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. 2013 Aug 6;2013(8):CD009963.
doi: 10.1002/14651858.CD009963.pub2.

In-work tax credits for families and their impact on health status in adults

Frank Pega  1 , Kristie Carter, Tony Blakely, Patricia J Lucas
Affiliations

In-work tax credits for families and their impact on health status in adults

Frank Pega et al. Cochrane Database Syst Rev. .

Abstract

Background: By improving two social determinants of health (poverty and unemployment) in low- and middle-income families on or at risk of welfare, in-work tax credit for families (IWTC) interventions could impact health status and outcomes in adults.

Objectives: To assess the effects of IWTCs on health outcomes in working-age adults (18 to 64 years).

Search methods: We searched 16 electronic academic databases, including the Cochrane Public Health Group Specialised Register, Cochrane Database of Systematic Reviews (The Cochrane Library 2012, Issue 7), MEDLINE and EMBASE, as well as six grey literature databases between July and September 2012 for records published between January 1980 and July 2012. We also searched key organisational websites, handsearched reference lists of included records and relevant journals, and contacted academic experts.

Selection criteria: We included randomised and quasi-randomised controlled trials and cohort, controlled before-and-after (CBA) and interrupted time series (ITS) studies of IWTCs in working-age adults. Included primary outcomes were: self rated general health; mental health/psychological distress; mental illness; overweight/obesity; alcohol use and tobacco use.

Data collection and analysis: Two review authors independently extracted data and assessed the risk of bias in included studies. We contacted study authors to obtain missing information.

Main results: Five studies (one CBA and four ITS) comprising a total of 5,677,383 participants (all women) fulfilled the inclusion criteria and were synthesised narratively. The in-work tax credit intervention assessed in all included studies is the permanent Earned Income Tax Credit in the United States, established in 1975. This intervention distributed nearly USD 62 billion to over 27 million individuals in 2011, and its administration costs were less than one per cent of its total costs. All included studies carried a high risk of bias (especially from confounding and insufficient control for underlying time trends). Due to the small number of (observational) studies and their high risk of bias, we judged this body of evidence to have very low overall quality.One study found that IWTC had no detectable effect on self rated general health and mental health/psychological distress five years after its implementation (i.e. a considerable change in the generosity of the permanent IWTC) and on overweight/obesity eight years after implementation. One study found no effect of IWTC on tobacco use five years after implementation, one a moderate reduction in tobacco use one year after implementation (odds ratio 0.95, 95% confidence interval (CI) 0.94 to 0.96), and one differential effects, with no effect in African-Americans and a large reduction in European-Americans two years after implementation (risk difference -11.1%, 95% CI -20.9% to -1.3%). No evidence was available for the effect of IWTC on mental illness and alcohol use. No adverse effects of IWTC were identified.One study also found no detectable effect of IWTC on the number of bad physical health days and of risky biomarkers for inflammation, cardiovascular disease and metabolic conditions eight years after implementation. One study found that IWTC had a large, positive effect on income from wages or salaries one year after implementation. Two studies found no effect on employment two and five years after implementation, whereas two found a moderate increase five and eight years after implementation and one a large increase in employment due to IWTC one year after implementation.No differences in outcomes between groups with different educational status were found for self rated health and mental health/psychological distress. In one study European-American women with lower levels of education were more likely to reduce tobacco use, while tobacco use did not change among African-American women with lower levels of education. However, no differences in tobacco use by educational status were observed in a second study. Two studies found that the intervention may have reduced inequity with respect to employment, where women with less education were more likely to move into employment (although one did not establish whether this difference was statistically significant), while two studies found no such difference and no studies found differences by ethnic group on employment rates.

Authors' conclusions: In summary, the small and methodologically limited existing body of evidence with a high risk of bias provides no evidence for an effect of in-work tax credit for families interventions on health status (except for mixed evidence for tobacco smoking) in adults.

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Conflict of interest statement

No known potential conflicts of interest exist. In varied capacities, the authors involved in this review are currently employed or receive grants or scholarships to work on research investigating the impact of social policy on health that could potentially be included in future updates of this review.

