Monday, March 17, 2014

Wages are a public health issue

When people think about minimum wage, they most often think about the impact on their bank account and their job. But policies that impact employment and income are actually about health – the health of individuals, families, and communities.

When 19th Century industrialization drove workers from farms and home workshops into urban areas and factory work, our economic system changed dramatically. This change was particularly devastating for poor families and children. Working conditions were unregulated and often unsafe, leading to tens of thousands of work-related deaths. Millions of children were forced to work long hours in hazardous conditions at low wages because their poor families desperately needed the income to supplement the parents' low wages. Factory owners benefitted from child labor because children were more manageable, cheaper, and less likely to strike. The reality for children was poor health and loss of educational opportunities.

These horrid conditions persisted for decades until progressive 20th Century laws restricted child labor, improved working conditions, and established a minimum wage. These laws significantly reduced fatalities and improved overall health. Families at the lower end of the socio-economic scale benefited the most. Low-income communities saw improvements in life expectancy and lifetime earning capacity.

Even though Minnesotans no longer work in sweatshops or send children into dangerous mines, how we work and what we earn continues to impact our health and that of our communities. Studies show that income is the strongest and most consistent predictor of health and disease. People with higher incomes are healthier and live longer than people with lower incomes. Lower incomes are consistently associated with higher rates of disabilities and chronic physical and mental conditions. Poverty also leads to faster disease progression, more complications, and poorer survival rates. The vast majority of diseases are much more common among the poor and near-poor at all ages. Recent data show Minnesotans making less than $20,000 a year were more than twice as likely to have diabetes compared to those making $75,000 or more a year.

Children are particularly vulnerable to the health impacts of poverty, and the more years a child spends in poverty, the more negative outcomes accrue. Poor children are more likely to experience injuries, violence, inadequate health care, poor nutrition, and insecure housing. These conditions have a powerfully negative affect on health and development. Children from poor families are less likely to live in a neighborhood with healthy food options, safe places to play, good schools, libraries, or other quality public services that help set them on the path to a successful, healthy life.

The relationship between health and income is not just about individual access to medical care, but how income affects a range of opportunities for health. Communities with residents with higher incomes are likely to have better recreational amenities, housing stock, food access, and schools, and tend to be safer – all of which impact health. Income is also associated with other factors that create the opportunity to be healthy, such as employment opportunities, reduced environmental contamination, and greater transportation options.

Health improves with increasing income, and the impacts of a rise in income are greatest for those at the lowest end of the wage scale. Moving from the lowest income level to the next lowest provides the largest percentage increase in life expectancy and health status. In other words, a family living on minimum wage realizes greater health benefits from an increase, in that low salary, than a middle-class family receiving the same raise. Increasing the minimum wage is a sound public health investment for Minnesota. The health of Minnesota’s lowest wage earners will improve along with that of their families and communities.

We all benefit from and have a role in creating healthier communities. It’s time for us to come together to implement a minimum wage that further enhances the health benefits of employment and lifts more than 350,000 Minnesotans out of poverty. As Health Commissioner and a physician, I prescribe an increase in the minimum wage to improve the lives and health of vulnerable Minnesota children and families. It will be a great investment in the health of individuals, families, communities, and our state.


P.S.  Check out our White Paper on Income and Health -

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