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Policy Framework
It is widely recognized that having no job or a job that pays a low wage puts people at risk of living in poverty. Less well known, though also well documented, are the dangers that low-wage work and unemployment pose to health by exposing people to physical hazards and psychological stressors that satisfactory employment could prevent. Lacking a good job can affect a person’s health not only through economic hardship but more directly — for example, by increasing the likelihood of workplace injury. A joint project of the California Endowment and The Rockefeller Foundation launched in 2000, California Works for Better Health (CWBH) aims to build four community-based collaboratives that will develop interventions designed to improve health through better jobs. The project’s goal is to increase low-income people’s access to regional economic opportunities and, ultimately, to improve their health indicators. MDRC is evaluating the initiative and providing support to local researchers who are working closely with technical assistance providers and the collaboratives in each region.
Agenda, Scope, and Goals
The principle guiding CWBH is “better jobs, better health.” In this context, a good job is one in a safe environment that pays a living wage and offers health benefits. Several populations of people do not have good jobs: the unemployed, workers who earn less than a living wage, workers whose job is threatened by a weak or unstable local economy or sector, and the underemployed (that is, workers who earn less than what would be expected given their education and training).
CWBH’s ambitious objective is to improve health in high-poverty neighborhoods of four California cities through grassroots efforts to improve access to and the quality of local job opportunities. Such efforts could include initiatives to reduce employment barriers (for instance, through vocationally oriented instruction in English as a Second Language) and to encourage employers to provide a safe working environment and health benefits to their workers. The implementation phase of CWBH, now in progress, focuses on helping the project sites develop feasible strategies to improve health through employment-related programs and policies.
The evaluation seeks to address these questions during CWBH’s implementation phase:
- How do the collaboratives generate and reach consensus on their goals and strategies for improving health indicators among low-wage workers?
- What types of capacity, support, partnerships, and resources are required for sites to implement their proposed strategies successfully?
- What strategies and interventions have the greatest potential to help low-income people get good jobs? What strategies in the project’s first phase show promise?
- Judging from pilot efforts, how likely are the collaboratives to have a large effect on outcomes in their respective regions if CWBH progresses to a second phase?
The long-term goal of the evaluation, to be realized in the next stage of the project’s development, is to discover how the interventions devised by the collaboratives affect the physical and mental health of low-income people in the targeted communities.
Design, Sites, and Data Sources
CWBH is launching collaboratives in four regions of California with high concentrations of low-income people:
- Fresno
- Los Angeles
- Sacramento
- San Diego
If MDRC’s assessment of CWBH’s early implementation indicates that the initiative is functioning well, MDRC will undertake a study of work- and health-related outcomes aimed at discovering the connections — if any — between the collaboratives’ activities and changes in community health.
What's Next
MDRC is working with the project funders and the collaboratives to decide how to measure key employment outcomes (such as unemployment, underemployment, and take-up of work supports) and how improvements in these outcomes could affect individual and family health as CWBH enters its next phase.
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