Rajiv Bhatia

Rajiv Bhatia, MD, MPH, conducted a health impact assessment of SB 935, which would increase the minimum wage in California periodically over the next three years. Photo by Rajiv Bhatia

In February, U.S. President Barack Obama announced an executive order to raise minimum wage for federal workers from $7.25 per hour to $10.10. While national legislation has yet to pass, 34 states considered increases to their minimum wages in 2014.

According to Rajiv Bhatia, MD, MPH, increases will dramatically bolster the nation’s overall health. In a health impact assessment he led for Human Impact Partners and the California Health Officers Association in California, Bhatia estimated that its minimum wage increase proposed in SB 935 — from $9 per hour to $13 within the next three years — would boost income for 7.5 million lower-income people and prevent at least 389 premature deaths per year. Bhatia spoke with Public Health Newswire about the study and the short- and long-term effects of minimum wage increases, both in California and nationwide.

Hourly minimum wage in California per hour was proposed to increase from $8 to $9 on July 1, and could be increased to $13 by 2017. How would this affect the state’s overall population health?

If the minimum wage were $13 in California today, about 7.5 million lower-income Californians could expect an increase in family income. That figure takes into account not only the boost from higher wages but also reductions in work time and wage-related changes to hiring.

Immediately, families getting higher wages would have more ability to meet their daily needs for food, transportation, child care and housing. With more money, families would be less likely to have to make tradeoffs with their essential needs; for example, going without food in order to pay rent. Higher income would also allow families to purchase healthier but more expensive foods like fruits and vegetables.

Not having enough money to pay bills not only means tradeoffs between essential needs — it is also stressful. In California, adults in families living in poverty are over twice as likely to face serious psychological distress and problems with family life as those in higher-income families. With a higher minimum wage, fewer families would have to make tradeoffs among needs and fewer would suffer the chronic stress of financial strain. Children would benefit both because of the reduced stress and strain in the family and because they would have parents who could work a few less hours.

Raising wages would probably reduce risky health behaviors as well. California families in poverty are 50 percent more likely to be smokers.  We saw similar statistics for other unhealthy behaviors. We know that people under less financial strain are more able to think ahead and address life problems. We expect that increasing wages will reduce smoking and other risky behaviors because more people will have added capacity to follow through on prevention.

Higher wages and higher incomes benefit every social and behavioral factor important to health. These improved health determinants will reduce the avoidable disease and illnesses being treated in hospitals and emergency rooms. We estimated that, in the short term, a $13 minimum wage would prevent at least 389 premature deaths among lower-income Californians each year. Newborns in families whose income increased would be more likely to be born healthier, develop stronger bodies and brains, and suffer from fewer chronic diseases as adults.

Your research touched on topics not often associated with income, such as physical fitness and caregiver-to-child reading. What was the most surprising data that you came across in this health impact assessment?

We actually found a few things that we did not expect. From previous studies on child development and education, we already knew that income has powerful effects on child well-being lasting into adolescence and adulthood. The California research confirmed this, but the results on more traditional factors like healthy eating and active living were mixed.

For children in California, while physical activity increased with higher family income, fruit and vegetable consumption decreased. We feel that the lower physical activity might be explained by differences in parks and safety in lower-income neighborhoods. The better diets might be explained by cultural traits or by access to supplemental nutrition programs such as the Special Supplemental Nutrition Program for Women, Infants and Children.

We were struck by the size of the difference in people’s perceptions of their own health, which is a powerful predictor of many health outcomes. In our study, people who self-rated their health as fair or poor dropped from 35 percent to 5 from the lowest- to highest-income groups in our study.

We were intrigued by, but did not report, impacts of the minimum wage on eligibility for subsidized health insurance. Changes in the minimum wage would have led about 600,000 working-aged people to lose Medicaid eligibility and gain eligibility for subsidies in the state health exchanges. This probably would not change health status significantly but would result in significant state cost savings and have impacts on the delivery systems. This issue should be studied more.

Now that we have this study, what is the role of the public health community — including APHA — in helping raise minimum wage nationally?

Most of the facts are not new. As a community or interest group, public health has not been active in economic and employment policy — even though I think most public health professionals would agree that there is no single factor more harmful to health than persistent poverty.

I hope this study brings attention to the fact that public health has valuable information to contribute to economic policy.

In 2014, at least 34 states proposed increases to the state minimum wage. Connecticut, Delaware, Hawaii, Maryland, Michigan, Minnesota, West Virginia and Washington, D.C., have enacted increases. Labor, business, faith and many other groups are making their interests and positions known to policymakers, public health should too. It may not be possible for a public health agency to take a position but individuals and non-governmental organizations should be able to get their voices heard.

Public health professionals are often leaders in their communities and their voices tend to be respected. The public health voice may be what tips the outcome to a successful one.

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