Poverty disproportionately impacts minority and rural populations and is very strongly correlated with poor health over the life cycle, and has been hypothesized to lead to a shorter, less healthy aging process. Poverty is associated with a greater burden of disease than smoking and obesity combined and accounts for the bulk of health disparities by race. It is widely believed that an anti-poverty policy?such as Earned Income Tax Credit (EITC)?could improve healthy aging among working-age low-income adults over the life cycle. It does so by increasing material hardship and psychological stress?two risk factors that are strongly correlated with biological markers of premature aging (e.g., shorter telomeres, higher cholesterol levels, and higher blood pressure.) However, the literature linking poverty to health is largely built on correlational data, which is subject to confounding and reverse causation. The experienced research firm MDRC has secured private and public funding for a groundbreaking multicenter Randomized Controlled Trial (RCT) that examines the causal impacts of quadrupling EITC for working adults without dependent children in Atlanta, GA and New York City, NY called Paycheck Plus (PP). Randomization exposes the treatment group to up to $2000 in PP compared to up to $496 in the control group. However, MDRC is not studying the impacts of PP on health. We propose leveraging MDRC?s existing infrastructure and our long history of collaboration with MDRC to add clinical, survey, and administrative measures to explore whether PP improves the health and survival of adult recipients without dependent children. Timed with launch of the study in Atlanta, we propose in-person health screenings with collection of important biomarkers of chronic disease, such as blood pressure, Body Mass Index (BMI), blood glucose, cholesterol, and C-reactive protein (measures that are conceptually linked to poverty). For both the NYC and Atlanta Cohorts, we propose adding survey data that measures health-related quality of life and depression. Since not everybody randomized to the treatment group will file taxes (a requisite for the treated group to receive PP or the control group to receive traditional EITC), we will analyze our health outcomes using an Intent to Treat (ITT) versus Treatment on the Treated (ToT) analysis. This will produce Local Average Treatment Effect (LATE) estimates of the unbiased impact of increased PP on health. In addition, we will collect long-term follow up data on mortality for both treatment sites. We will do so by linking individual identifiers administrative mortality data from the National Death Index. Finally, we will model the health and longevity gains associated with PP relative to traditional EITC. This project is innovative for exploiting a planned and fully funded social science experiment to explore outcome measures that were not originally considered by the policymakers. This project is also innovative for being a RTC of an anti-poverty program that uses administrative and clinical health data at a very low cost. We anticipate that PP will be an efficient approach to promoting healthy aging by lifting adults without dependent children out of poverty.
The Columbia University team has partnered with the research firm MDRC to conduct a multicenter randomized controlled trial (RCT) that examines the health and survival outcomes associated with an extension of the Earned Income Tax Credit (EITC) for lower-income Americans without dependent children. Associational evidence suggests that EITC may have a significant impact on the health and survival over the life cycle of those who receive the credit, leading to healthy aging. However, experimental data is needed to prove this linkage.
