This page is optimized for a taller screen. Please rotate your device or increase the size of your browser window.

Economic Well-Being and Health: The Role of Income Support Programs in Promoting Health and Advancing Health Equity

Diane Paulsell, Abt Global; Daniel M. Finkelstein, Jessica F. Harding, Brittany English, Mathematica; Gina R. Hijjawi, Jennifer Ng’andu, Robert Wood Johnson Foundation


June 27, 2023

Extensive research shows that lower income is associated with worse health. Social safety net programs such as the Earned Income Tax Credit (EITC) and Temporary Assistance for Needy Families (TANF) can improve health outcomes for those with lower incomes by enabling them to meet basic needs and move up the income ladder. But access to these programs isn’t equitable. For example, Black TANF participants are more likely to face financial penalties for rule violations than white participants.

Those are the conclusions of the introductory article in a special issue of Health Affairs focused on equitable access to income supports for families with young children. The issue discusses findings of research funded by the Robert Wood Johnson Foundation’s Equity-Focused Policy Research program. The research explored the causes of families’ inequitable access to income supports and innovative approaches to improving access.

Life expectancy is on the decline in the U.S., so the potential for improving overall health is substantial. The difference in average life expectancy between the top one percent and bottom one percent of the income distribution is 15 years for men and 10 years for women. And health risks decline with every $15,000 in additional income. It’s not just a correlation relationship. Recent experimental studies show measurable health benefits for people who are offered increased tax credits, conditional cash transfers, and the chance to live in a higher-income neighborhood.

Higher incomes play a role in better health in several ways. As the introductory article notes, “People from households with high incomes are more likely to afford materials and services that help them stay healthy, live in communities with healthier environments and fewer exposures that are detrimental to health, experience lower levels of stress, and have better access to health care and preventive services.”

The same dynamic plays out in families that receive the EITC. The article said that research found that “EITC receipt has been associated with reduced maternal smoking, improved self-reported maternal mental health, and improvements in biological markers of stress. For children, family EITC receipt has been associated with reduced incidence of low birthweight and preterm birth, as well as parent-reported health status.”

The article concludes that the relationship between low incomes and health may be responsible in part for the large-scale racial and ethnic inequalities in health. It recommends policy and program changes to improve access to support and reduce inequalities based on race, ethnic group, geographic location, and immigration status. The article states, “Ultimately, sweeping policy changes, such as universal access to health care and needed income support, could also have an important impact on health outcomes.”