Women affected by U.S. welfare reform: considering health and its relationship to public policy

Abstract

The concept of environment is considered fundamental to the paradigm of nursing. Nurse scientists, however, often do not consider how public policy (other than "health" policy) in the broader socioeconomic environment affects health. Adopting an ecological health framework proposed by Milio (1981), this research examines how welfare policy influences the lives and health of women.Using secondary analysis as the research method, data from the Washington State Family Income Study were examined to determine whether there were differences in the psychosocial health of women leaving welfare for paid employment and those remaining on welfare. An additional question asked of the data was whether the Family Support Act (FSA) of 1988 (which provided childcare and extended health insurance benefits to women) was effective in increasing women's participation in job training and educational programs. Propensity score matching and multiple imputation procedures were applied to adjust for restrictions in the data set.No differences in psychosocial health were found between women leaving welfare for paid employment and those remaining on welfare ($p = {>}.05$ on all measures), although the psychosocial measures used limit the interpretation of this finding. Prior studies indicates the life circumstances of women leaving welfare for paid employment rarely improves, and, may even become more difficult. In this context, this finding is consistent with previous research.As a policy intended to increase participation in job training and employment programs, the FSA was found to be effective (p =.001, OR = 2.16) in increasing participation. With respect to this policy, although support services for women were provided, there were also constraints imposed on women's lives.The implications for nursing include broadening the concept of environment to include the socioeconomic and political environments, and considering methods such as secondary analysis as valid for use in the policy research arena. Increasing involvement in public policy research by nurses is imperative, as a better understanding of how policies such as those directed toward welfare reform influence women's health.