Abstract
Study objective: To estimate the relative health effects of the income and health insurance provisions of the Los Angeles City living wage ordinance.
Setting and participants: About 10 000 employees of city contractors are subject to the Los Angeles City living wage ordinance, which establishes an annually adjusted minimum wage ($7.99 per hour in July 2002) and requires employers to contribute $1.25 per hour worked towards employees' health insurance, or, if health insurance is not provided, to add this amount to wages.
Design: As part of a comprehensive health impact assessment (HIA), we used estimates of the effects of health insurance and income on mortality from the published literature to construct a model to estimate and compare potential reductions in mortality attributable to the increases in wage and changes in health insurance status among workers covered by the Los Angeles City living wage ordinance.
Results: The model predicts that the ordinance currently reduces mortality by 1.4 deaths per year per 10 000 workers at a cost of $27.5 million per death prevented. If the ordinance were modified so that all uninsured workers received health insurance, mortality would be reduced by eight deaths per year per 10 000 workers at a cost of $3.4 million per death prevented.
Conclusions: The health insurance provisions of the ordinance have the potential to benefit the health of covered workers far more cost effectively than the wage provisions of the ordinance. This analytical model can be adapted and used in other health impact assessments of related policy actions that might affect either income or access to health insurance in the affected population.
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Selected References
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- Ale B. J., Piers M. The assessment and management of third party risk around a major airport. J Hazard Mater. 2000 Jan 7;71(1-3):1–16. doi: 10.1016/s0304-3894(99)00069-2. [DOI] [PubMed] [Google Scholar]
- Anderson L., Fullilove M., Scrimshaw S., Fielding J., Normand J., Zaza S., Wright-DeAguero L., Higgins D. A framework for evidenced-based reviews of interventions for supportive social environments. Ann N Y Acad Sci. 1999;896:487–489. doi: 10.1111/j.1749-6632.1999.tb08177.x. [DOI] [PubMed] [Google Scholar]
- Backlund E., Sorlie P. D., Johnson N. J. A comparison of the relationships of education and income with mortality: the National Longitudinal Mortality Study. Soc Sci Med. 1999 Nov;49(10):1373–1384. doi: 10.1016/s0277-9536(99)00209-9. [DOI] [PubMed] [Google Scholar]
- Bhatia R., Katz M. Estimation of health benefits from a local living wage ordinance. Am J Public Health. 2001 Sep;91(9):1398–1402. doi: 10.2105/ajph.91.9.1398. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Duncan G. J., Brooks-Gunn J. Family poverty, welfare reform, and child development. Child Dev. 2000 Jan-Feb;71(1):188–196. doi: 10.1111/1467-8624.00133. [DOI] [PubMed] [Google Scholar]
- Ettner S. L. New evidence on the relationship between income and health. J Health Econ. 1996 Feb;15(1):67–85. doi: 10.1016/0167-6296(95)00032-1. [DOI] [PubMed] [Google Scholar]
- Fehr R. Environmental health impact assessment: evaluation of a ten-step model. Epidemiology. 1999 Sep;10(5):618–625. doi: 10.1097/00001648-199909000-00019. [DOI] [PubMed] [Google Scholar]
- Franks P., Clancy C. M., Gold M. R. Health insurance and mortality. Evidence from a national cohort. JAMA. 1993 Aug 11;270(6):737–741. [PubMed] [Google Scholar]
- Hammitt J. K., Belsky E. S., Levy J. I., Graham J. D. Residential building codes, affordability, and health protection: a risk-tradeoff approach. Risk Anal. 1999 Dec;19(6):1037–1058. doi: 10.1023/a:1007070325219. [DOI] [PubMed] [Google Scholar]
- Joffe M., Mindell J. A framework for the evidence base to support Health Impact Assessment. J Epidemiol Community Health. 2002 Feb;56(2):132–138. doi: 10.1136/jech.56.2.132. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kemm J. R. Can health impact assessment fulfil the expectations it raises? Public Health. 2000 Nov;114(6):431–433. [PubMed] [Google Scholar]
- Lantz P. M., House J. S., Lepkowski J. M., Williams D. R., Mero R. P., Chen J. Socioeconomic factors, health behaviors, and mortality: results from a nationally representative prospective study of US adults. JAMA. 1998 Jun 3;279(21):1703–1708. doi: 10.1001/jama.279.21.1703. [DOI] [PubMed] [Google Scholar]
- Mindell J., Hansell A., Morrison D., Douglas M., Joffe M., Quantifiable HIA Discussion Group What do we need for robust, quantitative health impact assessment? J Public Health Med. 2001 Sep;23(3):173–178. doi: 10.1093/pubmed/23.3.173. [DOI] [PubMed] [Google Scholar]
- Nilunger Louise, Diderichsen Finn, Burström Bo, Ostlin Piroska. Using risk analysis in Health Impact Assessment: the impact of different relative risks for men and women in different socio-economic groups. Health Policy. 2004 Feb;67(2):215–224. doi: 10.1016/s0168-8510(03)00122-2. [DOI] [PubMed] [Google Scholar]
- Parry J., Stevens A. Prospective health impact assessment: pitfalls, problems, and possible ways forward. BMJ. 2001 Nov 17;323(7322):1177–1182. doi: 10.1136/bmj.323.7322.1177. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Ponce R. A., Bartell S. M., Wong E. Y., LaFlamme D., Carrington C., Lee R. C., Patrick D. L., Faustman E. M., Bolger M. Use of quality-adjusted life year weights with dose-response models for public health decisions: a case study of the risks and benefits of fish consumption. Risk Anal. 2000 Aug;20(4):529–542. doi: 10.1111/0272-4332.204050. [DOI] [PubMed] [Google Scholar]
- Ratner P. A., Green L. W., Frankish C. J., Chomik T., Larsen C. Setting the stage for health impact assessment. J Public Health Policy. 1997;18(1):67–79. [PubMed] [Google Scholar]
- Ross C. E., Mirowsky J. Does medical insurance contribute to socioeconomic differentials in health? Milbank Q. 2000;78(2):291-321, 151-2. doi: 10.1111/1468-0009.00171. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Sorlie P. D., Johnson N. J., Backlund E., Bradham D. D. Mortality in the uninsured compared with that in persons with public and private health insurance. Arch Intern Med. 1994 Nov 14;154(21):2409–2416. [PubMed] [Google Scholar]
- Williams R. B. Lower socioeconomic status and increased mortality: early childhood roots and the potential for successful interventions. JAMA. 1998 Jun 3;279(21):1745–1746. doi: 10.1001/jama.279.21.1745. [DOI] [PubMed] [Google Scholar]
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