States that raise minimum wage see improvements in health outcomes, but health inequities also grow, according to new research led by a health policy researcher at the University of Pittsburgh School of Public Health and published in the journal Health Equity.
The study, which focused on blood pressure as a proxy for heart health, found that increasing state minimum wage worsens, rather than improves, health disparities between Black and white U.S. adults, indicating that achieving lasting and equitable improvement in the heart health of Americans may require a wage system overhaul.
“Minimum wage policies were originally created with classist and racist ideologies, so it is not surprising that continuing to work within this system furthers health disparities along racial lines,” said lead author Dr. Brittany Brown-Podgorski, assistant professor of health policy and management at Pitt Public Health.
“Instead of a minimum wage, federal and state lawmakers could consider a livable wage,” she said. “This would switch the focus from the employer and the minimum they must pay their employees, to the employee and the minimum amount a person needs to earn in order to meet all of their basic needs.”
In 2001, 20% of states set the minimum wage above the federal limit. By 2019 that had tripled to 60% of states. Brown-Podgorski and her colleagues were curious if this mandated change in income led to changes in heart health between states that increased minimum wage compared to those that didn’t, and if this policy changes impacted Black populations differently than white populations. They merged state-level minimum wage data with data from a national survey that asks, among many other questions, whether participants have ever been told by a doctor that they have high blood pressure.
High blood pressure, or hypertension, affects nearly half of U.S. adults and puts people at greater risk for heart disease and stroke. It disproportionately affects Black adults. Medication and lifestyle changes can reverse hypertension, but only about 1 in 4 adults with hypertension have it under control, according to the U.S. Centers for Disease Control and Prevention.
The researchers found that as state wage limits increase, the odds of hypertension decrease by 3% among Black adults. But the improvements were better among white adults, meaning the health disparities gap grew and Black adults fell further behind.
“When you’re just looking at Black adults and comparing states that raised minimum wage to those that didn’t, the outcome looks good,” Brown-Podgorski said. “But that good news is masking the more insidious story that keeping the minimum wage system is making health disparities worse over time. Equality — when everyone gets the same thing — is not the same as equity, when everyone gets what they need.”
When federal minimum wage limits were established 85 years ago, they specifically excluded occupations largely held by Black workers. That, coupled with several other policies, have resulted in an over-representation of Black adults in lower wage occupations.
Brown-Podgorski and her colleagues urge lawmakers to recognize increasing wages as a policy lever that could lead to improvements in health but suggest a more thoughtful alternative to measures that reinforce existing wage structures.
“We need to rethink wage policies in this country from the bottom up and bring in a level of nuance that wasn’t in the original policy,” Brown-Podgorski said. “Factor in the cost-of-living and the number of dependents someone may have. The solution, in my mind, is not changing a policy that started off with a dark history, but rather a large-scale overhaul that focuses on the worker and not the employer making the most profit possible.”
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