Figures

1
1
Conceptual framework of the relationship between in‐work tax credit and health.
2
2
Study flow diagram. Notes: aECOSOC Dialogues at the Economic and Social Council series;b ILO working papers; cOECD Health Working Papers (n = 58), OECD Taxation Working Papers (n = 10) and OECD Social, Employment, and Migration Working Papers (n = 129) series; d World Bank briefing papers, policy papers, publications, research papers and studies indexed under the Health, Nutrition, and Population (n = 66) and Social Protections and Labour (n = 129) topic areas.
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References

References to studies included in this review

Averett 2012 {published data only}
    1. Averett SL, Wang Y. The Effects of EITC Payment Expansion on Maternal Smoking. Discussion Paper No. 6680. Bonn, Germany: Institute for the Study of Labor (IZA), 2012.
    1. Averett SL, Wang Y. The effects of EITC payment expansion on maternal smoking. Health Economics 2012 Dec 13 [Epub ahead of print]. [DOI: 10.1002/hec.2886] - DOI - PubMed
Cowan 2011 {published data only}
    1. Cowan B, Tefft N. Education, Maternal Smoking, and the Earned Income Tax Credit. Working paper. Pullman, WA & Lewiston, ME: School of Economic Sciences, Washington State University & Department of Economics, Bates College, 2012.
    1. Cowan B, Tefft N. The Effect of Earned Income Tax Credit Expansions on Smoking Behavior of Women. Working paper. Pullman, WA & Lewiston, ME: School of Economic Sciences, Washington State University & Department of Economics, Bates College, 2011.
Evans 2011 {published data only}
    1. Evans WN, Garthwaite C. Giving Mom a Break: The Impact of Higher EITC Payments on Maternal Health. Working paper. Notre Dame, IN & Evanston, IL: University of Notre Dame & Northwestern University, 2011.
Gomis‐Porqueras 2011 {published data only}
    1. Gomis‐Porqueras P, Mitnik OA, Peralta‐Alva A, Schmeiser MD. The Effects of Female Labor Force Participation on Obesity. Federal Reserve Bank of St. Louis Working Paper 2011‐035A. St. Louis: Federal Reserve Bank of St. Louis, 2011.
Strully 2010 {published data only}
    1. Strully KW, Rehkopf DH, Xuan Z. Effects of prenatal poverty on infant health: State Earned Income Tax Credits and birth weight. American Sociological Review 2010;75(4):534‐62. - PMC - PubMed

