WORK AND WELLNESS: PROMOTING PUBLIC HEALTH BY INCENTIVIZING WORK D - PowerPoint PPT Presentation

WORK AND WELLNESS: PROMOTING PUBLIC HEALTH BY INCENTIVIZING WORK D R . S TE V E C O R S I , P S Y . D . D R . R A N D A LL W . W I LLI A M S , M D , FA C O G V A LE R I E H U H N A N A L Y S I S B Y : D A N I E L B O G L E

WORK AND WELLNESS • Une mplo yme nt, in o f itse lf, c a use s ne g a tive physic a l a nd me nta l he a lth e ffe c ts. 1,2 • E mplo yme nt do e s no t inhe re ntly impro ve he a lth, b ut it do e s pre ve nt the ne g a tive he a lth e ffe c ts o f une mplo yme nt. • Re -e mplo yme nt impro ve s individua l he a lth e no ug h to o ffse t the ne g a tive e ffe c ts o f re c e nt une mplo yme nt. • Spe c ific a lly, une mplo yme nt inc re a se s the risk o f 3 : • Ac c ide nts • Suic ide • Alc o ho l-re la te d de a ths • De a ths a sso c ia te d with c a rdio va sc ula r dise a se

WORK AND WELLNESS (CONT) • T he re la tio nship b e twe e n une mplo yme nt a nd he a lth risks is no t so le ly b e c a use pe o ple who a re ill a re o fte n une mplo ye d. • I ndividua ls e xpe rie nc ing jo b -lo ss fo r no n-he a lth re a so ns sho w de c lining physic a l he a lth a nd inc re a se d le ve ls o f de pre ssio n. 4 • A UK study fo und tha t a mo ng une mplo ye d yo ung me n, une mplo yme nt pre c e de d inc re a se s in de pre ssio n a nd a nxie ty e ve n a mo ng tho se who sho we d no pre vio us psyc ho lo g ic a l vulne ra b ility. 5

WORK AND WELLNESS (CONT) • Une mplo yme nt e a rly in life c a n e ndure into la te r a dultho o d. • Yo ung pe o ple who le a ve sc ho o l a t 16 a nd e xpe rie nc e une mplo yme nt displa y po o re r me nta l he a lth a nd hig he r smo king ra te s tha n the ir pe e rs who le ft sc ho o l a t 16 a nd fo und e mplo yme nt, e ve n 14 ye a rs la te r. 6 • Une mplo yme nt a mo ng yo ung pe o ple c a n pre dic t the ir ne e d to ta ke e xte nde d sic k le a ve o r to re c e ive disa b ility a ssista nc e la te r in life . 7 • Me n e xpe rie nc e hig he r le ve ls o f o b e sity, illne ss, a nd mo rta lity la te r in life if une mplo ye d while yo ung . T he sa me e ffe c t wa s no t se e n in wo me n.

WORK AND WELLNESS (CONT) • Une mplo yme nt ne g a tive ly e ffe c ts pe o ple who a re a lre a dy ill. • T he stre ss fro m une mplo yme nt re sults in wo rse he a lth o utc o me s fo r pa tie nts unde rg o ing c a rdia c re ha b ilita tio n. 8 Pe o ple who a lre a dy to o k me dic a tio n fo r psyc ho so ma tic sympto ms inc re a se d the ir pre sc riptio ns a fte r invo lunta ry jo b lo ss. 9 • E mplo yme nt c a n ha ve po sitive implic a tio ns fo r pe o ple who a re a g ing • Me n who wo rk in o c c upa tio ns during a dultho o d tha t a re inte lle c tua lly o r so c ia lly e ng a g ing de mo nstra te hig he r c o g nitive func tio n la te r in life , re g a rdle ss o f pre vio us e duc a tio n o r inte llig e nc e . 10

