Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Department of Economics, Glendon College, York University, Toronto, Ontario, Canada.
J Epidemiol Community Health. 2019 Mar;73(3):198-205. doi: 10.1136/jech-2018-211351. Epub 2018 Nov 15.
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.
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.
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.
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.
改善收入、财富和就业等关键社会经济资源的可及性和分配的社会政策，被认为是减少健康不平等的最有希望的途径。本研究旨在估计美国和加拿大的社会救助领取对低收入者健康的影响。
利用全国代表性调查数据（国家健康访谈调查和加拿大社区健康调查），我们采用倾向评分匹配将社会救助的领取者与可比的非领取者“对照组”相匹配。使用多种匹配算法，我们估计了社会救助领取对自我评估健康、慢性疾病、高血压、肥胖、吸烟、狂饮和身体活动不足的治疗效果。
在考虑到领取者和非领取者在人口统计学和社会经济特征方面的潜在差异后，我们发现社会救助领取与较差的健康状况相关，或者充其量是缺乏明确的健康优势。这一发现与几种不同的匹配策略和多种不同的健康结果一致。
从公共卫生的角度来看，我们的研究结果表明，有必要干预以扩大和增加现有的社会援助计划的范围和慷慨程度。这可能包括扭转过去几十年实施的福利改革，提高福利水平，并取消对严格工作条件的福利领取者的限制。
