More than a century of research has found strong connections between income and health. As a group, people with higher incomes live longer lives and experience better physical and mental health outcomes. Understanding how income influences health can inform policies, programs and resource allocation to improve the health and economic wellbeing of Ohioans.
In 2017, HPIO hosted an educational forum, Linking Health and Wealth: How Economic Vitality Can Lead to Healthier Ohioans, and released a policy brief on the topic, Connections between Income and Health.
This page provides links to resources that were referenced during the forum and in the brief, as well as additional data and information on income and health. If there is a resource you believe would be a useful addition to this page, please e-mail Zach Reat, email@example.com.
This page was last updated on 02/02/2018.
Income basicsRead more
In HPIO’s 2017 Health Value Dashboard, Ohio ranked 29 out of 50 states and the District of Columbia on metrics related to the social and economic environment, including unemployment, poverty, labor force participation and income inequality. Below are links to state and national resources with information about income and related factors.
Income in the U.S.
The agencies and websites listed below are resources for information about income in the U.S. In some cases, data is also available at state and local levels and may be disaggregated by race/ethnicity, gender, age or other factors.
- U.S. Census Bureau
- American Community Survey, American FactFinder
- Current Population Survey
- U.S. Department of Labor, Bureau of Labor Statistics
- Internal Revenue Service
Income in Ohio
The websites and reports listed below include information about income in Ohio. Some of the resources disaggregate information by race/ethnicity, gender, age and other factors.
- Ohio Labor Market Information: This website, maintained by the Ohio Department of Job and Family Services, publishes data about the labor market in Ohio, including monthly unemployment numbers.
- Ohio Kids Count Data Books: The Children’s Defense Fund publishes Kids Count data books for the U.S. and each state. The report includes data about child outcomes on metrics, related to health and social and economic factors.
- The Ohio Poverty Report: February 2017: This annual report published by the Ohio Development Services Agency provides up-to-date information about poverty in Ohio, including information about the individuals and households living in poverty in Ohio.
- 2016 State of Poverty: A Portrait of Ohio Families: This report from the Ohio Association of Community Action Agencies provides up-to-date information about poverty in Ohio.
Income-related state agencies
Specific offices within the agencies listed below are responsible for developing and administering policies and programs that can impact the incomes of Ohioans.
- Ohio Development Services Agency
- Ohio Department of Job and Family Services
- Ohio Department of Taxation
- Ohio Department of Commerce
- Governor’s Office of Workforce Transformation
- OhioMeansJobs.com: OhioMeansJob.com is a website with resources for jobseekers in Ohio, including skills assessments, information about in-demand careers, connections to training opportunities, and job postings.
Glossary of income-related terms
- Assets: Anything that holds economic value (including cash, bank accounts, investments, property and other material items). Assets that can be quickly turned into cash are considered to be liquid. Non-liquid assets, such as a home or car, may take weeks or months to convert to cash.
- Debt: Money owed by an individual or household to another entity or individual.
- Economic self-sufficiency: The ability to meet basic needs such as housing, food, transportation and medical needs without subsidies or other assistance from government programs directed to people with low incomes.
- Income: The total amount of money earned or received by an individual or household during a set time period. Income typically includes wages from employment and other sources, such as interest and capital gains. Some methods of counting income also include payments from programs, including food assistance and social security.
- Economic mobility: The ability of individuals and households to move up or down the economic ladder within a lifetime and across generations.
- Income inequality: A measure of the gap between high and low incomes in a given area.
- Wealth: The total value of an individual’s or household’s assets, minus debts and any other liabilities.
Health basicsRead more
Health in the United States
- U.S. Health in International Perspective: Shorter Lives, Poorer Health: This report explores why people living in the U.S. have shorter life expectancies and poorer health throughout the life course than residents of other high-income, democratic countries.
- From Vision to Action: A Framework and Measures to Mobilize a Culture of Health: This report by the Robert Wood Johnson Foundation provides a comprehensive picture of the factors that impact health. It encourages a broader understanding of health than solely what happens in a healthcare setting and outlines a plan for creating a culture of health, which aims to optimize health, wellbeing and equity among Americans.