POLICY GOALS 1. T ra nsitio n individua ls fro m ne e ding we lfa re to o b ta ining e mplo yme nt in b o th the sho rt- a nd lo ng -te rm. 2. I mpro ve the we llb e ing a nd he a lth o f individua ls c urre ntly in ne e d o f we lfa re b y tra nsitio ning the m to e mplo yme nt. 3. Pro vide e xe mptio ns fo r tho se inc a pa b le o f wo rk due to me dic a l fra ilty, a g e , o r o the r sig nific a nt o b sta c le s to wa rds e mplo yme nt. 4. E nsure tha t the a dministra tive a nd b ure a uc ra tic b urde n fo r c o mplia nc e with wo rk re q uire me nts is stra ig htfo rwa rd to a vo id individua ls lo sing b e ne fits due to re d ta pe . 5. Ac c o unt fo r lo c a l so c io e c o no mic fa c to rs tha t ma y pre se nt b a rrie rs to e mplo yme nt suc h a s the urb a n/ rura l divide a nd la b o r ma rke t diffe re nc e s.

HISTORY OF WELFARE REFORM • Pe rso na l Re spo nsib ility a nd Wo rk Oppo rtunity Ac t o f 1996 PWORA re pla c e d AF DC with T ANF , whic h ha s a time limit o f 60 mo nths a nd • re q uire s wo rk a c tivitie s to ma inta in e lig ib ility • I so la ting the c a usa l e ffe c t o f wo rk re q uire me nts o n c a se lo a d is diffic ult, b ut re se a rc h a nd e mplo yme nt tre nds indic a te the y pla y a sig nific a nt ro le . 11 AF DC/ T ANF Re c ipie nts, 1975- 2017 16,000,000 14,000,000 12,000,000 10,000,000 8,000,000 6,000,000 4,000,000 2,000,000 0 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013 2015 2017

HISTORY OF WELFARE REFORM (CONT.) • “L e a ve r studie s” c o nte mpo ra ry with re fo rms: • L e a ve rs w/ HS Diplo ma o r GE D e mplo ye d 78% o f the time , a nd D, 61% o f the time . 12 w/ o diplo ma o r GE • 60% o f le a ve rs who fo und e mplo yme nt fo und full-time jo b s. 13 • E mplo yme nt a nd me a n e a rning s ro se fo r sing le mo the rs b e twe e n 1993 a nd 1999. • Re se a rc h sho ws tha t ma nda to ry wo rk-re la te d a c tivitie s re sulte d in hig he r e mplo yme nt a nd ye a rly e a rning s fo r sing le mo the rs. 14 • Ho we ve r, e vide nc e o f the inc re a se d e a rning s b e ing suffic ie nt e no ug h to ra ise we lfa re re c ipie nts o ut o f po ve rty is mixe d. 15 • Mo st sing le mo the rs c o ntinue d to re c e ive Me dic a id o r o the r fo rms o f pub lic a ssista nc e a fte r finding e mplo yme nt.

HISTORY OF WELFARE REFORM (CONT) • SNAP (fo o d sta mps) ha s re q uire d wo rk a c tivitie s sinc e 1971, b ut PWORA c ha ng e d the se re q uire me nts. • Ab le Bo die d Adults Witho ut De pe nde nts (ABAWDs) must wo rk, unle ss e xe mpt, to re c e ive SNAP fo r lo ng e r tha n thre e mo nths. • Ame ric a ns turne d to SNAP during the re c e ssio n, with a pe a k 51 millio n pa rtic ipa nts in 2013, na tio na lly. • SNAP wo rk ra te s ha ve inc re a se d ste a dily sinc e PWORA. 16 • E spe c ia lly a mo ng ho use ho lds with c hildre n a nd no n-e lde rly, no n-disa b le d a dults. • Ma ny fa milie s using SNAP a re c a pa b le o f wo rk a nd do wo rk. • E ithe r wo rk is inc e ntivize d b y SNAP wo rk re q uire me nts, o r a t minimum the y ha ve mitig a te d disinc e ntive s to wo rk.

OTHER STATES • T hre e sta te s ha ve b e e n a ppro ve d b y US He a lth a nd Huma n Se rvic e s (HHS) to imple me nt wo rk re q uire me nts fo r Me dic a id: • Arka nsa s • I ndia na • Ne w Ha mpshire • K e ntuc ky a lso re c e ive d a ppro va l, b ut it wa s struc k do wn in fe de ra l c o urt. • Rule d the HHS did no t c o nside r ho w it wo uld impa c t the he a lth o f pe o ple who lo st Me dic a id. • Six o the r sta te s ha ve sub mitte d wa ive r a pplic a tio ns b ut ha ve ye t to re c e ive a ppro va l.

