Long term employment of African-American and white welfare recipients and the role of persistent health and mental health problems.
ABSTRACT We use a panel study of Michigan current and former welfare recipients to estimate the prevalence and persistence of health problems in the post-reform welfare population and their role in women's employment. Rates of health problems were disproportionately high. Over 70 percent of current and former welfare recipients reported limitations in physical functioning; over 60 percent met the criteria for a mental health disorder measured in the study; and 37 percent reported having a child with a health problem in at least one of four interviews over a 4 1/2-year period. Women who reported physical health, mental health, or child health problems at multiple waves worked fewer months. There were no race-based differences in employment length or in physical health problems, but African-Americans were less likely than whites to meet the diagnostic screening criteria for depression, to meet criteria for general anxiety disorder, and to report a child with a health problem. These findings suggest that the inclusion of persistent health problems as determinants of work in human capital models increases understanding of the transition from welfare to work. Policies need to reexamine welfare's work requirements to encourage states to provide services and supports to recipients.
Long Term Employment of African-American and White Welfare Recipients and the
Role of Persistent Health and Mental Health Problems
Sandra K. Danziger
FORTHCOMING in Women & Health, Vol. 39 #4.
Mary Corcoran is Professor of Political Science, Public Policy, Social Work, and
Women’s Studies at the University of Michigan.
Sandra K. Danziger is Associate Professor of Social Work and Director of the Michigan
Program on Poverty and Social Welfare Policy at the University of Michigan.
Richard Tolman is Professor of Social Work at the University of Michigan.
This research was supported in part by grants from the U.S. Department of Health and
Human Services. Office of the Assistant Secretary for Planning and Evaluation, the Joyce
Foundation, the Charles Stewart Mott Foundation, the John D. and Catherine T.
MacArthur Foundation, the National Institute of Mental Health (R24-MH51363) and the
Office of the Vice President for Research at the University of Michigan. The authors
thank survey manager Bruce Medbery and the interview staff. We also thank Sheldon
Danziger, LaDonna Pavetti, Don Oellerich, Kristine Siefert, two anonymous reviewers
and journal editor for helpful comments on a previous draft, Myung Ho Park for excellent
research assistance and Susan Carpenter for excellent typing assistance.
Long term employment of welfare recipients 1
Long Term Employment of African-American and White Welfare Recipients and the Role of
Persistent Health and Mental Health Problems
We use a panel study of Michigan current and former welfare recipients to estimate the prevalence and
persistence of health problems in the post-reform welfare population and their role in women’s
employment. Rates of health problems were disproportionately high. Over 70 percent of current and
former welfare recipients reported limitations in physical functioning; over 60 percent met the criteria
for a mental health disorder measured in the study; and 37 percent reported having a child with a health
problem in at least one of four interviews over a 4½ -year period. Women who reported physical health,
mental health, or child health problems at multiple waves worked fewer months. There were no race-
based differences in employment length or in physical health problems, but African-Americans were
less likely than whites to meet the diagnostic screening criteria for depression, to meet criteria for
general anxiety disorder, and to report a child with a health problem. These findings suggest that the
inclusion of persistent health problems as determinants of work in human capital models increases
understanding of the transition from welfare to work. Policies need to reexamine welfare’s work
requirements to encourage states to provide services and supports to recipients.
KEY WORDS. Employment of welfare recipients, race differences, health problems
The Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996 led
some analysts to warn that physical and mental health problems might hinder recipients’ abilities to
successfully move from welfare to work. Olson and Pavetti (1996) and Loprest and Acs (1996) reported
that rates of depressive symptoms and physical health problems among welfare recipients and their
children were higher than among women and children in the general population. Recent reviews report
Long term employment of welfare recipients 2
that health problems are common among recipients and are related to employment status at a point in
time (S. K. Danziger et al. 2000, Blank 2002, Lichter and Jayakody 2001).
The receipt of cash welfare is now conditioned on work and/or participation in work-related
activities. Most states primarily provide job search assistance in welfare-to-work programs and do not
systematically screen and assess participants for physical and mental health problems that may constrain
their ability to work. These programs also tend not to provide referral, treatment, and counseling
services to recipients with such problems. (S.K. Danziger and Seefeldt, 2002)
A related concern is whether health problems make it harder for African-American welfare
recipients than white, non-Hispanic recipients to establish stable employment and leave welfare. In the
general population, African-American women have higher rates of chronic physical health problems
than do white women. The existence and extent of race differences in the physical and mental health
status of welfare recipients and how this affects employment has not yet been demonstrated.