Health status of Ohioans
- Ohio’s 2016 State Health Assessment (SHA): HPIO conducted the 2016 SHA under a contract with the Ohio Department of Health and leadership of the Governor’s Office of Health Transformation. The SHA is a comprehensive and actionable picture of health and wellbeing in Ohio, including over 140 metrics organized into data profiles, as well as information gathered through five regional forums, a review of local health department and hospital assessments and plans and key informant interviews.
- Ohio’s 2017-2019 State Health Improvement Plan (SHIP): Released by the Governor’s Office of Health Transformation and the Ohio Department of Health in February 2017, the SHIP is a strategic menu of priorities, outcome objectives and evidence-based strategies designed to address three of Ohio’s greatest health challenges: mental health and addiction, chronic disease and maternal and infant health. The SHIP was developed based upon findings from the 2016 SHA.
- HPIO’s 2017 Health Value Dashboard: The 2014 Health Value Dashboard was a first-of-its-kind combined state ranking of health outcomes and healthcare spending. This second iteration of the Dashboard shows that Ohioans are living less healthy lives and spending more on health care than people in most other states.
Health-related state agencies
How income and health are connectedRead more
Researchers have identified three primary ways in which income and health are connected:
- Higher income contributes to better health
- Better health supports higher income-earning potential
- Other factors, including toxic stress, racism, education, housing and neighborhood conditions can influence health and income
Overviews of the connections between income and health
The resources below provide an overview of the connections between income and health.
- Connections between Income and Health, Health Policy Institute of Ohio, 2017.
- The Health and Wealth Connection: Opportunities for Investment across the Course of Life, Asset Funders Network, 2017.
- How are Income and Wealth Linked to Health and Longevity?, Urban Institute, 2015.
- The Poor Pay More – Poverty’s High Cost to Health, Kaplan, George A., 2009.
Specific areas of consideration for policymakersRead more
Income and health behaviors
Individual health behaviors reflect personal choice, but research shows that social and environmental factors also have a strong influence on health behaviors.
- Socioeconomic Status, Neighborhood Disadvantage and Poverty-Related Stress: Prospective Effects of Psychological Syndromes among Diverse Low-Income Families: This study examined the connections between poverty-related stress and psychological problems using a cohort of families with low incomes from Denver, Colorado. The study found that poverty-related stress is associated with psychological problems, including anxious/depressed symptoms and social problems. (Requires access)
- Does Social Class Predict Diet Quality?: This review of research literature about the connections between socioeconomic status and diet quality explores the mechanisms through which income, education and social status affect diet quality.
- The Grocery Gap: Who Has Access to Healthy Food and Why It Matters: This report reviews existing evidence about the prevalence of food deserts and the impact of food deserts on community wellbeing. The report also reviews evidence of effective policy interventions.
- The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General, 2014: This report provides an overview of the harmful effects of smoking on individuals and communities. It also includes information on evidence-based strategies that have reduced the prevalence of tobacco use over the past 50 years.
- Monograph 22: A Socioecological Approach to Addressing Tobacco-Related Health Disparities: This monograph from the National Institutes of Health National Cancer Institute examines tobacco-related health disparities with particular attention to implications for future research and interventions to reduce disparities. The monograph emphasizes the need for ensuring equitable access to advances in tobacco-related control and prevention.
- Tobacco Outlet Density and Demographics: Analyzing the Relationships with a Spatial Regression Approach: This study assesses associations between tobacco outlet density and three demographic characteristics—income, race and ethnicity—at the census tract-level in New Jersey. (Requires access)
- Tobacco Industry Marketing to Low Socioeconomic Status Women in the USA: This journal article describes the marketing strategies used to market tobacco products to women with low socioeconomic status in the past four decades. (Requires access)
Income and access to health care
Income influences access to health care through several factors, including access to high-quality healthcare services and affordable health insurance coverage.
- Key Facts About the Uninsured Population: This fact sheet published by the Kaiser Family Foundation shares information about the uninsured population in the U.S., including decreases in the size of the population since implementation of the Affordable Care Act. The fact sheet also summarizes the implications of being uninsured on access to health care and personal finances.