References to studies excluded from this review

Ajrouch 2010 {published data only}
    1. Ajrouch KJ, Reisine S, Lim S, Sohn W, Ismail A. Situational stressors among African‐American women living in low‐income urban areas: The role of social support. Women & Health 2010;50(2):159‐75. - PubMed
Alegria 2003 {published data only}
    1. Alegria M, Perez DJ, Williams S. The role of public policies in reducing mental health status disparities for people of color. Health Affairs 2003;22(5):51‐64. - PubMed
Arno 2009 {published data only}
    1. Arno PS, Sohler N, Viola D, Schechter C. Bringing health and social policy together: The case of the Earned Income Tax Credit. Journal of Public Health Policy 2009;30(2):198‐207. - PMC - PubMed
Baker 1999 {published data only}
    1. Baker D, North K. Does employment improve the health of lone mothers?. Social Science & Medicine 1999;49(1):121‐31. - PubMed
Greenberg 2009 {published data only}
    1. Greenberg D. Chapter 12: Welfare‐to‐work and work‐incentive programs. In: Weimer DL, Vining AR editor(s). Investing in the Disadvantaged: Assessing the Benefits and Costs of Social Policies. Washington, DC: Georgetown University Press, 2009:205‐18.
Gregg 2007 {published data only}
    1. Gregg P, Harkness S, Smith S. Welfare Reform and Lone Parents in the UK. Working Paper No. 07/182. Bristol: The Centre for Market and Public Organisation, 2007.
    1. Gregg P, Harkness S, Smith S. Welfare reform and lone parents in the UK. Economic Journal 2009;19(535):F38‐F65.
Hoynes 2011 {published data only}
    1. Hoynes HW, Miller DL, Simon D. Income, the Earned Income Tax Credit, and Infant Health. Davis, CA: University of California, Davis, 2011.
Kenkel 2011 {published data only}
    1. Kenkel DS, Schmeiser MD, Urban C. Is smoking inferior? Evidence from variation in the Earned Income Tax Credit. Available from: http://dx.doi.org/10.2139/ssrn.1961196) 2011.
Kneipp 2000 {published data only}
    1. Kneipp SM. The health of women in transition from welfare to employment. Western Journal of Nursing Research 2000;22(6):656‐82. - PubMed
Larrimore 2011 {published data only}
    1. Larrimore J. Does a higher income have positive health effects? Using the Earned Income Tax Credit to explore the income‐health gradient. The Milbank Quarterly 2011;89(4):694‐727. - PMC - PubMed
Martin 2012 {published data only}
    1. Martin CT, Keswick JL, Crayton D, Leveck P. Perceptions of self‐esteem in a welfare‐to‐wellness‐to‐work program. Public Health Nursing 2012;29(1):19‐26. - PubMed
Pollack 2006 {published data only}
    1. Pollack HA, Reuter P. Welfare receipt and substance‐abuse treatment among low‐income mothers: The impact of welfare reform. American Journal of Public Health 2006;96(11):2024‐31. - PMC - PubMed
Rehkopf 2011 {published data only}
    1. Rehkopf D, Strully K, Dow W. The impact of poverty reduction policy on child and adolescent overweight: A quasi‐experimental analysis of the Earned Income Tax Credit. American Journal of Epidemiology 2011;173:S238.
Rodriguez 2001 {published data only}
    1. Rodriguez E, Frongillo EA, Chandra P. Do social programmes contribute to mental well‐being? The long‐term impact of unemployment on depression in the United States. International Journal of Epidemiology 2001;30(1):163‐70. - PubMed
Rodriguez 2006 {published data only}
    1. Rodriguez E, Chandra P. Alcohol, employment status, and social benefits: One more piece of the puzzle. American Journal of Drug and Alcohol Abuse 2006;32(2):237–59. - PubMed
Schmeiser 2009 {published data only}
    1. Schmeiser MD. Three Essays on Obesity, Poverty, and the Labour Market. New York: Cornell University, 2008.
    1. Schmeiser MD. Expanding wallets and waistlines: The impact of family income on the BMI of women and men eligible for the Earned Income Tax Credit. Health Economics 2009;18(11):1277‐94. - PubMed
Zabkiewicz 2010 {published data only}
    1. Zabkiewicz D. The mental health benefits of work: Do they apply to poor single mothers?. Social Psychiatry and Psychiatric Epidemiology 2010;45(1):77‐87. - PubMed

References to ongoing studies

Pega 2013 {unpublished data only}
    1. The Tax Credit and Health Study. Ongoing study 2010.

