Association for Public Policy Analysis & Management

There is a long established link between one’s socioeconomic status and their health status; of greater interest to policymakers is the link between social policy and public health outcomes, particularly how variations in welfare assistance programs lead to divergent public health results. In particular, public health researchers have shown that improvements in the underlying determinants of health such as the provision of appropriate prenatal care in utero are more important in shaping an individual’s health status than particular medical advances in the treatment of disease. There exists a causal link between social generosity and improvements in these health determinants, as demonstrated by the improved birth outcomes of participants in WIC’s prenatal program relative to similar women who were not enrolled. Other social programs, however, which potentially allow poor expectant mothers better pregnancy outcomes, whether that is due to receipt of funds, nutritional assistance or medical care, vary widely by state. Especially in the wake of the 1996 Personal Responsibility and Work Opportunity Reconciliation Act (so-called “welfare reform”), states have gained considerable control over the administration of public assistance. To evaluate the effect these disparities in assistance have on public health outcomes, it is first necessary to measure divergences across states. We have created a “welfare generosity index” which sets out to measure the relative generosity of each state based on their policies for administering four different welfare programs. Because our outcome of interest was pre-term and low-weight births, the programs selected for inclusion were AFDC/TANF, Medicaid, SNAP and UI, which we identified as the programs most associated with assistance during pregnancy which also varied most widely across states and over time. This paper sets out the methodology by which our welfare generosity index was created. We examined the rules laid out in federal and state legislation, looking mainly at eligibility requirements, monetary amounts of benefits, time limits for receipt of benefits, transitional benefits, behavioral requirements of recipients and the sanctions applied in cases where recipients do not adhere to the requirements, among other policy rules. By creating a database of state laws and policies as applied to the administration of these programs, we then assigned relative valuations of generosity and of importance for each policy to both qualifying for assistance and the monetary value of that assistance. As a method, the compiling of varied state policies into one measure for use in further statistical analysis serves as a means of synthesizing more qualitative legal research with the quantitative, evidence-based research valued by policy practitioners. This method has applications not only for public health law but can easily be expanded to any policy-relevant field where policy varies based upon legal distinctions. It is to be hoped that the existence of this type of data, and its availability for policy research, will allow practitioners to better target their policies to achieve their desired outcomes, ultimately making better policy decisions.