Assessing the policy and practice impact of an international policy initiative: the State of the World's Midwifery 2014.

BACKGROUND: Understanding how policies lead to changes in health systems and in practice helps policymakers and researchers to intervene more successfully. Yet identifying all the possible changes that occur as a result of a new policy is challenging not only methodologically and logistically, as limited resources are available to conduct indefinite evaluations, but also theoretically, as a complete mapping and attribution of post-hoc changes requires a full understanding of the mechanisms underpinning all change. One option is to identify possible changes across a number of policy impact domains. METHODS: Using a Policy Impact Framework, we brought together data from media, documents and interviews to identify changes to midwifery policy, practice and provision, following the launch of a new global policy initiative, the State of the World's Midwifery (SoWMy 2014) report published in 2014. We used these identified impacts to develop a map of the mechanisms underpinning these changes. RESULTS: SoWMy 2014 contributed to a number of changes at national levels, including increased status of midwifery within national governments, improved curricula and training opportunities for midwives, and improved provision of and access to midwifery-led care. These contributions were attributed to SoWMy 2014 via mechanisms such as stakeholder interaction and acquisition of government support, holding national and international dissemination and training events, and a perceived global momentum around supporting midwifery provision. Policy initiatives of this kind can lead to changes in national and international policy dialogue and practice. We identify factors and mechanisms that are likely to increase the scope and scale of these changes, at contextual, national and global levels. CONCLUSIONS: Identifying changes following a policy using a policy impact framework can help researchers and policymakers understand why policies have the effect they do. This is important information for those wishing to increase the effectiveness of future policies and interventions

The role of poverty and racial discrimination in exacerbating the health consequences of COVID-19

There were more than 800,000 confirmed coronavirus disease 2019 (COVID-19) deaths in the United States (U.S) by the end of 2021. The health consequences of COVID-19, however, have not affected all residents equally. In this review, we synthesize recent evidence suggesting that high levels of poverty in the U.S. compared to other high-income countries, as well as historic and ongoing racial/ethnic discrimination, have exacerbated the health consequences of COVID-19, particularly for racial/ethnic minorities. We discuss four mechanisms through which poverty and discrimination affect COVID-19-related health consequences: greater pre-existing health challenges, reduced access to healthcare, lower-quality neighbourhood and housing conditions, and unequal exposure to high-risk occupations. Evidence suggests that economic and policy institutions that contributed to higher pre-pandemic poverty rates in the U.S., particularly among racial/ethnic minorities, have been central determinants of unequal health outcomes during the COVID-19 pandemic

Exposure to childhood poverty and racial differences in economic opportunity in young adulthood

Young adults in the United States, especially young Black adults, experience high poverty rates relative to other age groups. Prior research has largely attributed racial disparities in young adult poverty to differential attainment of benchmarks related to education, employment, and family formation. This study investigates that mechanism alongside racial differences in childhood poverty exposure. Analyses of Panel Study of Income Dynamics data reveal that racial differences in childhood poverty are more consequential than differential attainment of education, employment, and family formation benchmarks in shaping racial differences in young adult poverty. Whereas benchmark attainment reduces an individual's likelihood of poverty, racial differences in benchmark attainment do not meaningfully explain Black-White poverty gaps for three reasons. First, childhood poverty is negatively associated with benchmark attainment, generating strong selection effects into the behavioral characteristics associated with lower poverty. Second, benchmark attainment does not equalize poverty rates among Black and White men. Third, Black children experience four times the poverty rate of White children, and childhood poverty has lingering negative consequences for young adult poverty. Although equalizing benchmark attainment would reduce Black-White gaps in young adult poverty, equalizing childhood poverty exposure would have twice the reduction effect

