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May 2001
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The Health of Poor Urban Women
Findings from the Project on Devolution and Urban Change
Denise F. Polit, Andrew S. London, John M. Martinez
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To what extent might the health of welfare recipients and their children
play a role in the new welfare environment? In 1996, Congress passed the
Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA),
creating a five-year lifetime limit on the receipt of federal cash welfare
benefits for most families. PRWORA dropped the language from prior legislation
that excused welfare recipients from mandatory participation in welfare-to-work
activities for health reasons. The new policy considers all recipients subject
to participation requirements and time limits, except for an undefined 20
percent of each state's caseload who may be excused for "good cause."
There is little information about whether the 20 percent figure is sufficient
to encompass all recipients with health problems - or whether women leaving
welfare will be able to secure the health care they need for themselves
and their children.
This report describes the health and health care needs of welfare recipients
(and former recipients) living in large urban areas, where a substantial
percentage of the national welfare caseload lives. The report is based on
1998-1999 survey and ethnographic data from the Project on Devolution and
Urban Change, a multi-component study designed to examine the implementation
and effects of PRWORA in four urban counties: Cuyahoga (Cleveland), Los
Angeles, Miami-Dade, and Philadelphia. Survey respondents were selected
randomly from among the May 1995 public assistance recipients residing in
high-poverty neighborhoods in each county. The report compares the health
of four groups of women based on their statuses at the time of the survey:
women who had left welfare and were working, women who combined welfare
and work, women who received welfare and did not work, and women who neither
worked nor received welfare. Ethnographic interview data, collected from
welfare recipients living in selected neighborhoods in each site, complement
and augment the survey findings.
Among the key findings:
- The women (and their children) had substantially
higher rates of physical and mental health problems than did national
samples of women and children - and their health problems were often
multiple and severe.
- Women who worked (especially if they had left welfare)
were in much better physical and mental health than those who did not
work.
- Nevertheless, working women who had left welfare
often lacked health insurance and still experienced substantial physical
and mental health problems, as did their children.
- The high prevalence of health problems among women
who were still receiving welfare suggests that there will be major challenges
to welfare agencies as a growing number of recipients face time-limit
pressures.
- Women with multiple health problems (and women
who had been physically abused) were more likely than other women to
have been sanctioned by the welfare agency in the previous year.
- Welfare leavers who were not employed had the most
compromised health situations: They tended to have high rates of health
problems, lack insurance, and experience high levels of unmet need for
health care.
Women's health problems and those of their children likely constrain women's
entry into the workforce and their ability to remain there. Additionally,
health problems compromise women's ability to comply with participation
requirements, which raises questions about current sanctioning policies.
Given the health care needs identified in this study, an especially critical
policy challenge is to develop mechanisms to ensure that women who leave
welfare maintain health insurance.
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Funders
Ford Foundation John S. and James L. Knight Foundation, Charles Stewart Mott Foundation The Joyce Foundation, The Pew Charitable Trusts, The Cleveland Foundation, W. K. Kellogg Foundation The George Gund Foundation, The Robert Wood Johnson Foundation, William Penn Foundation, U.S. Department of Health and Human Services (including interagency funds, from the U.S. Department of Agriculture), The James Irvine Foundation, The California Wellness Foundation, and The Edna McConnell Clark Foundation.
The findings and conclusions presented in this report do not necessarily represent the official positions
or policies of the funders.
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