State-level data on TANF policy changes during the COVID-19 pandemic.

OBJECTIVE: COVID-19 mitigation measures prompted many states to revise the administration of their welfare programs. States adopted policies that varied across the U.S. to respond to the difficulties in fulfilling program requirements, as well as increased financial need. This dataset captures the changes made to Temporary Assistance for Needy Families (TANF) programs during the COVID-19 pandemic, from March 2020 through December 2020. The authors created this dataset as part of a larger study that examined the health effects of TANF policy changes during the COVID-19 pandemic. DATA DESCRIPTION: TANF is the main cash assistance program for low-income families in the U.S., but benefits are often conditional on work requirements and can be revoked if an individual is deemed noncompliant. Structural factors during the COVID-19 pandemic made meeting these criteria more difficult, so some states relaxed their rules and increased their benefits. This dataset captures 24 types of policies that state TANF programs enacted, which of the states enacted each of them, when the policies went into effect, and when applicable, when the policies ended. These data can be used to study the effects of TANF policy changes on various health and programmatic outcomes.

The 2022 restructure of Aotearoa New Zealand's health system: Will it succeed in advancing equity where others have failed?

Aotearoa New Zealand has restructured its health system with the objective of addressing inequitable access to health services and inequitable health outcomes, particularly those affecting the indigenous Maori population. In July 2022, two new organisations were created to centralise planning, funding and provision responsibilities for publicly funded health services in Aotearoa New Zealand. Health New Zealand and the Maori Health Authority have been created to drive transformational change within the national health system and monitor and improve the health and wellbeing of Maori. At the local level, new Localities are to be formed with the aim of integrating services between government and non-government health and social services providers, while incorporating local Maori and local communities in co-design of services. These changes will be of interest to those in many other countries who are grappling with their own colonial histories and struggling to provide health services in ways that are equitable and contribute to positive health outcomes for their whole population. Although key aspects of the reforms are well supported within the health sector, the ambitious scope and timing of their introduction in the context of the COVID-19 pandemic and health workforce shortages can be expected to generate significant implementation challenges.

Adult Protective Services Perspectives on Responding to Elder Abuse and Serving Clients During the COVID-19 Pandemic.

The initial COVID-19 pandemic and subsequent public health measures dramatically impacted Adult Protective Services (APS), requiring rapid adjustments. Our goal was to describe challenges for APS and strategies developed to respond. We conducted six focus groups and seven interviews during March-April 2021 using a semi-structured topic guide, with 31 participants from APS leadership, supervisors, and caseworkers in New York City, a community hard hit by the initial COVID surge. Data from transcripts were analyzed to identify themes. Participants identified challenges faced by APS (e.g., clients less willing to engage with APS, inability to perform necessary job tasks remotely, and low staffing levels) as well as strategies APS used in response (e.g., increasing collaboration with other community-based programs and service providers, enabling remote court hearings through technology and in-person facilitation, and ensuring staff had access to personal protective equipment). These findings may inform APS planning for future large-scale societal disruptions.

Gaps in the welfare state: A role-based model of poverty risk in the U.S.

BACKGROUND: Research clearly demonstrates that income matters greatly to health. However, income distribution and its relationship to poverty risk is often misunderstood. METHODS: We provide a structural account of income distribution and poverty risk in the U.S., rooted in the 'roles' that individuals inhabit with relation to the 'factor payment system' (market distribution of income to individuals through wages and asset ownership). Principal roles are child, older adult, and, among working-age adults, disabled individual, student, unemployed individual, caregiver, or paid laborer. Moreover, the roles of other members of an individual's household also influence an individual's income level. This account implies that 1) roles other than paid laborer will be associated with greater poverty risk, 2) household composition will be associated with poverty risk, and 3) income support policies for those not able to engage in paid labor are critical for avoiding poverty. We test hypotheses implied by this account using 2019 and 2022 U.S. Census Current Population Survey data. The exposure variables in our analyses relate to roles and household composition. The outcomes relate to income and poverty risk. RESULTS: In 2019, 40.1 million individuals (12.7% of the population) experienced poverty under the U.S. Census' Supplemental Poverty Measure. All roles other than paid laborer were associated with greater poverty risk (p < .001 for all comparisons). Household composition, particularly more children and disabled working-age adults, and fewer paid laborers, was also associated with greater poverty risk (p < .001 for all comparisons). Five key policy areas-child benefits, older-age pensions, disability and sickness insurance, unemployment insurance, and out-of-pocket healthcare spending-represented gaps in the welfare state strongly associated with poverty risk. CONCLUSIONS: The role one inhabits and household composition are associated with poverty risk. This understanding of income distribution and poverty risk may be useful for social policy.

