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Income and health resources

Background

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, zreat@healthpolicyohio.org.

This page was last updated on 02/02/2018.

Income basics

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.

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.

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 basics

Read moreOhio ranked 43 out of 50 states and the District of Columbia on population health outcomes in HPIO’s 2017 Health Value Dashboard. This means that Ohioans are living less healthy lives than people in most other states. Below are links to websites, reports and data sources with more information about health in the U.S. and Ohio.

Health in the United States

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 connected

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.

Specific areas of consideration for policymakers

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.

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.

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.

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.

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.

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.

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.

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.

Evidence-based policies and programs to improve health through increased income

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

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 employment

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