health insurance in the affected population.

  • health impact assessment
  • wage policy
  • health insurance

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  • Funding: this study was supported by a contract with the Washington DC based Partnership for Prevention with funding from the Robert Wood Johnson Foundation.

  • Conflicts of interest: none declared.

  • Ethics approval: this study relied exclusively on previously published data. Human subjects research approval by the institutional review board was not necessary, as no human subjects were contacted, nor were any individual level data with potential identifiers used in the analysis.

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