RT Journal Article
SR Electronic
T1 Government social assistance programmes are failing to protect the health of low-income populations: evidence from the USA and Canada (2003–2014)
JF Journal of Epidemiology and Community Health
JO J Epidemiol Community Health
FD BMJ Publishing Group Ltd
SP 198
OP 205
DO 10.1136/jech-2018-211351
VO 73
IS 3
A1 Faraz Vahid Shahidi
A1 Odmaa Sod-Erdene
A1 Chantel Ramraj
A1 Vincent Hildebrand
A1 Arjumand Siddiqi
YR 2019
UL http://jech.bmj.com/content/73/3/198.abstract
AB Background Social policies that improve the availability and distribution of key socioeconomic resources such as income, wealth and employment are believed to present the most promising avenue for reducing health inequalities. The present study aims to estimate the effect of social assistance recipiency on the health of low-income earners in the USA and Canada.Methods Drawing on nationally representative survey data (National Health Interview Survey and the Canadian Community Health Survey), we employed propensity score matching to match recipients of social assistance to comparable sets of non-recipient ‘controls’. Using a variety of matching algorithms, we estimated the treatment effect of social assistance recipiency on self-rated health, chronic conditions, hypertension, obesity, smoking, binge drinking and physical inactivity.Results After accounting for underlying differences in the demographic and socioeconomic characteristics of recipients and non-recipients, we found that social assistance recipiency was associated with worse health status or, at best, the absence of a clear health advantage. This finding was consistent across several different matching strategies and a diverse range of health outcomes.Conclusions From a public health perspective, our findings suggest that interventions are warranted to improve the scope and generosity of existing social assistance programmes. This may include reversing welfare reforms implemented over the past several decades, increasing benefit levels and untethering benefit recipiency from stringent work conditionalities.