Community and Economic Development

Home » Closing the Divide:
Income-Related Approaches to Improving Health
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These approaches focus on improving the lives of low-income people while also improving the communities in which they live, learn, work and play. Local interventions matter: lower income people tend to live longer in places with a high concentration of college graduates and higher local government spending. Higher poverty rates point to places and populations that may benefit from the right set of interventions aimed at improving public health and creating a vibrant economy.

Adequate income to support basic needs and paid leave

The Colorado economy has experienced steady growth in recent years, but without broadly shared prosperity. Since 2000, the cost of living has increased three times faster than wages. And for the lowest paid workers in the state, inflation adjusted wages have been flat or falling for the last decade. Income gains from our growing economy have disproportionately gone to earners at the top of the income ladder.

Having an adequate income is a prerequisite for good health and thriving communities. Policies that directly increase income, such as raising the minimum wage and creating opportunities for asset building and retirement savings, are economic and public health policies. People who earn more income live longer, regardless of where they live. Income also makes a difference in how you start out in life. A recent analysis by the National Bureau of Economic Research concluded that raising the minimum wage reduces the likelihood of infants being born at a low birth weight.

Another important aspect of health is ensuring workers can take time off when they are sick or have sick family members. Nearly 43 percent of workers in Colorado do not have access to paid sick leave. Allowing workers to earn paid sick days promotes healthy families, communities and ultimately a healthy economy.

Equal opportunity for economic security

A growing economy characterized by equitable opportunity for economic security and health would see low rates of unemployment for all workers and equal pay for equal work regardless of race or ethnicity.

Regardless of the economic climate, Blacks and Latinos in Colorado tend to experience higher rates of unemployment and underemployment relative to White workers. (Underemployment counts unemployed workers along with people involuntarily working part-time jobs and those who have given up looking for work.) Median income among Latino and Black households lags significantly behind White households. In 2015, Latinos and Black workers earned just 65 percent of income earned by non-Hispanic White workers in Colorado.

Fig. 13: Work is more difficult to find for Latino and Black Coloradans
Unemployment and underemployment rates, by race and ethnicity, 2015

Source: U.S. Census Bureau Current Population Survey

Differences in pay and job quality by race and ethnicity result from differences in education, training and experience. These differences are also due to concrete barriers to employment for workers of color, such as English language skills, lack of transportation, criminal records and bias among employers and institutions. As people of color comprise a larger share of the labor force, their social and economic progress will increasingly determine the health and prosperity of the state. Addressing these barriers to equal opportunity is essential to the health of communities across the state and building a sustainable economy.

Close gender pay gap

Women earn less than men at every educational level and the gap widens with increasingly higher levels of education. Colorado women working full-time earn only 82 percent of what men earn. The gap grows substantially at the upper rungs of the education ladder, with the largest income gap existing at the highest levels of education.

Women of color in Colorado earn even less compared to non-Hispanic White men. Latina workers earn just 54 percent of White men followed closely by Native American women earning 58 percent and African American women earning 64 percent of White men.

Fig. 14: Gender wage gap is even greater for women of color in Colorado
Median Earnings by Gender, Race and Ethnicity, 2014

Women White Men Lifetime lost
All $41,690 $50,898 $368,300
Latina $31,221 $57,767 $1,061,800
Black $36,728 $57,767 $841,600
Native American $33,724 $57,767 $961,700
Asian $40,555 <$57,767 $688,500

Source: National Women’s Law Center

Women are more likely to live in poverty and poverty rates are highest among single mother families. Women also make up the majority of minimum wage workers. Policies aimed at closing the gender wage gap, such as increasing the minimum wage and providing paid leave, will positively improve the health and economic security of women and their children in the state.

Educational attainment

Higher levels of education are associated with lower morbidity from the most common diseases, such as heart disease, diabetes and hypertension. Education is also a key pathway out of poverty—another serious risk factor for poor health. Less than 5 percent of Coloradans with at least a bachelor’s degree live in poverty. On the other end of the education spectrum, nearly one-quarter of those without a high school diploma live in poverty.

