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“Addressing food insecurity by improving the financial status of low-income families could be seen as an investment in a healthier, more productive workforce.” - Dr. Ninez Ponce
WHILE THE IMPACT OF POVERTY on nutrition has been widely recognized, there has been far less research on what can be done to address the problem. Seemingly straightforward approaches like raising the minimum wage have been political footballs, with some contending a higher minimum wage lowers the income of poor families through job loss while others say this risk is overstated. Whether raising the minimum wage can serve as a powerful tool for improving nutritional outcomes is among the questions being pursued by several Fielding School research groups.
Using data from the FSPH-based WORLD Policy Analysis Center, a team headed by Dr. Ninez Ponce has found that in low- and middle-income countries, an increase in the inflation-adjusted minimum wage of 20 percent over an average of more than five years led to statistically significant declines, even among the poorest fifth of families, in the probability of two consequences of malnutrition in children under age 5: stunting (impeded growth as measured by height for age) and anthropometric failure, a composite measure that includes stunting, wasting (weight for height) and underweight (weight for age).
“Macroeconomic policies can have major consequences on the wellbeing of families,” says Ponce, professor in FSPH’s Department of Health Policy and Management. “The minimum wage is one policy lever that can help to protect children in the poorest families against malnutrition, which is a factor in approximately 45 percent of child deaths worldwide.”
Focusing on 23 low- and middle-income countries (mostly in South Asia and Africa, which have the highest malnutrition rates), Ponce’s team linked data from the WORLD center on national minimum wages with individual-level data from the U.S. Agency for International Development’s Demographic Health Surveys. The study compares the impact on malnutrition in countries that raised the minimum wage during the period from 2003 to 2012 with the impact over the same period in countries where the minimum wage remained constant.
Arguments for and against increasing the minimum wage typically focus on market consequences, including the potential impact on employment. But Ponce argues that the health effects should also be considered. “Beyond the moral argument, addressing food insecurity by improving the financial status of low-income families could be seen as an investment in a healthier, more productive workforce,” she says.
Minimum wage increases also appear to have beneficial health effects on adults in low-income countries, according to a separate study led by Dr. Annalijn Conklin while she was a postdoctoral fellow at the Fielding School last year. Conklin was joined on the study by Ponce, as well as FSPH Dean Jody Heymann, who also serves as WORLD’s founding director; Dr. Kate Crespi, associate professor in FSPH’s Department of Biostatistics; Dr. Arijit Nandi of McGill University; and Dr. John Frank of the University of Edinburgh, UK.
Taking advantage of the WORLD center’s unique data set, which enables the comparative effects of countries’ minimum-wage policies to be analyzed, Conklin’s group found that a $10-per- month increase was associated with a reduction in underweight among the more than 150,000 women in the 24 low-income countries studied — a benefit that became more pronounced over time. “Our findings suggest that a social protection policy such as higher minimum wage has some impact on health over and above the more standard economic influences that are usually the focus, such as an individual’s income and education,” says Conklin, who has since joined the faculty at the University of British Columbia. “Yes, income and education are strong influences, but what governments do also matters.”
In the U.S., raising the minimum wage has emerged as a major issue in recent years, with many states and cities enacting significant increases. Dr. Frederick Zimmerman, a professor in FSPH’s Department of Health Policy and Management, notes that the issue elicits strong reactions on both sides. “There has been fairly extensive research on the impact of minimum-wage increases on labor markets, which has found that the effects on employment are small enough that it should not be a major concern,” Zimmerman says. “However, most of the increases in the minimum wage that have been studied have been relatively small. In Los Angeles, by contrast, the minimum wage is set to go up by 50 percent over seven years. I am not aware of any study that tests the effects of such a large increase.”
Moreover, Zimmerman says, wages and employment are only part of the puzzle. More important for the plight of low-income households is how the policy affects their overall resources and quality of life. “It could be that the effects of a minimum-wage increase on a household budget are different from what has been studied so far,” Zimmerman explains. “It’s important to test the impact on health behaviors like physical activity and healthy eating, health outcomes, and access to health care.” Zimmerman is now doing just that, in a national study using data from the annual Behavioral Risk Factor Surveillance System survey.
Apart from the effects of wages on nutritional status, Tabashir Nobari (PhD ’16), a research scientist at the Fielding School and a research analyst at the Public Health Foundation Enterprises (PHFE) Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), has found evidence that unaffordable housing exacerbates the problem of childhood obesity — particularly in a city such as Los Angeles, where housing costs are high. Nobari examined data from the 2011 and 2014 Los Angeles County WIC Survey run by PHFE WIC. She found that in families reporting having a “very difficult” time paying for housing, the children had 33 percent greater odds of obesity than children in non-burdened families.
Nobari points to several factors that likely contribute to the increased risk. “Reduced resources left over after paying for housing mean less money for spending on healthy foods and a greater likelihood of relying on processed and energy-dense foods,” she says. “These families are also more likely to be food insecure, and to have stressful home environments for children.” The stress on parents who are worried about being able to pay rent and have a place to live may also affect their interactions with their children, Nobari notes, making them less likely to cook or limit their children’s screen time, both of which can contribute to obesity risk.
“At a minimum, we need to look at interventions that would buffer these effects, such as programs to reduce stress or to increase the amount of supplemental foods WIC provides to families,” Nobari says. “But ultimately, this shows that as part of the fight against childhood obesity, we need more affordable housing for low-income populations.”