Income and stress in the workplace
Jobs that pay a living wage, offer flexibility to address life’s challenges and give employees a sense of control over their work promote better mental and physical health.
- Issue Brief #3 – Exploring the Social Determinants of Health: Stress and Health: This issue brief is the third in a series of twelve briefs released by the Robert Wood Johnson Foundation about the social determinants of health. It provides an overview of the links between stress and health, as well as an explanation of the effect of socioeconomic status on how people experience and cope with stress.
- The Influence of Income on Health: Views from an Epidemiologist: This article explores two pathways through which income influences health. The first pathway is direct, through material deprivation experienced by people with very low incomes. The second pathway is less direct and considers the opportunities for social participation and the ability to control life circumstances that increase along with household incomes.
- Effects of Psychosocial Characteristics of Work on Pregnancy Outcomes: A Critical Review: This literature review examines studies that looked for an association between work activities and birth outcomes.
- Irregular Work Scheduling and its Consequences: This report uses data from the General Social Survey to describe the prevalence of irregular scheduling in the U.S. workforce, characteristics of jobs and employers that use irregular scheduling and the impacts of irregular schedules on stress and other related outcomes.
Health and absenteeism
Health-related absenteeism impacts income by reducing productivity and making it more difficult to pursue advancement opportunities such as education, training or job promotion.
- Economic Status and Health in Childhood: The Origins of the Gradient: This article explores the influence of a child’s health on future earnings, as well as the potential for a parent’s low income to impact the health of a child.
- Healthy Bodies and Thick Wallets: The Dual Relation between Health and Economic Status: This report discusses pathways through which income can impact health, as well as the impact of health on savings and the accumulation of wealth throughout the life course.
- Paid Sick Leave and Job Stability: This article tests the argument that workers with paid sick leave can deal with life challenges without risking temporary or permanent job loss.
- Multiple Chronic Conditions and Labor Force Outcomes: A Population Study of U.S. Adults: This research examines the relationship between having multiple chronic conditions and labor force outcomes, including the probability of being employed and the number of work days missed.
Health and disability
Temporary or permanent disabilities can impact income for working-age adults through job loss, reduction of hours, changing work duties and/or limiting access to opportunities for advancement.
- Half in Ten: Why Taking Disability into Account is Essential to Reducing Income Poverty and Expanding Economic Inclusion: This report outlines the connections between income, poverty and disability and argues that policymakers should elevate the needs of people living with disabilities in anti-poverty initiatives.
- The Double Burden: Health Disparities among People of Color Living with Disabilities: This article describes the double burden on health faced by people living with a disability who are also members of a racial or ethnic minority group. The article argues for better data collection to support research on the compounding nature of health disparities for people who are members of more than one at-risk group.
- Disability and Income: This research analyzed data from the Rehabilitation Services Administration to determine the impact of vocational rehabilitation services on the incomes of people living with disabilities. (Requires access)
Income, health and racism
Institutional, structural and interpersonal racism can influence both health and income. For example, residential segregation is shown to increase risk for poor birth outcomes, and discrimination in the workplace contributes to persistent wage and employment disparities experienced by minority groups.
- Inequality in Quality: Addressing Socioeconomic, Racial and Ethnic Disparities in Health Care: This article reviews literature on socioeconomic and racial/ethnic disparities in health care quality and proposes five principles for modifying quality performance measures to improve outcomes of health disparity reduction initiatives. (Requires access)
- The Economics of Racism: This article examines racism and its impact on the functioning of markets as well as the participation of certain consumers in markets. (Requires access)
- Race, Socioeconomic Status and Health: The Added Effects of Racism and Discrimination: This article provides an overview of health disparities by socioeconomic status and race/ethnicity. The authors conclude that racism (individual and institutional) is an added burden on the health of minority populations.
- Racism and Health I: Pathways and Scientific Evidence: This article reviews scientific evidence that supports three pathways by which racism negatively impacts the health of nondominant populations.
- Black-White Wage Gaps Expand with Rising Wage Inequality: This article examines how black-white wage disparities changed between1979 and 2014.
