Years ago, I started my career interested in how we could decrease poverty in our country. I wrote an esoteric doctoral dissertation on a seemingly impossible idea of subsidizing wages for low-income workers (to my surprise, others made this idea work in the form of our nation's incredibly important Earned Income Tax Credit Program).
Over time, I drifted to spending more and more time trying to figure out how to improve the health of low-income New Yorkers and the most vulnerable among our neighbors. What I have learned over the years is that poverty and health challenges are intrinsically intertwined: each causes the other.
So, there are few days better than today for me! We New Yorkers are making an enormous stride to address the low wage crisis in our State by mandating a $15 minimum wage for fast food workers. This policy, of course, addresses the poverty challenge. But I would argue that it is also the most important public health advance of the year.
A firm body of research has established family income as one of the strongest and most far-reaching determinants of health and life expectancy. For instance, we know that the poorest Americans live an average of 4-5 years less than those earning the average wage.
This is not insignificant! The 180,000 fast-food workers in New York who get raises to $15 per hour--a 70% increase in income that places them right at the average per capita income for New York State--have just earned the possibility of living five extra years of life.
No matter how much more money we spend on our health care system, it would not come close to producing such substantial gains in life expectancy. New Yorkers--and really all Americans!--seem to have blind faith in the power of medical care, but income is a much more important driver of health.
This takes me to a recent grievance I have about how we prioritize health resources in our State. Just recently, New York State officials were able to quickly (and magically) come up with $1 billion to support private hospitals participating in the State's Medicaid Waiver program.
While I am intrigued by magic and pleased that our hospitals will not be hurt by a shortfall of resources, I found it somewhat troubling when rumors started emerging that our State government may need to cut $10 million in support for population health improvement projects--long promised--to community-based organizations across the State. What concerns me is that we somehow found a billion dollars to make up for a shortfall in expectations about resources for medical care, but I am not confident it will happen for prevention initiatives.
I open my newsfeeds every day waiting for a magical fix to emerge again so that we can get the dollars needed for investments that really would improve the health of New Yorkers. The magic has not happened yet, even though the prevention investments probably would outperform further investments in medical care on the margin.
Our health care system matters; of course we want it to be as robust and as functional as it can be. But the focus of our investments and the energy we spend identifying funds for more health care compared to more prevention are out of balance.
Today was an important step in the right direction for improving New Yorkers' health by making a policy change--one that might not seem like a health policy, but in fact is. I hope we can find more and more ways to make pro-health investments improving the odds that all New Yorkers live long and healthy lives.
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