Upstream Solutions: Does the Supplemental Security Income Program Reduce Disability in the Elderly?

University of Wisconsin, Madison, WI 53706, USA.
Milbank Quarterly (Impact Factor: 3.38). 04/2008; 86(1):5-45. DOI: 10.1111/j.1468-0009.2007.00512.x
Source: PubMed

ABSTRACT The robust relationship between socioeconomic factors and health suggests that social and economic policies might substantially affect health, while other evidence suggests that medical care, the main focus of current health policy, may not be the primary determinant of population health. Income support policies are one promising avenue to improve population health. This study examines whether the federal cash transfer program to poor elderly, the Supplemental Security Income (SSI) program, affects old-age disability.
This study uses the 1990 and 2000 censuses, employing state and year fixed-effect models, to test whether within-state changes in maximum SSI benefits over time lead to changes in disability among people aged sixty-five and older.
Higher benefits are linked to lower disability rates. Among all single elderly individuals, 30 percent have mobility limitations, and an increase of $100 per month in the maximum SSI benefit caused the rate of mobility limitations to fall by 0.46 percentage points. The findings were robust to sensitivity analyses. First, analyses limited to those most likely to receive SSI produced larger effects, but analyses limited to those least likely to receive SSI produced no measurable effect. Second, varying the disability measure did not meaningfully alter the findings. Third, excluding the institutionalized, immigrants, individuals living in states with exceptionally large benefit changes, and individuals living in states with no SSI supplements did not change the substantive conclusions. Fourth, Medicaid did not confound the effects. Finally, these results were robust for married individuals.
Income support policy may be a significant new lever for improving population health, especially that of lower-income persons. Even though the findings are robust, further analyses are needed to confirm their reliability. Future research should examine a variety of different income support policies, as well as whether a broader range of social and economic policies affect health.

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Available from: Pamela Herd, Sep 28, 2015
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    • "The fact that we find no evidence that changes in state unemployment benefit policies influence CVD risk suggest that, at ages 50 and above, unemployment may influence CVD risk through some of these non-financial mechanisms, so that other policies than unemployment benefits may be more important in preventing CVD incidence. On the other hand, our results are at odds with previous evidence that among US elderly, an increase in the Supplemental Security Income (SSI) cash transfer program benefits is associated with a fall of 0.46 percentage points in the rate of disability among US adults aged 65 and older.[41] A possible explanation for this discrepancy is that CVD risk is less sensitive to temporary income support benefits than other outcomes such as physical disability and mental health. "
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    ABSTRACT: Objective Previous studies suggest that unemployment predicts increased cardiovascular disease (CVD) risk, but whether unemployment insurance programs mitigate this risk has not been assessed. Exploiting US state variations in unemployment insurance benefit programs, we tested the hypothesis that more generous benefits reduce CVD risk. Methods Cohort data came from 16,108 participants in the Health and Retirement Study (HRS) aged 50–65 at baseline interviewed from 1992 to 2010. Data on first and recurrent CVD diagnosis assessed through biennial interviews were linked to the generosity of unemployment benefit programmes in each state and year. Using state fixed-effect models, we assessed whether state changes in the generosity of unemployment benefits predicted CVD risk. Results States with higher unemployment benefits had lower incidence of CVD, so that a 1% increase in benefits was associated with 18% lower odds of CVD (OR:0.82, 95%-CI:0.71–0.94). This association remained after introducing US census regional division fixed effects, but disappeared after introducing state fixed effects (OR:1.02, 95%-CI:0.79–1.31).This was consistent with the fact that unemployment was not associated with CVD risk in state-fixed effect models. Conclusion Although states with more generous unemployment benefits had lower CVD incidence, this appeared to be due to confounding by state-level characteristics. Possible explanations are the lack of short-term effects of unemployment on CVD risk. Future studies should assess whether benefits at earlier stages of the life-course influence long-term risk of CVD.
    PLoS ONE 07/2014; 9(7):e101193. DOI:10.1371/journal.pone.0101193 · 3.23 Impact Factor
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    • "Using variations in EITC benefits to address the direction of the income-health gradient has three advantages. First, earlier research indicated that the income-health gradient is strongest in the low-income population (Backlund, Sorlie, and Johnson 1996; Herd, Schoeni, and House 2008; McDonough et al. 1997). Therefore, since the EITC is targeted at the low-income population, it can be used to analyze this group of particular relevance to the gradient. "
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    ABSTRACT: The existence of a positive relationship between income and morbidity has been well documented in the literature. But it is unclear whether the relationship is positive because increased income allows individuals to purchase more health inputs that improve their health, because healthy individuals are more productive and thus can earn higher wages in the labor market, or because a third factor is improving health and increasing income. This article explores whether increases in income improve the health of the low-income population. Because health status may affect income, this article uses an "instrumental variable" strategy that considers income variations over seventeen years of changes in the generosity of state and federal Earned Income Tax Credits (EITC, a measure that should be exogenous to health status). I measured health status using both the self-reported health status and the functional limitations indicated on the Survey of Income and Program Participation (SIPP), as well as the self-reported health status indicated on the March Current Population Survey (CPS). I found only limited support for the theory that the relationship between income and morbidity is derived from shifts in income. Although I did observe a correlation between income and self-reported health, I found no evidence that increases in income significantly improve self-reported health statuses. In addition, while increases in income appear to reduce the prevalence of hearing limitations when using corrective measures, these increases did not have a significant effect on most of the other functional limitations considered here. These findings suggest that the ability to improve short-term health outcomes through public transfer payments may be limited. However, the lifetime effects on the health of people with higher incomes would still be a valuable avenue for future research.
    Milbank Quarterly 12/2011; 89(4):694-727. DOI:10.1111/j.1468-0009.2011.00647.x · 3.38 Impact Factor
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    • "Occupational position determines psychosocial and other chemical and physical exposures at work, as well as job security, which can affect health (Karasek and Theorell1992). Income and wealth are hypothesized to affect health via their impact on material deprivation, such as proper nutrition and safe homes and neighborhoods and stress that is a product of deprivation, but also broadly inequality (Herd et al. 2008). Finally, those with higher educational attainment are less likely to smoke, be obese or live sedentary lives, and are better able to manage chronic diseases like diabetes (Goldman and Smith 2002). "
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    ABSTRACT: Just as postsecondary schooling serves as a dividing line between the advantaged and disadvantaged on outcomes like income and marital status, it also serves as a dividing line between the healthy and unhealthy. Why are the better educated healthier? Human capital theory posits that education makes one healthier via cognitive (skill improvements) and noncognitive psychological resources (traits such as conscientiousness and a sense of mastery). I employ the Wisconsin Longitudinal Study (1957-2005) to test the relative strength of measures of cognitive human capital versus noncognitive psychological human capital in explaining the relationship between education and health outcomes among high school graduates. I find little evidence that noncognitive psychological human capital is a significant mediator, but find a relatively significant role for cognitive human capital, as measured by high school academic performance. It is not just higher educational attainment; academic performance is strongly linked to health in later life.
    Journal of Health and Social Behavior 12/2010; 51(4):478-96. DOI:10.1177/0022146510386796 · 2.72 Impact Factor
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