Additional references

Bambra 2005
    1. Bambra C, Whitehead M, Hamilton V. Does 'welfare‐to‐work' work? A systematic review of the effectiveness of the UK's welfare‐to‐work programmes for people with a disability or chronic illness. Social Science & Medicine 2005;60(9):1905‐18. [PUBMED: 15743642] - PubMed
Bambra 2010
    1. Bambra C, Gibson M, Sowden A, Wright K, Whitehead M, Petticrew M. Tackling the wider social determinants of health and health inequalities: Evidence from systematic reviews. Journal of Epidemiology and Community Health 2010;64(4):284‐91. [PUBMED: 19692738] - PMC - PubMed
Barrientos 2011
    1. Barrientos A. Social protection and poverty. International Journal of Social Welfare 2011;20(3):240‐9.
Bartley 2004
    1. Bartley M, Sacker A, Clarke P. Employment status, employment conditions, and limiting illness: Prospective evidence from the British household panel survey 1991‐2001. Journal of Epidemiology and Community Health 2004;58(6):501‐6. - PMC - PubMed
Benach 2010a
    1. Benach J, Solar O, Santana V, Castedo A, Chung H, Muntaner C, EMCONET Network. A micro‐level model of employment relations and health inequalities. International Journal of Health Services: Planning, Administration, Evaluation 2010;40(2):223‐7. - PubMed
Benach 2010b
    1. Benach J, Solar O, Vergara M, Vanroelen C, Santana V, Castedo A, et al. EMCONET Network. Six employment conditions and health inequalities: A descriptive overview. International Journal of Health Services: Planning, Administration, Evaluation 2010;40(2):269‐80. - PubMed
Benzeval 2001
    1. Benzeval M, Judge K. Income and health: The time dimension. Social Science & Medicine 2001;52(9):1371‐90. - PubMed
Black 2009
    1. Black J, Hashimzade N, Myles G. A Dictionary of Economics. 3rd Edition. New York: Oxford University Press, 2009.
Bureau of Labor Statistics 2013
    1. Bureau of Labor Statistics. Economic News Release: County Employment and Wages Summary. Washington, DC: United States Department of Labor, 2013.
Campbell & Cochrane Equity Methods Group 2011
    1. Campbell & Cochrane Equity Methods Group. Equity Checklist for Systematic Review Authors. Campbell & Cochrane Equity Methods Group, 2011.
Cebulla 2005
    1. Cebulla A, Ashworth K, Greenberg D, Walker R. Welfare‐to‐work: New Labour and the US Experience. Aldershot and Burlington: Ashgate Publishing Limited, 2005.
Cochrane 2012
    1. The Cochrane Collaboration. Glossary. http://www.cochrane.org/glossary 2012.
Cochrane EPOC 2012a
    1. Cochrane Effective Practice and Organization of Care Group. EPOC‐specific resources for review authors. http://epocoslo.cochrane.org/epoc‐specific‐resources‐review‐authors 2012.
Cochrane EPOC 2012b
    1. Cochrane Effective Practice and Organization of Care Group. Suggested risk of bias criteria for EPOC reviews. http://epocoslo.cochrane.org/sites/epocoslo.cochrane.org/files/uploads/S... 2012.
Cochrane PHG 2011
    1. Cochrane Public Health Group. Guide for Developing a Cochrane Protocol. Cochrane Public Health Group, 2011.
Connor 1999
    1. Connor J, Rodgers A, Priest P. Randomised studies of income supplementation: A lost opportunity to assess health outcomes. Journal of Epidemiology and Community Health 1999;53(11):725‐30. - PMC - PubMed
CSDH 2008
    1. Commission on Social Determinants of Health. Closing the Gap in a Generation: Health Equity Through Addressing the Social Determinants of Health. Geneva: World Health Organization, 2008.
Farrell 2003
    1. Farrell C, O'Connor W. Low‐income Families and Household Spending. Department for Work and Pensions Research Report No. 192. London: TCO, 2003.
Gao 2009
    1. Gao Q, Kaushal N, Waldfogel J. How have expansions in the earned income tax credit affected family expenditures?. In: Ziliak JP editor(s). Welfare Reform and its Long Term Consequences for America's Poor. Cambridge: Cambridge University Press, 2009.
Gibson 2012
    1. Gibson M, Thomson H, Banas K, Bambra C, Fenton C, Bond L. Welfare to work interventions and their effects on health and well‐being of lone parents and their children. Cochrane Database of Systematic Reviews 2012, Issue 5. [DOI: 10.1002/14651858.CD009820] - DOI
Glennerster 2009
