Our November issue: Economic support for COVID-19 and more

The Coronavirus Relief, Assistance, and Economic Security (CARES) Act passed in March 2020 provided various types of temporary assistance to millions of Americans. The November issue of Health matters includes articles examining the health impact of several economic security policies, some funded by CARES.

The Economic Security Articles were supported by the Blue Shield of California Foundation and the Episcopal Health Foundation.

Featured articles highlighted and described below:

Paid sick leave reduces vaccine disparities.

The US is one of the few wealthy nations that does not have a national paid leave program. As cities, counties, and states fill the gap by creating their own paid leave laws, there is wide variation in access to paid sick leave. To understand whether U.S. cities with paid sick leave laws would have higher COVID-19 vaccination coverage and smaller coverage gaps than those without these policies, Drexel University’s Alina Schnacke-Mahl and coauthors reviewed data on county-level vaccination and paid sick leave policy data from thirty-seven large US cities for 2021. They found that after controlling for demographic, political, and health system differences, cities with paid sick leave policies had 17 percent higher rates of vaccination coverage against COVID-19 than cities without these policies. According to the authors, differences in vaccination rates between less and more vulnerable neighborhoods were also smaller in cities with paid sick leave policies. The authors note that the 2022 US national COVID-19 plan includes an emphasis on vaccination and requires employers to provide paid leave to employees. However, in the absence of a national policy, the researchers conclude that the lack of paid sick leave may act as a structural barrier to vaccination uptake, particularly in the most vulnerable neighborhoods, and that state and local paid sick leave policies may help remove this barrier and promote absorption of the vaccine.

Unequal access to supplemental unemployment insurance during COVID-19 has affected health.

Research shows that receiving unemployment insurance reduces psychological stress. However, previous work has also shown racial and ethnic disparities in receiving unemployment benefits that result from differences in work history and geography. To better understand the impact of receiving unemployment benefits during COVID-19, Elizabeth Oltmans Annath of Barnard College and co-authors surveyed groups of hourly workers with similar work histories working in retail, restaurant, or hospitality positions at a and also place, Philadelphia, Pennsylvania. The data was collected between August 2019 and November 2021. The authors found that across racial groups, workers experienced severe financial and psychological hardships when they were laid off, but these hardships were alleviated if they received unemployment insurance, especially the additional benefits available during COVID-19. However, black and Hispanic respondents were much less likely to receive unemployment insurance than white respondents, despite their shared locations and work experience. The authors conclude that increasing equality in access to unemployment insurance may help reduce the disparate effects of job loss on nonwhite workers and related racial disparities in health.

DATAWATCH: Who was willing to use telehealth during COVID-19?

The COVID-19 pandemic has changed the use of telehealth from a rare service to one that has become widely available, including by patients’ usual providers. Before the COVID-19 pandemic, certain populations, including blacks and lower-income adults, as well as adults with less education, were less likely to use telehealth. To assess how COVID-19 has changed patient attitudes about using telehealth, Shira Fischer and coauthors from the RAND Corporation analyzed data from a survey of US adults taken between February 2019 and March 2021 and found that the share of patients willing to use it increased from 50.8 percent in February 2019 to 62.2 percent in March 2021, with increases particularly notable among black adults and adults with less education. The authors conclude that willingness to use telehealth increases with experience and with greater access to telehealth from a familiar provider, which may be important to policymakers considering telehealth legislation.

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