Saving Lives by Raising Wages

What if we could reduce infant mortality and lower health spending simultaneously? The annual cost of preterm or low weight births in the United States was estimated to exceed $26.2 billion in 2005. A new study provides a compelling argument about how to address these linked problems.

Kelli Komro and colleagues’ recent paper in the American Journal of Public Health (AJPH) demonstrates a compelling link between increased minimum wages and improved birth and post-neonatal outcomes in American infants (defined as infants aged 28 to 364 days). While there is robust evidence linking poverty and negative health outcomes, including low birth weight and infant mortality, little research has examined minimum wage and its connection with health outcomes.

The study’s authors took advantage of a natural experiment, building a dataset of 206 state-level minimum wage changes between 1980 and 2011. The study illustrated clear decreases in low birth weight births and in post-neonatal deaths when state minimum wage levels increased, even after controlling for a wide variety of factors. Specifically, low birth weight births were reduced by 1% to 2%, and post-neonatal deaths were reduced by 4%, for every one dollar a state minimum wage was higher than the federal minimum.

This study includes a charge to public health: “Public health professionals have long studied and long lamented the severe deleterious health effects of poverty. It is now time to move directly into developing, testing, and evaluating the health effects of specific public policies affecting poverty.”

While we don’t know that poverty is the only factor causing preterm births, it is strongly linked to that essential cause of low weight births and infant deaths.

U.S. infant health outcomes remain strikingly poor compared to peer nations. Six out of every 1,000 infants dies, as compared to between 2 and 4 out of every 1,000 infants in all major European countries. Similarly, 8% of US births are low birth weight compared to 6% in Canada and 6.4% in Europe. These differences are largely explained by the variation in preterm birth: 12% of US infants are born preterm compared to 7.8% in Canada and in the United Kingdom, 5.9% in Japan and Sweden, and 8.6% as an average of all wealthy nations.

While many factors influence preterm birth, poverty has been established as an independent risk factor in addition to its correlation with other major risk factors, including maternal age, race, substance use, stress, nutrition, and prenatal care. Research is needed to tease out whether poverty is the primary factor differentiating poor U.S. infant health outcomes from those of peer nations, but certainly the US poverty rate of 17% and child poverty rate of 23% are strikingly higher than Canada’s respective rates of 12% and 13.3% or Sweden’s rates of 8% and 7%.

The real value of the federal minimum wage has dropped significantly in the last 50 years – so much that minimum wage workers today earn 25% less than minimum wage workers a half-century ago. Working full time at the current federal minimum wage of $7.25/hour does not provide sufficient income to raise a family with two or more members above the federal poverty line, explaining the enormous difference in US child poverty rates compared with peer nations.

While we don’t know that poverty is the only factor causing preterm births, it is strongly linked to that essential cause of low weight births and infant deaths. If the current push to raise the federal minimum wage to $15/hour succeeds, Komro and colleagues’ findings suggest low birth weight could drop by more than 7%, and post-neonatal deaths could drop by a staggering 28% in states using federal minimum wage levels . While it’s unlikely minimum wage increase alone could lead to a 28% drop in infant deaths, there is every reason to believe the positive impact on infant outcomes of higher minimum wages would be boosted by a significant minimum wage increase.

Feature image: Melissa Hillier, Mabry, used under CC BY 2.0/cropped from original