    1. Glennerster H, Bradshaw J, Lister R, Lundberg O. The Report of the Social Protection Task Force: Task Group Submission to the Marmot Review. London: University College London, 2009.
Gregg 2006
    1. Gregg P, Waldfogel J, Washbrook E. Family expenditures post‐welfare reform in the UK: Are low‐income families starting to catch up?. Labour Economics 2006;13(6):699‐720.
Higgins 2011
    1. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Holtzblatt 1999
    1. Holtzblatt J, Liebmann JB. The earned income tax credit abroad: Implications of the British working families tax credit for pay‐as‐you‐earn administration. Proceedings of the National Tax Association. 1999:198‐207.
ILO 2006
    1. International Labour Organization. The social protection floor. www.ilo.org/gimi/gess/ShowTheme.do?tid=1321 2006.
ILO 2012
    1. International Labour Organization. Global Employment Trends 2012: Preventing a Deeper Jobs Crisis. Geneva: International Labour Organization, 2012.
Imlach Gunasekara 2011
    1. Imlach Gunasekara F, Carter K, Blakely T. Change in income and change in self‐rated health: Systematic review of studies using repeated measures to control for confounding bias. Social Science & Medicine 2011;72(2):193‐201. [PUBMED: 21146277] - PubMed
Immervoll 2009
    1. Immervoll H, Pearson M. A Good Time for Making Work Pay? Taking Stock of In‐work Benefits and Related Measures Across the OECD. OECD Social, Employment and Migration Working Papers, No. 81. Paris: OECD Publishing, 2009.
Jin 1997
    1. Jin RL, Shah CP, Svoboda TJ. The impact of unemployment on health: A review of the evidence. Journal of Public Health Policy 1997;18(3):275‐301. - PMC - PubMed
Joyce 2010
    1. Joyce K, Pabayo R, Critchley JA, Bambra C. Flexible working conditions and their effects on employee health and wellbeing. Cochrane Database of Systematic Reviews 2010, Issue 2. [DOI: 10.1002/14651858.CD008009.pub2] - DOI - PMC - PubMed
Kaushal 2007
    1. Kaushal N, Gao Q, Waldfogel J. Welfare reform and family expenditures: How are single mothers adapting to the new welfare and work regime?. Social Service Review 2007;81(3):369‐96.
Lorenc 2012
    1. Lorenc T, Petticrew M, Welch V, Tugwell P. What types of interventions generate inequalities? Evidence from systematic reviews. Journal of Epidemiology and Community Health 2013;67(2):190‐3. - PubMed
Lucas 2008
    1. Lucas PJ, McIntosh K, Petticrew M, Roberts H, Shiell A. Financial benefits for child health and well‐being in low income or socially disadvantaged families in developed world countries. Cochrane Database of Systematic Reviews 2008, Issue 2. [DOI: 10.1002/14651858.CD006358.pub2] - DOI - PMC - PubMed
Ludbrook 2004
    1. Ludbrook A, Porter K. Do interventions to increase income improve the health of the poor in developed economies and are such policies cost effective?. Applied Health Economics and Health Policy 2004;3(2):115‐20. [PUBMED: 15702949] - PubMed
Lundberg 2008
    1. Lundberg O, Aberg Yngwe M, Stjärne MK, Elstad JI, Ferrarini T, et al. NEWS Nordic Expert Group. The role of welfare state principles and generosity in social policy programmes for public health: An international comparative study. Lancet 2008;372(9650):1633‐40. - PubMed
Lundberg 2010
    1. Lundberg O, Fritzell J, Aberg Yngwe M, Kölgard ML. The potential power of social policy programmes: Income redistribution, economic resources and health. International Journal of Social Welfare 2010;19:S2‐S13.
Marmot 2010
    1. Marmot M, Allen J, Goldblatt P, Boyce T, McNeish D, Grady M, et al. Fair Society, Healthy Lives: The Marmot Review. The Marmot Review, 2010.
McDonough 2005
    1. McDonough P, Sacker A, Wiggins RD. Time on my side? Life course trajectories of poverty and health. Social Science & Medicine 2005;61(8):1795‐808. - PubMed
Morris 1994
    1. Morris JK, Cook DG, Shaper AG. Loss of employment and mortality. BMJ 1994;308(6937):1135‐9. - PMC - PubMed
OECD 2011a
    1. Organization for Economic Co‐operation and Development. Society at a Glance 2011: OECD Social Indicators. Paris: Organization for Economic Co‐operation and Development, 2011.
OECD 2011b
    1. Organization for Economic Co‐operation and Development. Divided We Stand: Why Inequalities Keep Rising. Paris, France: Organization for Economic Co‐operation and Development, 2011.