Income, health and housing and neighborhood conditions
Housing and neighborhood conditions impact health and income in numerous ways, including exposure to dangerous materials such as lead, exposure to violent crime and restricted access to quality education and employment opportunities.
- Housing Affordability and Health among Homeowners and Renters: This research used a quasi-experimental design to examine the association between housing affordability and health. The study finds that unaffordable housing is associated with trade-offs that can negatively affect health.
- U.S. Concentrated Poverty in the Wake of the Great Recession: This report documents the concentration of poverty into certain neighborhoods in the years following the Great Recession. The report also highlights the negative effects of concentrated poverty on the health of neighborhoods and their residents.
- Neighborhood Effects on Health: Exploring the Links and Assessing the Evidence: This article reviews research that has found connections between neighborhood and health outcomes. The authors discuss the pathways by which neighborhood can effect health and methodological challenges of assessing neighborhood effects on health. (Requires access)
- The Impacts of Neighborhoods on Intergenerational Mobility: Childhood Exposure Effects and County-Level Estimates: This large-scale study examined the impact of where a child grows up on his or her ability to improve economic outcomes across generations. The study finds that “low-income children are more likely to succeed in counties with less concentrated poverty, less income inequality, better schools, a larger share of two-parent families and lower crime rates.”
- The Effects of the 1930s Home Owner’s Loan Corporation (HOLC) “Redlining” Maps: This working paper examines the impact of HOLC “redlining” maps created in the 1930s on the formation of segregated neighborhoods in subsequent decades. Segregation peaked in the 1970s, and there is evidence that redlining maps had a long-term impact on home ownership, house values and access to credit in areas designated by the maps.
Income, health and education
Higher educational attainment is associated with higher income-earning potential and better health. In addition to the health benefits of higher income, higher educational attainment equips people with skills to more effectively navigate the healthcare system, communicate with providers and manage complex and/or chronic conditions.
- HPIO is publishing a series of briefs about the connections between education and health. The first publication, Connections between Education and Health, was released in January 2017, the second publication, Connections between Education and Health No. 2: Health Services in Schools, was released in July, and the third, Connections between Education and Health No. 3: The Importance of Early Learning, was released in October. The fourth and final publication in this series will be released in 2018.
- Multi-Generational Income Disadvantage and the Educational Attainment of Young Adults: This research examines the relationship between multi-generational income disadvantage and the educational attainment of young adults.
- Help Wanted: Projections of Jobs and Education Requirements Through 2018: This report provides a comprehensive analysis of changes to the U.S. job market in the wake of the Great Recession and the impact on educational requirements for jobs moving forward. The report concludes that increased postsecondary education and training will be required to meet the demands of the job market.
- A Stronger Nation: Learning beyond high school builds American talent: This report and accompanying website tracks progress toward achieving a goal of 60 percent of Americans holding a degree, certificate or other high-quality postsecondary credential by 2025.
Income, health and toxic and persistent stress
Long-term exposure to stress can negatively affect health and potentially lead to unhealthy coping mechanisms, such as smoking and excessive drinking.
- Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults (The Adverse Childhood Experiences study): This study examines the connections between certain Adverse Childhood Experiences (ACEs) and leading causes of death among adults. The study “found a strong graded relationship between the breadth of exposure to abuse or household dysfunction during childhood and multiple risk factors for several of the leading causes of death in adults.”
Evidence-based policies and programs to improve health through increased incomeRead more
Policies and programs to increase incomes typically involve taxes, employment training/retraining or other supports such as food assistance or child care assistance. The evidence inventory below was developed for the Ohio Legislative Service Commission and included in the report, A New Approach to Reduce Infant Mortality and Achieve Equity: Policy Recommendations to Improve Housing, Transportation, Education and Employment. This report focused primarily on women of childbearing age, but the evidence inventory below includes policies and programs that impact incomes throughout the life course.
Program implementation in Ohio
Three evidenced-based programs—tax credits, work supports and employment training and/or workforce development programs—were highlighted in the Connections between Income and Health brief. Information about these programs and how they are implemented in Ohio is provided below.