This paper uses data from four waves of the Women’s Employment Survey (WES), a
representative sample of African-American and white single mothers who were welfare recipients in an
urban Michigan county in February 1997. We investigate whether physical health problems, mental
health problems, and child health problems limit their ability to establish stable employment (holding
constant characteristics such as family structure and human capital deficits). We address these questions
and discuss their implications for welfare policy and research:
• What percentage of respondents reported physical health problems, mental health problems, and a
child with a health problem at each of the four waves?
• Does the prevalence of these problems persist or change over time?
• Does the prevalence or persistence of these problems vary by race?
• Are persistent physical health problems, persistent mental health problems, and persistent child
health problems associated with fewer months of employment, controlling for other factors?
Long term employment of welfare recipients 3
• Do African-Americans work fewer months than whites? Do effects of health on long term
employment vary by race?
Despite concerns that physical and mental health problems hinder transitions from welfare to
work, research on the health status of recipients and their service needs prior to the 1996 reform was
limited (O’Campo and Rojas-Smith, 1998). Olson and Pavetti (1996) and Loprest and Acs (1996)
documented high rates of both physical health problems and psychological distress among recipients.
Salomon, Bassuk, and Brooks (1996) found high rates of limitations in physical functioning and chronic
medical conditions in a cross-sectional study of welfare recipients; they also found that long-term
recipients had lower levels of physical functioning than did short term recipients. The research showed
that these problems were common, but did not link them to work or to length of employment.
These early studies could understate the health problems of recipients in the new welfare
program, Temporary Assistance to Needy Families (TANF), since welfare caseloads dropped sharply
after welfare reform (Zedlewski and Alderson 2001; Blank et al. 2002). Three studies--Zedlewski and
Alderson 2001, Loprest 2001, Danziger et al. 2000 – report high rates of health problems among TANF
recipients. Danziger et al. (2000) report that the prevalence rates of mental and physical health problems
among 753 women who were TANF recipients in an urban county in Michigan in February 1997 were
considerably higher than those for women of comparable ages in the larger population. They found that
contemporaneous health problems and meeting the diagnostic screening criteria for major depressive
disorder were significantly and negatively associated with employment. A recent review of several
studies of TANF recipients also confirms high rates of health and mental health problems and that these
problems pose employment risks (Levin-Epstein, 2003).
Most research on recipients’ health and employment examines their relationship over short
periods of time. There is little research either on the persistence of their health problems or on the
associations between persistent health problems and long term employment. One exception,
Long term employment of welfare recipients 4
Ensminger’s (1995) longitudinal study of 833 African American mothers in a Chicago neighborhood,
found that long-term Aid to Families with Dependent Children recipients were more likely to report
poor health, having a chronic illness, and high levels of psychological stress, than were women who had
never received welfare. Ensminger speculated that poor health may be a cause of persistent welfare
receipt. This suggests that persistent health problems may be associated with shorter terms of
employment, but neither Ensminger (1995) nor others have directly examined this issue.
Past studies have not explored how health problems among TANF mothers are related to their
long term employment. Nor have they addressed whether white and African American women differ in
the patterns of relationships between health and work. When examining this relationship, it is important
to control for likely confounding characteristics. Factors highly prevalent among welfare mothers that
have been found to predict employability at a point in time include: being single, having young
children, low education, low work skills and experience, long history of welfare, lack of transportation,
and problems such as perceived discrimination , substance dependence and domestic violence (Corcoran
et al., 2000; Danziger et al., 2000).
This study’s approach (1) particularizes the established associations between socioeconomic
status (SES), gender, race, and health, and (2) expands human capital models of employment for welfare
women. The association between poverty (low SES) and poor physical health is well documented
(Mullahy & Wolfe, 2001; Williams, 2001). Racial and ethnic disparities in health are in part due to SES
differences (such as higher poverty and welfare reliance among African Americans compared with
Whites) as well as differences in medical care, racism, and stress (Williams, 2002). Wheaton (2001,
221-222), describes the connection between SES and mental health: “First, social environment is both a
starting point and a carrier of the fact of emotional inequality, and, second, variation in emotional
functioning has specific social consequences for our institutions and our society.”
We argue that models of work for women generally, and in particular, low wage women, are
limited if they focus solely on human capital. According to Conrad, human capital theory predicts that a