Paz‐Fuchs 2008
    1. Paz‐Fuchs A. Welfare to Work: Conditional Rights in Social Policy. Oxford and New York: Oxford University Press, 2008.
Pega 2012a
    1. Pega F, Blakely T, Carter K, Sjöberg O. The explanation of a paradox? A commentary on Mackenbach with perspectives from research on financial credits and risk factor trends. Social Science & Medicine 2012;75(4):770‐3. - PubMed
Pega 2012b
    1. Pega F, Carter K, Blakely T, Lucas P. In‐work tax credits for families and their impact on health status in adults. Cochrane Database of Systematic Reviews 2012, Issue 7. [DOI: 10.1002/14651858.CD009963] - DOI - PMC - PubMed
RevMan 2011 [Computer program]
    1. The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.1. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2011.
Robins 2000
    1. Robins JM, Hernan MA, Brumback B. Marginal structural models and causal inference in epidemiology. Epidemiology 2000;11(5):550‐60. - PubMed
Saunders 2005
    1. Saunders P. Welfare to Work in Practice: Social Security and Participation in Economic and Social Life. Vol. 10, Aldershot and Burlington: Ashgate Publishing Limited, 2005.
Schuring 2011
    1. Schuring M, Mackenbach J, Voorham T, Burdorf A. The effect of re‐employment on perceived health. Journal of Epidemiology and Community Health 2011;65(7):639‐44. - PubMed
Sjöberg 2010
    1. Sjöberg O. Social insurance as a collective resource: Unemployment benefits, job insecurity and subjective well‐being in a comparative perspective. Social Forces 2010;88(3):1281‐304.
Skivington 2010
    1. Skivington K, McCartney G, Thomson H, Bond L. Challenges in evaluating welfare to work policy interventions: Would an RCT design have been the answer to all our problems?. BMC Public Health 2010;10:254. - PMC - PubMed
Slater 2011
    1. Slater R. Cash transfers, social protection and poverty reduction. International Journal of Social Welfare 2011;20(3):250‐9.
Spencer 2004
    1. Spencer N. The effect of income inequality and macro‐level social policy on infant mortality and low birthweight in developed countries: A preliminary systematic review. Child: Care, Health and Development 2004;30(6):699‐709. - PubMed
Statistics New Zealand 2012
    1. Statistics New Zealand. New Zealand Income Survey: June 2012 quarter. Wellington: Statistics New Zealand, 2012.
The World Bank 2011
    1. The World Bank. Global Monitoring Report 2011: Improving the Odds of Achieving the MDGs. Washington DC: The International Bank for Reconstruction and Development/The World Bank, 2011.
UNDP 2011a
    1. United Nations Development Program. Human Development Report 2011: Sustainability and Equity: A better Future for All. New York, NY: United Nations Development Program, 2011.
UNDP 2011b
    1. United Nations Development Program and International Labour Organization. Successful Social Protection Floor Experiences. United Nations Development Program and International Labour Organization, 2011.
United States Department of Treasury 2012
    1. United States Department of Treasury. About EITC. http://www.eitc.irs.gov/central/abouteitc/ 2012.
UNRISD 2010
    1. United Nations Research Institute for Social Development. Combating Poverty and Inequality: Structural Change, Social Policy and Politics. Geneva, Switzerland: United Nations Research Institute for Social Development, 2010.
Waldfogel 2007
    1. Waldfogel J. Welfare Reform and Child Well‐being in the US and the UK. London: Centre for Analysis of Social Exclusion, London School of Economics, 2007.
Waldfogel 2009
    1. Waldfogel J, Lucas PJ, Petticrew M, Roberts HM. Commentary on 'Financial benefits for child health and well‐being in low income or socially disadvantaged families in developed world countries' with a response from the review authors. Evidence‐Based Child Health: A Cochrane Review Journal 2009;4(2):1138‐9. - PMC - PubMed
WHO 2011
    1. World Health Organization. Closing the Gap: Policy into Practice on Social Determinants of Health: Discussion paper. Geneva: World Health Organization, 2011.
Wilkinson 2009
    1. Wilkinson RG, Pickett K. The Spirit Level: Why More Equal Societies Almost Always Do Better. London: Allen Lane, 2009.

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