Tax credits reduce the amount of taxes households are required to pay. Refundable tax credits provide additional income for households that do not owe any income tax. Eligibility for refundable tax credits is typically limited to households with low incomes. An example of a refundable tax credit is the federal Earned Income Tax Credit (EITC).
Most tax credits and deductions are designed to promote economic activity, such as work and home ownership, and there is evidence that they are effective. For example, recent research found that the EITC and Child Tax Credit reduce poverty and encourage work among recipients. Research also shows that increases in the EITC may be related to improvements in health outcomes, including reduced pre-term birth and low birth weight.
Ohio allows tax filers with low incomes to claim a portion of the federal EITC on their state return. In tax year 2016, the Ohio EITC was non-refundable and capped for filers with incomes above $20,000.
Incorporating Economic Policy Into A ‘Health-In-All-Policies’ Agenda (requires access) compares population health outcomes in states to determine if certain economic policies are associated with better health outcomes. The study described in the article found better health outcomes in states with policies that increase the incomes of low-income families, such as higher tax credits, higher minimum wages or the absence of a right-to-work law. The study’s findings are summarized in this blog post.
Work support programs
Government programs for households with very low incomes, including Special Supplemental Nutrition Program for Women, Infants and Children (WIC), Medicaid, Temporary Assistance for Needy Families (TANF) and Supplemental Security Income (SSI), provide cash or in-kind support to households with qualifying incomes. For example, WIC provides vouchers to purchase healthy foods for pregnant women and young children with incomes below 185 percent of the Federal Poverty Level (FPL).
The structure of some programs for people with very low incomes can be a barrier to achieving economic self-sufficiency. Most social safety net programs reduce benefits for recipients as earned income increases. This can create an economic disincentive to accepting a small raise or working more hours because the increase in earned income is at least partially offset by a decrease in benefits. This is referred to as a “benefit cliff.”
Workforce development: Ohio’s Combined State Plan
The federal government and states fund several programs to connect job seekers with the basic skills, training and supportive services they need to participate in the workforce. The federal Workforce Innovation and Opportunity Act (WIOA), signed into law in 2014, required states to submit a four-year workforce development strategy. Ohio’s Combined State Plan coordinates services for job seekers provided through the funding sources and programs listed below:
- Title I of WIOA, which funds county OhioMeansJobs Centers and job training and job search assistance programs for adults, dislocated workers and low-income youth
- The Wagner-Peyser Act Program, which funds a variety of employment services to connect job seekers and employers
- Adult Basic and Literacy Education, which funds GED preparation, adult math, reading and literacy courses
- The Vocational Rehabilitation Program through Opportunities for Ohioans with Disabilities, which supports vocational rehabilitation programs for individuals with disabilities
Ohio has chosen three additional programs to include in the state’s combined plan including:
- Carl D. Perkins Career and Technical Education, which provides funding for career-technical training for secondary and post-secondary students
- Senior Community Service Employment Program, which is a community service and work-based job training program for older Ohioans
- Jobs for Veterans State Grants Programs, which helps veterans find jobs through employment services at local OhioMeansJobs Centers
Credible sources of evidence for what works to increase income and employmentRead more
The following sources are highlighted in the HPIO publication, Navigating Sources of Evidence: A Guide to Effective Prevention Strategies
- What Works for Health: Click on “Employment” or “Income”
- Hi-5 (Health Impact in 5 Years): CDC recommendations for non-clinical interventions that have evidence reporting: 1) positive health impacts, 2) results within five years, and 3) cost effectiveness and/or cost savings over the lifetime of the population or earlier
- The Campbell Collaboration Library of Systematic Reviews: Use advanced search feature to select “Social Welfare”
- What Works Clearinghouse: Evidence registry from the Institute for Education Sciences, U.S. Department of Education (includes early childhood through post-secondary education)
- Top Tier Evidence: Systematic reviews on early childhood, education, employment/training, housing/homelessness and other topics
- Results First Clearinghouse Database: Clearinghouse that aggregates and rates evidence of effectiveness from several other registries. Topics include child welfare, social policy, criminal justice and education