Community Services and Social Involvement in COVID-19 Governance: Evidence from China.

This study explores how the services provided by different types of Chinese communities varied in their impact on the social involvement of residents during the COVID-19 pandemic. The literature revealed problems caused by travel restrictions, including using oversimplified measures for grassroots governance, which might result in decreased residents' social involvement during COVID-19. We argue that the services provided by "smart communities" in China not only adhered to the COVID-19 pandemic governance, but also promoted the social involvement of residents. Using a case study approach of the smart community Fang Xing and the traditional community Qili Tang, both of which are located in China, this article compared the traditional and smart community services based on 122 interviews with residents and frontline community staff members. The findings suggest that while the traditional community decreased the residents' social involvement by restricting certain services during the pandemic, the smart community was able to apply COVID-19 governance measures, considerably increasing the residents' social involvement. It offered an attractive option for residents to act as community service managers, and it prepared them for local-level pandemic governance. This study provides an understanding of the relationship between the community services and the residents' social involvement in terms of the community services. The smart community model can act as a reference for international community development during pandemic governance.

Changes in health-related quality of life scores among low-income patients on social welfare programs in Japan during the COVID-19 pandemic: a single-center repeated cross-sectional study.

BACKGROUND: Low-income is one of the well-established determinants of people's health and health-related behavior, including susceptibility to the coronavirus disease 2019 (COVID-19) infection. Two social welfare services are available in Japan to support financial and medical care among low-income patients: Public Assistance (PA), which provide both minimum income and medical costs; and Free/Low-Cost Medical Care (FLCMC), wherein only medical costs were covered. In this study, changes in Health-Related Quality of Life (HRQOL) scores of low-income patients on PA and FLCMC, before and after COVID-19 pandemic, were described and compared against those that are not utilizing the said services (comparison group) to evaluate the contribution of social welfare services in protecting the HRQOL of the beneficiaries during the pandemic. METHODS: We used repeated cross-sectional data of adult beneficiaries of FLCMC and PA, as well as those without social welfare services, who regularly visit the Kamigyo clinic in Kyoto, Japan. We collected the data from 2018 and 2021 using a questionnaire on patients' socioeconomic attributes and the Japanese version of Medical Outcomes Study 12-Item Short Form Health Survey (SF-12). The Japanese version of SF-12 can calculate the three components scores: physical health component summary (PCS), the mental health component summary (MCS), and the role-social component summary (RCS), which can be transformed to a 0-100 range scale with a mean of 50 and standard deviation of 10. RESULTS: Data of 200 and 174 beneficiaries in 2018 and 2021, respectively, were analyzed. Low-income patients on social welfare services had lower PCS, and RCS than the comparison group in both years. Multiple linear regression analyses with cluster-adjusted standard error estimator showed that the decline in MCS was significantly higher among FLCMC beneficiaries than in those without welfare services (Beta: -4.71, 95% Confidence Interval [CI]: -5.79 to -3.63, p < 0.01), and a decline in MCS among PA recipients was also observed (Beta: -4.27, 95% CI: -6.67 to -1.87 p = 0.02). CONCLUSIONS: Low-income beneficiaries of social welfare may have experienced mental health deterioration during the COVID-19 pandemic. To maintain healthy lives during the pandemic, additional support on mental health for low-income recipients of social welfare services may be required.

Epidemiological Profile and Social Welfare Index as Factors Associated with COVID-19 Hospitalization and Severity in Mexico City: A Retrospective Analysis.

Epidemiological data indicate that Mexico holds the 19th place in cumulative cases (5506.53 per 100,000 inhabitants) of COVID-19 and the 5th place in cumulative deaths (256.14 per 100,000 inhabitants) globally and holds the 4th and 3rd place in cumulative cases and deaths in the Americas region, respectively, with Mexico City being the most affected area. Several modifiable and non-modifiable risk factors have been linked to a poor clinical outcome in COVID-19 infection; however, whether socioeconomic and welfare factors are associated with clinical outcome has been scanty addressed. This study tried to investigate the association of Social Welfare Index (SWI) with hospitalization and severity due to COVID-19. A retrospective analysis was conducted at the Centro Médico Nacional "20 de Noviembre"-ISSSTE, based in Mexico City, Mexico. A total of 3963 patients with confirmed or suspected COVID-19, registered from March to July 2020, were included, retrieved information from the Virology Analysis and Reference Unit Database. Demographic, symptoms and clinical data were analyzed, as well as the SWI, a multidimensional parameter based on living and household conditions. An adjusted binary logistic regression model was performed in order to compare the outcomes of hospitalization, mechanical ventilation requirement (MVR) and mortality between SWI categories: Very high (VHi), high (Hi), medium (M) and low (L). The main findings show that lower SWI were independently associated with higher probability for hospital entry: VHi vs. Hi vs. M vs. L-SWI (0 vs. +0.24 [OR = 1.24, CI95% 1.01-1.53] vs. +0.90 [OR = 1.90, CI95% 1.56-2.32] vs. 0.73 [OR = 1.73, CI95% 1.36-2.19], respectively); Mechanical Ventilation Requirement: VHi vs. M vs. L-SWI (0 vs. +0.45 [OR = 1.45, CI95% 1.11-1.87] vs. +0.35 [OR = 1.35, CI95% 1.00-1.82]) and mortality: VHi vs. Hi vs. M (0 vs. +0.54 [OR = 1.54, CI95% 1.22-1.94] vs. +0.41 [OR = 1.41, CI95% 1.13-1.76]). We concluded that SWI was independently associated with the poor clinical outcomes in COVID-19, beyond demographic, epidemiological and clinical characteristics.

