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Earning Health

Staff Perspective

Los Angeles, San Francisco, Oakland, Mountain View, El Cerrito, Palo Alto, Sunnyvale… The list of jurisdictions raising their minimum wages has grown exponentially in the past several years, culminating this spring with the near simultaneous signing of statewide $15 minimum wage legislation in both New York and California. Originating in high-cost large metropolises, the movement has spread to whole states and smaller cities, including many throughout Silicon Valley.

The City of San Mateo has become the first in San Mateo County to consider an increase, with a vote expected in June to raise the minimum wage faster than the state’s timeline.

At San Mateo’s recent (May 2nd) City Council meeting, many city residents and Councilmembers spoke about how crucial decent wages can be for health, especially given the Peninsula’s high cost of living. There are hundreds of scholarly articles that document this connection, but for anyone who has tried to live on minimum wages, the link is obvious and sometimes disastrous.

I learned first-hand about the strong link between wages and health during my younger years, when I was able to get by living on minimum wages, but with significant health consequences. I remember especially vividly the panicked day I dislocated a joint, and because I had no health insurance and no savings, I was forced to relocate it myself. Other times, I skipped medical appointments and meals, and skimped on utilities in order to pay rent.

As I’ve written previously, income and wealth are some of the strongest predictors of health outcomes. More specifically, earning a decent wage can influence health by:

Allowing workers to pay for the goods and services that are necessary for a healthy life—such as medical care, healthy food, quality housing, and education.[i]

Making it possible to afford living in places with health-supportive amenities like parks, good schools, employment, clean air, social connections and safe streets.[ii], [iii] In San Mateo County, the average age of death varies by 19 years between our most and least wealthy cities (62 years in East Palo Alto to 81 years in Atherton).[iv]

Helping people avoid the trauma and chronic stressors of poverty, which have strong and long-term effects on both mental and physical health.[v],[vi], [vii],[viii]

Making it less necessary for people to work long hours and multiple jobs. This allows workers to engage with their communities, cook healthy meals, spend time with family and friends, go to medical appointments, and participate in physical activity and other healthy behaviors.[ix], [x], [xi]

Despite the current economic boom in San Mateo County, income inequality is rising and many workers do not earn enough money to keep their families healthy. These challenges and their health impacts are especially intense for low-wage workers. Estimates vary, but experts suggest that it takes anywhere from approximately $15 to $40 per hour to sustain a one to four person household in San Mateo County.[xii] Looking at Census data, we see that currently a fourth (24.9%) of workers in San Mateo County earn less than $15/hour.  Most of these workers are citizens, nearly three quarters are in their prime working years (age 25-64), over half have some college education, and nearly half have children.[xiii] The number of low-wage workers is projected to rise in the future —economists project that well over half of the jobs added in our economic region by 2022 will pay less than $50,000, creating an hourglass economy with many low and high-wage jobs, but little in between.[xiv],[xv]

This does not have to be the future of San Mateo County. The state’s recently passed $15/hour wage is an important step, and will help lift thousands out of poverty.  However, the timeline is long—California won’t reach $15 until 2022. Our communities have the opportunity to join the rising tide of cities like San Mateo that are passing minimum wage increases, to ensure workers can provide for their families and help them live healthy lives sooner than later. Additionally, these initiatives can also contain other provisions to support the holistic health of workers and their families like paid sick days and health insurance coverage.

If you are interested in exploring data to help you better understand the economic conditions in your city or for research on the connections of wages to health and examples from other jurisdictions, please contact me at Start the conversation on Twitter #HealthyEconomySMC.

[i] Robert Wood Johnson Foundation. Issue Brief #4: Income, Wealth and Health. 2011.

[ii] Centers for Disease Control and Prevention. Healthy Places Website

[iii] Robert Wood Johnson Foundation. Issue Brief #4: Income, Wealth and Health. 2011.

[iv] San Mateo County Epidemiology analysis of 2010 California Statistical Master Files Death Data.

[v] Marmot M, Bosma H, Hemingway H, Brunner E, Stansfeld S. Contribution of job control and other risk factors to social variations in coronary heart disease incidence. Lancet. 1997; 350: 235-239

[vi] Baum A, Garofalo JP, Yali AM. Socioeconomic status and chronic stress. Does stress account for SES effects on health? Ann N Y Acad Sci. 1999;896:131-44.

[vii] Robert Wood Johnson Foundation. Issue Brief #4: Income, Wealth and Health. 2011.

[viii] Matthews KA, Gallo LC, Taylor SE. Are psychosocial factors mediators of socioeconomic status and health connections? A progress report and blueprint for the future. Ann N Y Acad Sci. 2010;1186:146-73.

[ix] Salmon J, Owen N, Bauman A, Schmitz MK, Booth M. Leisure-time, occupational, and household physical activity among professional, skilled, and less-skilled workers and homemakers. Prev Med. 2000;30(3):191- 199.

[x] Adkins CL, Premeaux SF. Spending time: The impact of hours worked on work–family conflict. J Vocat Behav. 2012;80(2):380-389.

[xi]Health Impact Partners, UCLA Labor Center and Restaurant Opportunities Center- Los Angeles Health Impact Assessment of the Proposed Los Angeles Wage Theft Ordinance. 2014

[xii] See:

[xiii] San Mateo County Health System Analysis of U.S. Census Public Use Microdata (2009-2013).

[xiv] Benner, Chris. Center for Regional Change, UC Davis, Jobs-Housing Fit Analysis dataset.

[xv] California Employment Development Department, 2012-2022 Occupations With the Most Job Openings, Marin, San Francisco and San Mateo.