Professor Vincent Hildebrand publishes four new articles in BMC public health, Journal of Epidemiology and Community Health Energy Policy, Annals of Epidemiology and Canadian Public Policy
Faraz Vahid Shahidi, Odmaa Sod-Erdene, Chantel Ramraj, Vincent Hildebrand, Arjumand Siddiqi (2019),”The impact of social assistance programs on population health: a systematic review of research in high-income countries.” BMC Public Health, Publisher’s Site
Socioeconomic disadvantage is a fundamental cause of morbidity and mortality. One of the most important ways that governments buffer the adverse consequences of socioeconomic disadvantage is through the provision of social assistance. We conducted a systematic review of research examining the health impact of social assistance programs in high-income countries.
We systematically searched Embase, Medline, ProQuest, Scopus, and Web of Science from inception to December 2017 for peer-reviewed studies published in English-language journals. We identified empirical patterns through a qualitative synthesis of the evidence. We also evaluated the empirical rigour of the selected literature.
Seventeen studies met our inclusion criteria. Thirteen descriptive studies rated as weak (n = 7), moderate (n = 4), and strong (n = 2) found that social assistance is associated with adverse health outcomes and that social assistance recipients exhibit worse health outcomes relative to non-recipients. Four experimental and quasi-experimental studies, all rated as strong (n = 4), found that efforts to limit the receipt of social assistance or reduce its generosity (also known as welfare reform) were associated with adverse health trends.
Evidence from the existing literature suggests that social assistance programs in high-income countries are failing to maintain the health of socioeconomically disadvantaged populations. These findings may in part reflect the influence of residual confounding due to unobserved characteristics that distinguish recipients from non-recipients. They may also indicate that the scope and generosity of existing programs are insufficient to offset the negative health consequences of severe socioeconomic disadvantage.
2. Faraz Vahid Shahidi, Odmaa Sod-Erdene, Chantel Ramraj, Vincent Hildebrand, Arjumand Siddiqi (2018), “Government social assistance programmes are failing to protect the health of low-income populations: evidence from the USA and Canada (2003–2014).” Journal of Epidemiology and Community Health, Publisher’s Site
Background Social policies that improve the availability and distribution of key socioeconomic resources such as income, wealth and employment are believed to present the most promising avenue for reducing health inequalities. The present study aims to estimate the effect of social assistance recipiency on the health of low-income earners in the USA and Canada.
Methods Drawing on nationally representative survey data (National Health Interview Survey and the Canadian Community Health Survey), we employed propensity score matching to match recipients of social assistance to comparable sets of non-recipient ‘controls’. Using a variety of matching algorithms, we estimated the treatment effect of social assistance recipiency on self-rated health, chronic conditions, hypertension, obesity, smoking, binge drinking and physical inactivity.
Results After accounting for underlying differences in the demographic and socioeconomic characteristics of recipients and non-recipients, we found that social assistance recipiency was associated with worse health status or, at best, the absence of a clear health advantage. This finding was consistent across several different matching strategies and a diverse range of health outcomes.
3. Arjumand Siddiqi, Faraz Vahid Shahidi, Vincent Hildebrand, Anthony Hong, Sanjay Basu (2018), Illustrating a ‘Consequential’ Shift in the Study of Health Inequalities: A Decomposition of Racial Differences in the Distribution of Body Mass, Annals of Epidemiology. 28(4) , 236-241. Publisher’s Site
We present a conceptual introduction to “distributional inequalities”—differences in distributions of risk factors or other outcomes between social groups—as a consequential shift for research on health inequalities. We also review a companion analytical methodology, “distributional decomposition”, which can assess the population characteristics that explain distributional inequalities.
Using the 1999–2012 U.S. National Health and Nutrition Examination Survey, we apply statistical decomposition to (a) document gender-specific, black-white inequalities in the distribution of body mass index (BMI) and, (b) assess the extent to which demographic (age), socioeconomic (family income, education), and behavioral predictors (caloric intake, physical activity, smoking, alcohol consumption) are associated with broader distributional inequalities in BMI.
Black people demonstrate favorable or no different caloric intake, smoking, or alcohol consumption than whites, but worse levels of physical activity. Racial inequalities extend beyond the obesity threshold to the broader BMI distribution. Demographic, socioeconomic, and behavioral characteristics jointly explain more of the distributional inequality among men than women.
Black-white distributional inequalities are present both among men and women, although the mechanisms may differ by gender. The notion of “distributional inequalities” offers an additional purchase for studying social inequalities in health.
4.Can Erutku and Vincent Hildebrand (2018), “Carbon Tax at the Pump in British Columbia and Quebec”, Canadian Public Policy. 44(2), 126-133. Publisher’s Site
British Columbia and Quebec introduced a carbon tax on the sale of retail gasoline in July 2008 and October 2007, respectively. Our findings suggest that the BC carbon tax had a short-term negative effect on gasoline consumption per capita and led to an amplified behavioural response, but only initially. This amplified response might have been the consequence of a constant carbon tax after July 2012. In comparison, we find weak evidence that the QC carbon tax had a negative effect on gasoline consumption per capita and created an amplified behavioural response. Moreover, these impacts appeared only years after the introduction of the QC carbon tax. This delay might be explained by the increase in carbon cost incurred by QC fossil fuel distributors after their participation in the Western Climate Initiative Regional Carbon Market, which started in January 2015. We believe, however, that more research is necessary to reach more definitive conclusions about the effect of carbon taxes on gasoline consumption.