Estimating monthly poverty rates in the United States

Official poverty estimates for the United States are presented annually, based on a family unit's annual resources, and reported with a considerable lag. This study introduces a framework to produce monthly estimates of the Supplemental Poverty Measure and official poverty measure, based on a family unit's monthly income, and with a two-week lag. We argue that a shorter accounting period and more timely estimates of poverty better account for intra-year income volatility and better inform the public of current economic conditions. Our framework uses two versions of the Current Population Survey to estimate monthly poverty while accounting for changes in policy, demographic composition, and labor market characteristics. Validation tests demonstrate that our monthly poverty estimates closely align with observed trends in the Survey of Income & Program Participation from 2004 to 2016 and trends in hardship during the COVID-19 pandemic. We apply the framework to measure trends in monthly poverty from January 1994 through September 2021. Monthly poverty rates generally declined in the 1990s, increased throughout the 2000s, and declined after the Great Recession through the onset of the COVID-19 pandemic. Within-year variation in monthly poverty rates, however, has generally increased. Among families with children, within-year variation in monthly poverty rates is comparable to between-year variation, largely due to the average family with children receiving 37 percent of its annual income transfers in a single month through one-time tax credit payments. Moving forward, researchers can apply our framework to produce monthly poverty rates whenever more timely estimates are desired

Administrative Burdens and Economic Insecurity Among Black, Latino, and White Families

This study investigates how administrative burdens influence differential receipt of income transfers after a family member loses a job. Using the panel component of the Current Population Survey from 1990 through 2019, we find that administrative burdens have increased in the Temporary Assistance for Needy Families and Unemployment Insurance programs but declined for the Supplemental Nutrition Assistance Program. These administrative burden effects generally contribute to lower income replacement rates for Black and Latino families experiencing job loss relative to White families, though results are sensitive to adjustments for benefit underreporting. Moreover, states with higher shares of White residents have smaller administrative burden effects, on average. Reducing administrative burdens in income transfer programs would likely reduce racial-ethnic inequalities in economic insecurity

Unemployment and child health during COVID-19 in the USA

The COVID-19 pandemic has led to high rates of unemployment across advanced economies. The burdens associated with unemployment, however, have not hit all households equally. Families with children and unemployed parents have reported especially high rates of hardship, with potential long-term consequences for child wellbeing and development. The increase of parental unemployment in the USA necessitates greater attention towards these potential consequences

Automation, occupational earnings trends, and the moderating role of organized labor

Routine-biased technological change has emerged as the dominant explanation for the differential earnings growth of occupations at greater risk of automation, such as machine operators or office clerks, relative to less routine occupations. In contrast, this paper finds that the declining earnings returns to an occupation’s routine task intensity (RTI) can largely be attributed to the decline of organized labor. Using individual-level data on 3.3 million employed adults across the United States from 1983 to 2017, this paper finds that organized labor has two countervailing effects on occupations at greater risk of automation. First, higher union coverage within a state and industry inhibits the decline in earnings returns to an occupation’s RTI. Second, higher union coverage hastens the decline in employment shares of occupations with higher RTI. The result is that occupations at greater risk of automation experience more favorable earnings growth where unions are more resilient, but at the cost of accelerated declines in their employment shares. Counterfactual analyses demonstrate that if union coverage in the United States had remained stable at 1983 levels, the earnings returns to an occupation’s RTI might not have declined from 1983 to 2017, and the observed pattern of occupational earnings polarization in the 1990s might not have occurred. However, the mean RTI of occupations might have declined by an additional 21 percent from 1983 to 2017 relative to the observed decline. The findings suggest that the social consequences of automation are conditional on the strength of organized labor

Income support policies and the rise of student and family homelessness

This study investigates whether the generosity and accessibility of publicly provided income support contributes to levels of family homelessness. Using data on student homelessness from most public school districts in the United States, I find that greater access to cash assistance from the Temporary Assistance for Needy Families (TANF) program reduces levels of family homelessness and that the reduction is particularly strong for majority–Black and Native American school districts. The results suggest that the observed decline in access to TANF cash assistance may be an important driver of the rise in family homelessness. Evidence is inconclusive about whether greater access to the Supplemental Nutrition Assistance Program (SNAP) or greater generosity of the Earned Income Tax Credit (EITC) reduces levels of homelessness