By Andrew M. Seaman
NEW YORK (Reuters Health) - Pressuring welfare recipients to get a job or face losing their benefits may put them at a slightly increased risk of dying over the long term, according to new research.
A study that tracked Floridians on welfare over nearly 20 years found that death rates were a half percent higher among those offered job training and pushed to find employment compared to those receiving unrestricted benefits.
"The message of the finding is that there is a very small but statistically significant difference in the measured death rates between these two populations," said Dr. Jan Blustein, a professor of health policy and medicine at New York University who was not involved in the new study.
The researchers, led by Dr. Peter Muennig from Columbia University in New York, write in Health Affairs that plenty of past work has linked social policies and people's health, but few studies have looked at health outcomes after welfare reform.
In 1996, the federal Personal Responsibility and Work Opportunity Reconciliation Act limited the amount of time people could receive welfare benefits. The law was seen as a way to encourage people to rejoin the workforce.
During the buildup to welfare reform, a number of experiments were conducted across the country to see whether additional support - such as job training - and time limits on how long a family could receive benefits led to more people getting jobs and earning more money. It did.
For the new study, Muennig and his colleagues used data from one of those trials, conducted in Escambia County, Florida, between 1994 and 1999.
The trial randomized 3,224 people to either receive traditional, unrestricted welfare or to be allowed benefits for just two to three years - though during that period, the time-limited group would also have access to job training and placement services.
The researchers linked data on the people who participated in the experiment to the U.S. Social Security Administration's Master File to see how many had died by 2011.
Of the 1,611 people who were pressured to get jobs, 75 of them (4.7 percent) died by 2011. That compared to 67 deaths (4.2 percent) among the 1,613 people who received traditional welfare.
Muennig told Reuters Health in an email that the results might be explained by the fact that while some people in the group pressured to get jobs ended up finding employment and making more money, "others lost their lifeline and had to fall back on already poor family members and friends to eat and get shelter."
Significantly more people in the time-limited group got jobs, Muennig and his colleagues report, but few made more money than the total income from all sources, such as food stamps and other supplements, received by people in the unrestricted group.
And 50 percent of those in the time-limited group remained jobless during much of the program.
Blustein, who noted that most welfare recipients in the studied communities were likely to have been single mothers, said more research is needed to draw strong conclusions.
"I call this hypothesis generating. I don't think we should reform welfare again because it's causing higher deaths in women, but the study is intriguing and points to a possible connection between social policy and health," Blustein said.
Muennig told Reuters Health that his team is currently looking at whether mortality is also higher among the participants' children and whether the savings benefits of welfare limits outweigh the cost of increased deaths.
"That is, it may still be cost-effective to have (limits) even though mortality is higher. We as a society often make decisions that take lives in exchange for benefits," he wrote.
SOURCE: http://bit.ly/120y9Nl Health Affairs, June 2013.