MOVING FORWARD IN MISSOURI • T he Ce nte rs fo r Me dic a re & Me dic a id Se rvic e s (CMS) ha s dire c te d tha t Me dic a id wo rk re q uire me nts sho uld ma tc h T ANF a nd SNAP re q uire me nts • Po pula tio ns e xe mpt fro m wo rk re q uire me nts sho uld re ma in e xe mpt (i.e . pe o ple with disa b ilitie s, pre g na nt wo me n, e tc .) • I f so me o ne a lre a dy sa tisfie s wo rk re q uire me nts fo r T ANF o r SNAP the y a uto ma tic a lly sa tisfy Me dic a id re q uire me nts. • Misso uri wo uld like ly utilize the sa me me tho ds a nd re q uire me nts fo r Me dic a id tha t a lre a dy e xist fo r SNAP. • T his sho uld re duc e b ure a uc ra tic duplic a tio n a nd ma ke the po lic ie s e a sie r to c o mply with fo r re c ipie nts.

QUESTIONS?

WORKS CITED (CONT) 1. Wa d d e ll, Go rd o n, a nd A K . Burto n. "Is Wo rk Go o d fo r Yo ur He a lth a nd We ll- Be ing ? ." UK De pa rtme nt fo r Wo rk a nd Pe nsio ns. Ac c e sse d Aug ust, 2018. https:/ / c a rd ina l-ma na g e me nt.c o .uk/ wp-c o nte nt/ uplo a d s/ 2016/ 04/ Burto n- Wa d d e ll-is-wo rk-g o o d -fo r-yo u.pd f. 2. Wa rr, Pe te r, a nd Pa ul Ja c kso n. “F a c to rs Influe nc ing the Psyc ho lo g ic a l Impa c t o f Pro lo ng e d Une mplo yme nt a nd o f Re -E mplo yme nt.” Psyc ho lo g ic al Me dic ine 15, no . 4 (1985): 795–807. d o i:10.1017/ S003329170000502X 3. Ja nle rt, Urb a n. "Une mplo yme nt a s a d ise a se a nd d ise a se s o f the une mplo ye d ." Sc andinavian Jo urnal o f Wo rk, E nviro nme nt, & He alth 23, no . 3 (1997): 79-83. http:/ / www.sjwe h.fi/ sho w_a b stra c t.php? a b stra c t_id =248. 4. Bra nd , Je nnie . "T he F a r-Re a c hing Impa c t o f Jo b L o ss a nd Une mplo yme nt." Annual re vie w o f so c io lo g y 41 (2015): 359-75. Ac c e sse d Aug ust, 2018. https:/ / www.nc b i.nlm.nih.g o v/ pmc / a rtic le s/ PMC4553243/ # R10. 5. Mo ntg o me ry, Sc o tt M., De re k G. Co o k, Me l J. Ba rtle y, a nd Mic ha e l E J. Wa d swo rth. "Une mplo yme nt pre -d a te s sympto ms o f d e pre ssio n a nd a nxie ty re sulting in me d ic a l c o nsulta tio n in yo ung me n." Inte rna tio na l Jo urna l o f E pid e mio lo g y 28, no . 1 (F e b rua ry 1999): 95-100. Ac c e sse d Aug ust, 2018. https:/ / a c a d e mic .o up.c o m/ ije / a rtic le / 28/ 1/ 95/ 777542. 6. Ha mma rströ m, A., a nd U. Ja nle rt. "E a rly Une mplo yme nt Ca n Co ntrib ute to Ad ult He a lth Pro b le ms: Re sults fro m a L o ng itud ina l Stud y o f Sc ho o l L e a ve rs." Jo urnal o f E pide mio lo g y and Co mmunity He alth (1979-) 56, no . 8 (2002): 624-30. http:/ / www.jsto r.o rg / sta b le / 25569782.