Easing Cash Assistance Rules During COVID-19 Was Associated With Reduced Days Of Poor Physical And Mental Health.

Unemployment rates soared at the beginning of the COVID-19 pandemic in the US, increasing financial stress that can affect physical and mental health. Temporary Assistance for Needy Families (TANF) is the primary cash assistance program for low-income families in the US, with benefits conditional on work activities and subject to suspension. However, many states loosened requirements during the pandemic. Using TANF policy data and data from the Behavioral Risk Factor Surveillance System from the period January 2017-December 2020 with a triple-difference design, we found a general protective effect of supportive changes to TANF on poor physical and mental health days and binge drinking during the COVID-19 pandemic for likely TANF participants. For example, providing emergency cash benefits to those not already participating in TANF, waiving work requirements, waiving or pausing sanctions, and automatically recertifying benefits were associated with reductions in the number of mentally unhealthy days. This study provides support for increasing generosity and easing administrative burdens in safety-net programs to buffer against negative impacts of public health and economic crises.

Individuals' Assessments of Their Own Wellbeing, Subjective Welfare, and Good Life: Four Exploratory Studies.

This paper reports on four exploratory online studies of how wellbeing and welfare are valued and perceived from a subjective, individual perspective. Study 1 (n = 707) compares individuals' subjective ratings and correlations of the importance of the three wellbeing dimensions happiness, meaning in life, and a psychologically rich life, as well as their welfare. Study 2 (n = 679) factor-analyses the same four (five-item) wellbeing and subjective welfare constructs. Study 3 (n = 710) gauges how individuals' global assessments of the three dimensions of wellbeing and of subjective welfare contribute to their assessments of living a good life, using stepwise regression analysis. Study 4 (n = 663) replicates the stepwise regression analysis with global measures of relative, rather than absolute, wellbeing and subjective welfare.

The Factors Influencing Public Satisfaction with Community Services for COVID-19: Evidence from a Highly Educated Community in Beijing.

The satisfaction of highly educated citizens with community services for COVID-19 represents the attitude of the middle class and plays an important role in both the social and political stability of a country. The aim of this paper was to determine which factors influence public satisfaction with COVID-19 services in a highly educated community. Through a literature review and using the American Customer Satisfaction Index (ACSI) model, this paper constructed a public satisfaction model of community services for COVID-19 and proposed relevant research hypotheses. A community with many highly educated residents in Beijing was selected as the case study, where 450 official questionnaires were distributed based on the age ratio of residents, with 372 valid questionnaires being collected from May 2021 to July 2021. The study results obtained by a structural equation model (SEM) show that: (1) public satisfaction is significantly and positively influenced by quality perception (0.305 **), public demand (0.295 **), and service maturity (0.465 ***); (2) public satisfaction has a significantly positive effect on service image (0.346 ***) and public trust (0.232 **), and service image significantly affects public trust (0.140 *); (3) service maturity is positively influenced by public demand (0.460 ***) and quality perception (0.323 *); and (4) public demand is positively influenced by quality perception (0.693 ***) (* p < 0.05; ** p < 0.01; *** p < 0.00). The conclusions of the study can provide suggestions and recommendations to improve the satisfaction of highly educated residents with community healthcare services during the COVID-19 pandemic.

Does India need a new pharmaceutical policy? Examining the implications of the drug price control order.

