Increasing access to employment, education, food, housing, and transportation for all Americans
Unprecedented job loss due to COVID-19 has led to an economic crisis for families of all backgrounds and income levels. Current health and social services programs are ill-equipped to handle this need. Moreover, long-standing racial health inequities and the stigma associated with using social services will persist in the absence of significant systems-level change. The pandemic has revealed a population with limited access to preventive healthcare suffering from noncommunicable diseases such as obesity and diabetes. These individual-level health outcomes are largely determined by social and economic factors.
Policy transformation informed by public health and public policy research may help reverse current trends. Greater flexibility and efficiency in existing federal social safety net programs is one such transformation. The Social Services, Technology, and Administrative Restructuring Initiative (“SSTAR Initiative”), developed by scholars of health policy and management at Columbia University, would incorporate five sectors–education, employment, food, housing, and transportation–into a single entitlement program for all Americans. The SSTAR Initiative is rooted in the knowledge that healthier populations with lower levels of inequality contribute to a stronger economy.
Where people are born, grow, live, and work has a greater impact on health and well-being than healthcare. These conditions–the social determinants of health (SDoH)–are shaped by distributions of money, power, and resources and are largely responsible for unfair and avoidable differences in health status observed between racial and ethnic groups. Unequal access to quality education, food, housing, employment, and clean air are key determinants.
The SSTAR Initiative would create a single agency to manage eligibility determinations and distribution of benefits. Currently, multiple applications and independent verification processes significantly limit program access. Elimination of duplicative paperwork and automated eligibility determinations across programs would be a top priority. In its initial form, the agency would aggregate funds from all available programs into a single account.
Second, funds would be flexible, available for use however households deem most pressing. Current programs require participants to use funds in specific ways that may not meet shifting family needs. For example, SNAP benefits can only be used to purchase food and cannot be repurposed to cover rent. The SSTAR Initiative would allow every person to allocate funds according to specific need–families may prioritize housing assistance and may elect to use most or all of their monthly allotment to cover that expense.
Third, funds would be applied to a wider range of goods and services that are essential to promote health. Many of these services could be provided through existing small businesses. For example, funds could be used to pay for car repairs- this ensures that people can get to work while providing a new source of revenue for the local auto shop.
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