Fig. 15: Education is a key pathway out of poverty
Poverty rates by educational attainment, 2015

Source: U.S. Census Bureau American Community Survey

Fig. 16: Educational attainment varies by race and ethnicity
Highest educational level completed, by race and ethnicity, 2014

Source: U.S. Census Bureau American Community Survey

Educational attainment in Colorado varies by race and ethnicity. Communities of color are more likely to stop their formal education at high school, while White and Asian Coloradans are more likely to have completed a bachelor’s degree or higher. Nearly one-third of Latinos have completed less than a high school education. These disparities in educational attainment are stubbornly persistent and defy easy explanation. We do know that struggling students are more likely to be low-income. And low-income student are more likely to attend struggling schools. These students leave school for a variety of reasons directly related to the circumstances in their lives—frequent family moves, caregiving responsibilities or the need to work. Others are pushed out due to discipline problems or academic struggles.

Finishing high school and seeking additional training is critical to financial security in today’s economy. The share of jobs that only require a high school diploma are shrinking in Colorado. By 2020, an estimated three-quarters of all jobs in Colorado will require some level of post-secondary training. Having access to training and education and understanding the career pathways that lead to better paying jobs is critical to our growing economy and the health of Colorado families.

Access to affordable housing

Affordable and safe housing is central to healthy and thriving families and communities. Access to affordable housing is a growing problem across the state. In 40 of Colorado’s 64 counties, more than 40 percent of families are rent burdened, meaning they spend more than 30 percent of their total household income on rent. One-quarter of all renter households in Colorado spend over half their income on housing. These households are at greatest risk of homelessness.

Map 4: High cost of housing is felt across the state
Percent of Population Paying Rent in Excess of 30 Percent of Household Income, 2010-2014

Source: U.S. Census Bureau American Community Survey

The cost and quality of housing are influenced by the community in which it is located. Black and Latino Coloradans are substantially more likely to live in high-poverty communities (defined as neighborhoods with a poverty rate of 20 percent or higher). While 15 percent of Whites live in neighborhoods marked by high poverty, 42 percent of Blacks and 40 percent Latinos live in these neighborhoods. The clustering of low-income families in poverty can amplify the experience of living in poverty. Being surrounded by widespread poverty compounds the stress of living in economic hardship and can make it feel more pervasive because it extends outside the home and touches the entire community.

Fig. 17: Larger share of Latino and Black Coloradans live in high poverty neighborhoods
Percent of population living in concentrated poverty, by race and ethnicity, 2014

Source: U.S. Census Bureau American Community Survey

Fig. 18: Children of color are more likely to attend high poverty schools
Percent of students attending high poverty schools, by race and ethnicity, 2014

Source: National Center for Education Statistics

Given disproportionate rates of living in concentrated poverty, it follows that children of color are also more likely to attend high-poverty schools (where 75 percent of students are eligible for free or reduced price lunch). Nearly one-third of students of color in Colorado attended high-poverty schools in 2014 compared to less than 5 percent of White students. Recent analysis of test scores across thousands of school districts found that schools with the highest concentrations of kids living in poverty score on average four grade levels below their peers in the wealthiest school districts. Over half the achievement gap can be explained by racial or ethnic differences in exposure to poverty.

The toxic effect of concentrated poverty on children and families and the power of mobility and community investment to interrupt intergenerational poverty are now well documented. Zip code more than genetic code determines health outcomes for low-income families. Policies that expand access to affordable housing and reduce the burden of rent on low-income families can free up more family and financial resources for children, reduce the risk of homelessness and result in healthier outcomes. Infrastructure investments benefiting entire communities—such as access to mass transit options, health services, parks and healthy food options—can improve the health of entire communities.

Poverty reduction policies are public health policies

The Centers for Disease Control and Prevention has found that the broadest influence on health outcomes is not to deliver more health care (as important as that is) but rather from changing the context of people’s lives. As illustrated in the vignettes that accompany this report, helping people manage the circumstances of their lives directly influences their ability to be the healthiest person they can be.

Chronic diseases go untreated when transportation to a health clinic is unaffordable or unavailable. Eating well takes a back seat to paying rent when the alternative is eviction.

Early childhood education, well-resourced schools, connection to training that leads to a job paying adequate income, access to healthy food, transportation options along with safe and affordable housing all belong in the poverty reduction and health care tool boxes.

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