OBJECTIVES: This article aims to analyse the impact of the pharmaceutical policy on the availability, accessibility and affordability of medicines to the Indian populace. The article delves into the shortcomings of the Drug Price Control Order 2013 and highlights its real-world implications. METHODS: Published literature in the form of scientific articles on the proposed reforms that took place in the pharmaceutical policy was reviewed. The study used the memorandums, laws and government decisions published by the Department of Pharmaceuticals, Ministry of Health and Family Welfare and National Pharmaceutical Pricing Authority|National Pharmaceutical Pricing Authorities. RESULTS: The pharmaceutical policy in India underwent several changes during 2013-2020 to enhance the affordability and accessibility of drugs. The stringent policy hampered innovation due to the lack of profitability to the Multinational Companies. Moreover, it was found that the impact of the price control order on the low-cost local generic manufacturers affected much of the country's price-sensitive population. CONCLUSION: The pharmaceutical policy of India needs to be amended to extend its benefit to its stakeholders. The government should shift its attention to improving the quality of drugs, increasing competition amongst manufacturers and enhancing the accessibility of medicines through state/centre sponsored initiatives.

Does the National Fitness Policy Promote National Health?-An Empirical Study from China.

The influence of national health level in the stability and sustainable development of national society is increasingly prominent. The purpose of this study is to examine whether, when, and how national fitness policies exert influence on national health. Panel data from 2008 to 2017 of 30 Chinese provinces (cities) (except the Tibet autonomous region) were used to systematically reveal the direct impact of national fitness policies on national health and its characteristics in different regions, as well as the interaction mechanisms of human capital and finance health expenditures in public sports. This study found that first, national fitness policies had a positive effect on adult health. Second, sports human capital weakens the health effect of national fitness policies, while public finance health expenditures strengthen this effect. Lastly, the health effect of national fitness policies varies significantly across regions due to uneven regional economic development, and the differences in the effects on different age groups (adults and children) are equally pronounced. This study suggests that national fitness public service system and diverse national fitness plans improving national health level are important for a new dynamic balance and high quality coordinated development in both Chinese economic growth and social welfare.

Emergency provider perspectives on facilitators and barriers to home and community services for older adults with serious life limiting illness: A qualitative study.

BACKGROUND: Older adults account for a large proportion of emergency department visits, but those with serious life-limiting illness may benefit most from referral to home and community services instead of hospitalization. We aim to document emergency provider perspectives on facilitators and barriers to accessing home and community services for older adults with serious life-limiting illness. METHODS: We conducted interviewer-administered semi-structured interviews with emergency providers from health systems across the United States to obtain provider perspectives on facilitators and barriers to accessing home and community services. We completed qualitative thematic analysis using an iterative process to develop themes and subthemes to summarize provider responses. RESULTS: We interviewed 8 emergency nurses and 10 emergency physicians across 11 health systems. Emergency providers were familiar with local home and community services. Facilitators to accessing these services include care management and social workers. Barriers include services that are not accessible full-time to receive referrals, insurance/payment, and the busy nature of the emergency department. The most helpful reported services were hospice, physical therapy, occupational therapy, and visiting nursing services. Home-based palliative care and full-time emergency department-based care management and social work were the services most desired by providers. Providers expressed support for improving access to home and community services in the hopes of decreasing unnecessary emergency visits and inpatient admissions, and to provide patients with greater options for supportive care. CONCLUSION: Obtaining the perspective of emergency providers highlights important considerations to accessing HCS for older-adults with serious life-limiting illness from the emergency department. This study provides foundational information for futures studies and initiatives for improving access to home and community services directly from the emergency department.

Geographic microtargeting of social assistance with high-resolution poverty maps.

Hundreds of millions of poor families receive some form of targeted social assistance. Many of these antipoverty programs involve some degree of geographic targeting, where aid is prioritized to the poorest regions of the country. However, policy makers in many low-resource settings lack the disaggregated poverty data required to make effective geographic targeting decisions. Using several independent datasets from Nigeria, this paper shows that high-resolution poverty maps, constructed by applying machine learning algorithms to satellite imagery and other nontraditional geospatial data, can improve the targeting of government cash transfers to poor families. Specifically, we find that geographic targeting relying on machine learning-based poverty maps can reduce errors of exclusion and inclusion relative to geographic targeting based on recent nationally representative survey data. This result holds for antipoverty programs that target both the poor and the extreme poor and for initiatives of varying sizes. We also find no evidence that machine learning-based maps increase targeting disparities by demographic groups, such as gender or religion. Based in part on these findings, the Government of Nigeria used this approach to geographically target emergency cash transfers in response to the COVID-19 pandemic.

Structural adjustment programmes and infectious disease mortality.

