Answer: Frequently, community health initiatives, including collaborative activities, sometimes limit their vision and advocacy to policy changes related to health care and perhaps social services (Whittington et al., 2015). Communities—and the federal and state agencies that support them in their efforts to address health disparities—have multiple examples to follow in expanding their focus beyond health care and social services and examining opportunities in economic development, land use and housing, education, and criminal justice, areas which have not traditionally been the focus of health improvement efforts. Nevertheless, potential partners in those sectors are already working to improve outcomes, save money, and achieve other objectives that influence health. Examples include community development, justice reinvestment, and clean energy financing (Andrews et al., 2012; CSG, 2016; International Energy Agency, 2015). There are also policy changes that could be made at the federal and state level across non-health domains that would remove barriers or create opportunities for communities to promote health equity. The committee asserts that to attain health equity in the long term, policies that create structural barriers need to be addressed—addressing the root cause of the problem, not only treating the inequities that result. In this chapter, specific policies in six areas are discussed for their high relevance to community-based solutions that advance health equity: taxation and income inequality, housing and urban planning, education, civil rights, health, and criminal justice policy. As discussed in Chapter 3, income has been identified as one of many drivers of population health and health inequity over the life course, along with factors that are closely related to income such as education, occupation, and place of residence (Adler and Rehkopf, 2008; Chow et al., 2006; Cutler and Lleras-Muney, 2006).
The distribution of income is shaped by general economic conditions and by federal and state policies: most notably, taxes and government transfer programs such as Social Security, Supplemental Security Income (SSI), unemployment insurance, veterans’ benefits, food stamps, the Supplemental Nutrition Assistance Program (SNAP), and the free and reduced-price school meal program. Thus, an individual’s or a household’s income results from a combination of reinforcing factors, including market conditions, government transfers, and taxes. A longitudinal analysis by the Congressional Budget Office (CBO) (2016) reviews changes in income inequality over time and notes that there has been increasing inequality along several measures: market income, “before-tax” income, and “after-tax” income. Market income (e.g., wages, salaries, business income, investment income, retirement pensions, and other money income), which excludes government transfers, rose over a 35-year period from 1979 to 2013 but grew 188 percent for households in the top 1 percent and only 18 percent for the bottom four income quintiles.
Add a note to your bookmark
individual income taxes ($1.6 trillion) and payroll taxes ($1.1 trillion), with corporate income taxes ($300 billion) and other taxes playing smaller roles ($309 billion) (CBO, 2016). Over 35 years, households in the top 1 percent of the income distribution experienced an average 3 percent annual growth in inflation-adjusted, after-tax income compared with 1 percent for households in the bottom quintile. Thus, over 35 years, incomes at the top increased by 192 percent compared with an increase of 46 percent at the bottom. Half of tax offsets, including exclusions, deductions, preferential rates, and credits, go to those in the highest fifth of incomes (CBO, 2016). In 2013 average federal tax rates were below the 35-year average for most households, despite recent changes in tax law. Thus, across all three measures examined by the CBO, income inequality has grown substantially. These analyses also demonstrate the important role of government transfers and tax policy, as well as general economic conditions, in shaping income inequality.
HOPE THIS HELPS!!
Explanation:
