Women's health suffers under welfare reform

Women who are current and former welfare recipients suffer a whole host of health problems - and getting a job doesn't always help matters.

"Everyone says welfare reform is working because welfare rolls are dropping and this reverses a decades-long trend," said George Kaplan, professor of epidemiology at the University of Michigan School of Public Health. "But there has been virtually no attempt to ask what effect these changes would have on the health of the affected people."

Kaplan is lead author of an article in the July issue of the American Journal of Public Health.

The study looked at data from 1996 to 2000 when welfare reform cut welfare caseloads in half.

Comparing data from the Women's Employment Study, a random sample of single mothers receiving cash benefits in an urban county in Michigan, to women of the same age and race who participated in the National Health and Nutrition Examination Survey, University of Michigan researchers found the welfare recipients:

• 2.4 times more likely to have hypertension
• 1.8 times more likely to be obese
• Nearly five times as likely to have elevated levels of a marker related to diabetes, HbA1c

In addition, the women are almost three times as likely to describe their health as "poor" or "fair" than the NHANES women. Despite some improvement in the Women's Employment Study group over time, there was a 36 percent increase in the percentage of respondents who reported poor or fair health from 1996 to 2000.

Kaplan said the findings are not surprising given the many challenges poor women face. Though the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 led to a dramatic increase in the number of poor women who are working, many have low-skill jobs with constantly changing work schedules, struggle with child care and transportation, and have few or no benefits from their employers.

Kaplan emphasized that all of these findings are from data that ends in 2000, while the economy was still relatively strong. Since then, more women have hit their lifetime limits on receiving welfare benefits and economic conditions have declined.

"It might be that things are getting even worse for women," Kaplan said.

Kaplan said as lawmakers consider additional welfare reforms, he would like to see them evaluate potential fallout from their decisions and look for ways to minimize ill effects to benefit recipients.

"Social and economic policies are health policy," Kaplan said. "When governments or other agencies make decisions that are going to have an impact on people's lives, they need to understand the impact that could have on their health."

A lack of health care affects everyone, he said. "Somebody's going to pay for the poor health of these people, whether that's through our health care system or lost productivity on the job or other ways."

Kaplan collaborated on the paper with Kristine Siefert, Nalini Ranjit, Trivellore E. Raghunathan, Elizabeth A. Young, Diem Tran, Sandra Danziger, Susan Hudson, John W. Lynch and Richard Tolman.