Culture of Health Blog

This is the final post in a series that explores the double-edged sword of preemption. Here we examine how states have used preemption to impede local decision-making on popular, family-supporting, evidence-based policies.

Paid leave and a living wage are tremendously popular public policies proven to advance health equity for working people, families, and businesses. Yet why do millions in states across the nation lack access to these policies? One reason: preemption, which continues to be used to block progress time and again. 

Paid leave provides undeniable short- and long-term benefits for families including more time to bond with a new child, which is key to healthy development; reduced infant hospitalizations and lower infant mortality rates, particularly in households with lower incomes; and improved rates of on-time vaccinations, with the strongest impact on families below the poverty line. 

Research demonstrates that family-support policies also benefit business. A 2018 study revealed the financial return on investment and productivity gains of paid leave for companies across a range of industries and sectors. A 2021 study shows that employers’ perceptions of public paid leave programs improved during the pandemic. Paid family and medical leave can help businesses reduce costs and level the playing field for employers of all sizes while providing workers with needed flexibility to keep their jobs while meeting their health needs and caregiving responsibilities.

Editor’s note: This funding opportunity is now closed.

Can your family withstand a difficult diagnosis, a missed paycheck, or a significant rent increase? For many families and communities, those financial shocks are impossible to weather and gravely impact health and wellbeing. A survey conducted this year found that two-third of Americans have put off care they or a family member need because of cost.

This is the result of the racial wealth gap, which refers to how hundreds of years of structural racism have deprived Black and Indigenous families and other communities of color of assets and resources that accumulate and transfer from one generation to the next. Today, the racial wealth gap is a chasm; previous research shows that, for each dollar of wealth held by White families, Indigenous families have about 8 cents, Black families have about 13 cents, and Latino families about 19 cents.

Our nation’s policies have limited wealth and opportunity, especially for Black, Indigenous and other communities of color. From the appropriation of millions of acres of Native American land, to the Emancipation Proclamation which freed slaves but did not establish a federal policy that Black people could own land, to the internment camps that cost Japanese Americans their homes and businesses, home and land ownership have been afforded only to some. Housing discrimination in many forms, including redlining and predatory lending, continues today.

Both of us are proud of our immigrant roots and the paths our families forged after coming to the United States. Mona’s parents arrived from India, and Tina immigrated from South Korea as a toddler with her family. As members of the Asian American community, the past year’s wave of hate crimes has been painful and traumatic. But it is not new. What is new, though, is the attention these incidents and the Asian American community as a whole are receiving.

At times, these crimes bring back terrifying memories. Mona was just 10 years old when a hate group in Northern New Jersey sent a racist letter threatening Indians to a local newspaper, and the newspaper published it. The deep societal racism that letter exposed was manifested through verbal abuse, brutal assaults, and murders that occurred time and again over many years. Mona grew up hearing racist comments from police officers and teachers and seeing South Asian businesses and homes, including her own, vandalized.

At times, they remind us how few people seem to consider the intergenerational trauma and challenges faced by Asian Americans. Tina’s parents grew up in South Korea during the Korean War and her father remembers his family losing everything. Arriving in a new country not speaking the language while trying to navigate a culture with a different set of values was incredibly difficult for her parents. Adding to their stress was the need to lean heavily on their children to negotiate, translate, and serve as intermediaries with authorities and agencies.

At times, they compound the numbness and hurt we feel in the face of sometimes-profound insensitivity and endless microaggressions that add up over time and contribute to chronic stress that undeniably harms health.

EDITOR'S NOTE: This funding opportunity is now closed.

When Harris County voters approved a $2.5 billion bond to pay for more than 500 local flood-control projects, it seemed like a sound response to Hurricane Harvey. In 2017, the storm dropped 50 inches of rain in the Houston region, flooding some 166,000 homes. Based on a traditional return-on-investment analysis, it might also have appeared reasonable to spend that bond money in neighborhoods with the most expensive properties.

But county officials understood what that would mean—little protection for communities living with the most inadequate social, physical, and economic resources—many of whom are communities of color. And so, they chose a different policy approach. They gave preference to projects that ranked higher on the Centers for Disease Control and Prevention’s Social Vulnerability Index, which uses socioeconomic status, racial and ethnic status, household composition, housing, access to transportation, and other metrics to uncover potential vulnerability. The result: funds for flood control prioritized towards low-income communities and communities of color, those least able to recover from disasters.

For millions of people in America, having a home is an obstacle and a financial burden. Too many live in residentially segregated neighborhoods isolated from opportunity, making it difficult to break out of poverty and overcome the adversity that comes with it. 

The Robert Wood Johnson Foundation (RWJF) is offering funding for policy research aimed at overcoming deeply rooted problems related to housing stability and equity. We invite researchers, partnering with small cities or community-based organizations, to evaluate housing policies in hopes of turning up actionable lessons for other communities.

We Need Far-Ranging Solutions to Deeply Rooted Problems

RWJF president and CEO Richard Besser, MD, explained how safe and affordable housing supports positive outcomes across the lifespan—and how unsafe and insecure housing can deepen inequity and undermine a Culture of Health. Where we live can make it easier or harder for us to access opportunities: to get a good education, to have transportation options to living-wage jobs, to afford and have access to nutritious food; and to enjoy active lifestyles.

NOTE: The funding opportunity described in this post is now closed.  

Law and policies should address, not compound, inequities. This is personal and something I carry with me.

I was 10 years old when a man in my northern New Jersey community was beaten to death outside a neighborhood cafe. Soon after, another community member was beaten and sustained brain damage. The number of victims—all of whom were of South Asian descent—grew over the years. The violence ranged from verbal abuse to brutal assaults and murder. It wasn’t uncommon for my home and other South Asian homes to be vandalized while having to hear racial slurs.

Officials denied that these attacks were hate crimes and ethnically motivated. Research and data on discrimination and hate crimes against South Asians simply did not exist, and there wasn’t much diversity among local officials. It was therefore difficult for community members to get the protection we needed. It wasn’t surprising that there were subsequent and repeated acquittals of people who perpetrated the violence. Even living in the shadow of the Statue of Liberty, we didn’t feel a sense of freedom to live our healthiest lives because our laws didn’t do enough to stop racially motivated violence. It was years later when hate crime laws took effect.

There are countless examples of how policies, laws, and guidelines can help people in our society live better and healthier lives. For example, zoning ordinances can help keep dangerous manufacturing emissions away from homes and schools, ensuring that children aren’t exposed to toxic pollutants. Earned Income Tax Credits have been shown to improve infant mortality and birth outcomes. Healthy food guidelines can help our kids consume less sugar by recommending schools provide whole foods, like apples. These policies shape how we live, learn, work, and play.

But there is still too much we don’t know. If your organization is a non-profit or public research institution, this is where you come in.

Through the Policies for Action (P4A) program, the Robert Wood Johnson Foundation (RWJF) seeks to build a stronger evidence base for how policies, laws, and guidelines—in the public or private sectors—can help ensure everyone has the opportunity to live a healthier life.