Raising minimum wage good for public health, not just wallets: Advocates call for federal increase
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* Kim Krisberg

Last year, Minnesota legislators successfully enacted a raise in the minimum wage, taking Minnesota from one of the lowest-paying minimum wage states to one of the highest. State Health Commissioner Edward Ehlinger described the move as the greatest legislative victory of the year.

![Figure1](http://www.thenationshealth.org/http://www.thenationshealth.org/content/nathealth/45/2/1.1/F1.medium.gif)

[Figure1](http://www.thenationshealth.org/content/45/2/1.1/F1)

Ni’Jean Gibson, right, assists a customer in February 2014 at a Gap store in San Francisco. The company raised its minimum wage in June. Advocates are calling Congress to do the same, citing the relationship between income and health.

Photo by Justin Sullivan, courtesy Getty Images

“I’d argue that it was the biggest public health achievement in that legislative session — and probably in the four years I’ve been health commissioner,” Ehlinger, MD, MSPH, an APHA member, told *The Nation’s Health*. “Even the tobacco tax increase the year before is not as powerful as the minimum wage increase.”

In August, thousands of low-wage workers in Minnesota experienced the first in a series of incremental wage increases that will eventually reach $9.50 per hour by mid-2016. Prior to the new law, the state’s minimum wage for large employers was just $6.15 an hour — significantly lower than the federal minimum wage of $7.25. Small employers will raise their minimum wage to $7.75 by mid-2016, as well.

In the run-up to the vote, Ehlinger and his colleagues at the Minnesota Department of Health played an active role in educating policymakers and the public on the health benefits of raising the minimum wage and the evidence-based associations between income and health status.

Just a few months before the vote, the health department released a white paper on income and health, which showed that income is not only tied to health, but to the factors that create the opportunities for better health, such as safe homes, nutritious foods and good schools.

“If you look at the conditions that impact health, income is right at the top of the list,” Ehlinger said. “Anything we can do to help enhance economic stability will have a huge public health benefit. This is a major public health issue.”

The movement to raise the minimum wage has experienced great momentum in recent years, especially at the state and local levels. In 2014, lawmakers in 10 states and Washington, D.C., enacted minimum wage increases, while voters in four states approved ballot measures. A number of localities have taken action as well — for example, Seattle’s City Council voted last year to raise its minimum wage to $15 an hour, making it the highest in the nation. At the national level, President Barack Obama took executive action to raise the minimum wage to $10.10 for federal contract workers; similar legislation to raise the federal minimum wage for all Americans has stalled in Congress. APHA has shown support for raising the minimum wage, including advocacy on a Senate bill last year that would have increased it nationally. The issue is expected to come up again in Congress.

For a growing chorus of public health practitioners, raising the minimum wage is a fundamental step in addressing two key determinants of health: income and poverty.

“Income affects everything,” said Rajiv Bhatia, MD, MPH, founder and director of the Civic Engine, a consulting group focused on health and sustainability. “Income may not be the strongest risk factor for any particular disease or outcome, but it’s a risk factor for all of them.”

Bhatia previously worked at the San Francisco Department of Public Health, where he led an assessment on the health benefits of a local living wage ordinance that would raise the hourly wage to $11. The study, which was published in 2001 in APHA’s *American Journal of Public Health,* found that the wage increase would decrease the risk of premature death by 5 percent for adults ages 24 to 44 living in households with an income of about $20,000. In addition, the children of such workers would experience substantially increased odds of high school completion and a 22 percent decrease in the risk of early childbirth.

More recently, Bhatia authored a 2014 report for Human Impact Partners on a legislative proposal to raise California’s minimum wage to $13 by 2017. That report, “Health Impacts of Raising California’s Minimum Wage,” found that the wage increase would prevent nearly 400 premature deaths among lower-income Californians each year. The report also noted that nationwide, people with incomes above the federal poverty line typically live more than five years longer than those below the poverty line. Bhatia noted that growing public outcry to raise wages for those at the bottom of the economic ladder presents public health practitioners with the perfect opportunity to speak out.

“When the public is calling for something, you have a safe path to get behind it,” he told *The Nation’s Health*. “I think this is an interesting test for public health.”

Indeed, a number of local minimum wage campaigns have attracted the support of health organizations. In Illinois, the AIDS Foundation of Chicago is a coalition member of Raise Illinois, a campaign to increase the state minimum wage to $10.65. According to Suraj Madoori, MPH, MSJ, MA, manager of the foundation’s HIV Prevention Justice Alliance, supporting the campaign was a natural fit, as the research shows that “poverty and HIV go hand in hand — HIV is becoming a disease of poverty in many ways, especially in communities of color.

“You can raise your health status and lower your risk for so many other conditions because you don’t face the psychological stress of trying to find housing or making sure your family can eat,” he said. “By having the ability to get out of poverty, you can really think beyond those basic needs.”

To the west in Oakland, California, the Street Level Health Project joined the steering committee of Lift Up Oakland, which campaigned in support of a successful 2014 ballot measure that raised the minimum wage to $12.25. Joel Aguiar, interim executive director of the Street Level Health Project, which provides health and social services to underserved immigrant communities, said the additional income will have a “huge effect” on the ability of low-wage immigrant workers to care for their health. “It’ll mean someone who might not have been able to pay rent one month will not become homeless,” Aguiar said. “This isn’t just a workers’ rights issue — this is a public health issue.”

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[Figure2](http://www.thenationshealth.org/content/45/2/1.1/F2)

President Barack Obama greets a Costco bakery worker in January 2014 in Lanham, Maryland. Obama has called on Congress to raise the minimum wage, but legislation has stalled.

Photo by Mike Theiler, courtesy Getty Images

Unfortunately, minimum wage campaigns rarely go unopposed, with opponents arguing that wage increases are bad for business. However, the U.S. Department of Labor cites research finding that minimum wage increases have no “discernable effect” on employment, and that most small business owners believe higher wages are offset by decreased employee turnover and increased consumer spending power. In fact, research is finding that higher wages also benefit state health care spending.

In an October 2014 report from the Center for American Progress, “A Win-Win for Working Families and State Budgets: Pairing Medicaid Expansion and a $10.10 Minimum Wage,” authors found that higher minimum wages reduce enrollment in traditional Medicaid — the portion of the health insurance program in which states pay a substantial share.

Combined with an expansion in Medicaid eligibility, which was authorized via the Affordable Care Act and funded via federal dollars, a $10.10 minimum wage would reduce states’ pre-health reform Medicaid spending by more than $2.5 billion each year, the report found.

“The public health community may not feel like it has a set of tools to advocate for policies that raise wages,” said report co-author Rachel West, MPP, senior policy analyst with the Poverty to Prosperity Program at the Center for American Progress. “But with Medicaid expansion — this is one policy that directly addresses economic challenges and builds a bridge to health care access.”

For APHA member Rex Archer, MD, MPH, director of health for the Kansas City, Missouri, Health Department, achieving a “living wage has become one of the most important public health issues for us, period.” According to Archer, 47 percent of annual deaths in Kansas City are attributable to six root social factors, including individual- and community-level poverty and income inequality. In fact, average life expectancy varies by more than 10 years across Kansas City ZIP codes, with those at the bottom rung characterized by much higher rates of poverty and much lower family incomes.

“We can’t treat our way out of this problem,” he said. “We can’t ignore the stress of not having a living wage and what that’s doing to our population.”

To learn more about efforts to raise the U.S. minimum wage, visit [www.raisetheminimumwage.com](http://www.raisetheminimumwage.com).

*   Copyright The Nation’s Health, American Public Health Association