International financial organisations like the International Monetary Fund (IMF) play a central role in shaping the developmental trajectories of fiscally distressed countries through their conditional lending schemes, known as 'structural adjustment programmes'. These programmes entail wide-ranging domestic policy reforms that influence local health and welfare systems. Using novel panel data from 187 countries between 1990 and 2017 and an instrumental variable technique, we find that IMF programmes lead to over 70 excess deaths from respiratory diseases and tuberculosis per 100,000 population and that IMF-mandated privatisation reforms lead to over 90 excess deaths per 100,000 population. Thus structural adjustment programmes, as currently designed and implemented, are harmful to population health and increase global infectious disease burdens.

A theory of fiscal policy response to an epidemic.

Governments worldwide have issued massive amounts of debt to inject fiscal stimulus during the COVID-19 pandemic. This paper analyzes fiscal responses to an epidemic, in which interactions at work increase the risk of disease and mortality. Fiscal policies, which are designed to borrow against the future and provide transfers to individuals suffering economic hardship, can facilitate consumption smoothing while reduce hours worked and hence mitigate infections. We examine the optimal fiscal policy and characterize the condition under which fiscal policy improves social welfare. We then extend the model analyzing the static and dynamic pecuniary externalities under scale economies-the decrease in labor supply during the epidemic lowers the contemporaneous average wage rate while enhances the post-epidemic workforce health and productivity. We suggest that fiscal policy may not work effectively unless the government coordinates working time, and the optimal size of public debt is affected by production technology and disease severity and transmissibility.

Inégalités sociales de santé et rapports de pouvoir : Covid-19 au Québec.

This article proposes to clarify the concept of social inequality in health: theoretically first, then by mobilizing it on a specific study field, the Covid-19 pandemic in Quebec during the spring of 2020.It begins with a discussion of various definitions of social inequalities in health and then proposes the following one: these are differences in health observed between several social groups and which result from the power relation(s) between these groups.Applying this definition to the Covid-19 pandemic occurs in two stages. First, power relations that differentiate exposure to the various risks caused by the pandemic are identified: being infected, dying of it, but also seeing one's health affected by the pandemic without necessarily being infected with the new coronavirus. The study of this latter risk requires monitoring exposure to social determinants of health that is unbalanced by the context of the pandemic: income, social network, care and social services, education, stigma.This first step of the analysis considers power relations taken in isolation from each other. The second explores their articulation. Its common thread is the ethno-racial relation, of which are analyzed the links with socio-economic relation. Finally, a systemic perspective of inequalities is drawn, essential for identifying actions to be taken to fight against social inequalities in health.

Epidemiological Factors Associated with COVID-19 Clusters in Medical and Social Welfare Facilities.

The characteristics of coronavirus disease 2019 (COVID-19) clusters in medical and social welfare facilities and the factors associated with cluster size are still not yet fully understood. We reviewed COVID-19 cases in Japan identified from January 15 to April 30, 2020 and analyzed the factors associated with cluster size in medical and social welfare facilities. In this study, COVID-19 clusters were identified in 56 medical and 34 social welfare facilities. The number of cases in those facilities peaked after the peak of the general population. The duration of occurrence of new cases in clusters was positively correlated with the number of cases in both types of facilities (rho = 0.44, P < 0.001; and rho = 0.69, P < 0.001, respectively). However, the number of days between the first case in a prefecture and the onset of clusters was negatively correlated with the number of cases only in clusters in social welfare facilities (rho = - 0.4, P = 0.004). Our results suggest that COVID-19 cases in those facilities were prevalent in the latter phase of the disease's community transmission, although the underlying mechanisms for such a trend could differ between medical and social welfare facilities.

The Impact of Health and Wealth on Settlement Intention of Migrants: The Moderating Effect of Social Welfare.

Background: With the rapid urbanization, citizenization of migrants is becoming the development tendency in China. It is significant to analyze the determining factors of the settlement intention of migrants. Methods: The data we used were taken from the China Migrants Dynamic Survey (CMDS) in 2017. Multilevel mixed-effects logistic regression was used to analyze the relationship between air pollution, economic advantages, and settlement intention between different migrants and the moderating effect of social welfare. Results: At the individual level, being female, married, urban and other ethnic, having higher education, older, and health associated with likelihood of settlement intention of migrants. Higher health education, social integration, and, have a health record were positively associated with the likelihood of settlement intention. Higher educated, urban areas, and Han migrants were willing to reduce their pursuit of health for economic development. Conclusion: Health education and more social organizational participation can reduce the negative effect of air pollution and increase the positive effect of economic advantages on settlement intention of migrants. But, in less economically advantaged areas, it has no obvious effect. In the choice of health and wealth, the settlement intention of migrants shows difference, and unfairness and social welfare, in particular health education, can narrow this difference.