New Preemption as a Tool of Structural Racism: Implications for Racial Health Inequities

Corporate influenced state preemption and health: A legal mapping analysis of workers' rights preemption bills in the US south

Work is a structural determinant of health. As local governments have taken the lead on implementing workers' rights policies, state governments have increasingly been using preemption to block local them. These policies would improve work and employment conditions, particularly for Black, Brown, immigrant, and low-wage workers. Thus, preemption of workers' right policies is an important health equity issue. Legal epidemiology methods were used to analyze and quantify worker's rights preemption bills introduced in southern state legislatures between 2009 and 2019. Between 2009 and 2019, over 100 workers' rights preemption bills were introduced in southern state legislatures, and there was significant variation between states. Preemption of local paid leave and minimum wage ordinances were the most common. Textual analysis of the bills revealed that states prioritize the perspectives of employers instead of workers. State labor policies are prioritizing the perspectives of businesses over workers resulting in a labor environment that creates structural advantages for employers and is hostile to the well-being of workers. Preemption is part of the political and social context that is shaping the association between work and health in and is likely re (creating) racial and economic inequities.

State Minimum Wage Increases As a Potential Policy Lever to Reduce Black-White Disparities in Hypertension

Introduction

Black adults are disproportionately burdened by hypertension. Income inequality is associated with elevated risk of hypertension. Minimum wage increases have been explored as a potential policy lever to address the disparate impact of hypertension on this population. However, these increases may have no significant impact on health among Black adults due to structural racism and "diminished gain" of health effects from socioeconomic resources. This study assesses the relationship between state minimum wage increases and Black-White disparities in hypertension.

Methods

We merged state-level minimum wage data with survey data from the Behavioral Risk Factor Surveillance System (2001-2019). Odd survey years included questions about hypertension. Separate difference-in-difference models estimated the odds of hypertension among Black and White adults in states with and without minimum wage increases. Difference-in-difference-in-difference models estimated the impact of minimum wage increases on hypertension among Black adults relative to White adults.

Results

As state wage limits increase, the odds of hypertension significantly decreased among Black adults overall. This relationship is largely driven by the impact of these policies on Black women. However, the Black-White disparity in hypertension worsened as state minimum wage limits increased, and the magnitude of this disparity was larger among women.

Conclusion

States having a minimum wage above the federal wage limit are not sufficient to combat structural racism and reduce the disparities in hypertension among Black adults. Rather, future research should explore livable wages as a policy lever to reduce disparities in hypertension among Black adults.

Considering multiple governance levels in epidemiologic analysis of public policies

Epidemiology is increasingly asking questions about the use of policies to address structural inequities and intervene on health disparities and public health challenges. However, there has been limited explicit consideration of governance structures in the design of epidemiologic policy analysis. To advance empirical and theoretical inquiry in this space, we propose a model of governance analysis in which public health researchers consider at what level 1) decision-making authority for policy sits, 2) policy is implemented, 3) and accountability for policy effects appear. We follow with examples of how these considerations might improve the evaluation of the policy drivers of population health. Consideration and integration of multiple levels of governance, as well as interactions between levels, can help epidemiologists design studies including new opportunities for quasi-experimental designs and stronger counterfactuals, better quantify the policy drivers of inequities, and aid research evidence and policy development work in targeting multiple levels of governance, ultimately supporting evidence-based policy making.