摘要：Objectives. This study investigated whether health problems among poor mothers of chronically ill children affect their ability to obtain and maintain employment. Methods. Mothers of children with chronic illnesses were surveyed at clinical and welfare agency sites in San Antonio, Tex. Results. There were distinct health differences according to mothers’ TANF and employment status. Mothers without TANF experience reported better physical and mental health and less domestic violence and substance use than did those who had TANF experience. Those not currently working had higher rates of physical and mental health problems. Conclusions. Poor maternal health is associated with need for cash assistance and health insurance. Policymakers must recognize that social policies promoting employment will fail if they do not address the health needs of poor women and children. The landmark welfare reform legislation passed by Congress in 1996—the Personal Responsibility and Work Opportunity Reconciliation Act—revealed politicians’ beliefs that the primary solutions to poverty reside in stringent work and personal behavior requirements on individuals. 1 The law posited that requiring poor women with children to work and restricting their sexual and reproductive behaviors would lift poor families out of poverty within the federally mandated 5-year time limit and make them self-sufficient. Many have debated the ethical and causal assumptions of this approach. We highlight another component not considered in the legislation: the health status of poor women and children. The Personal Responsibility and Work Opportunity Reconciliation Act ended the entitlement to a basic level of subsistence that President Roosevelt’s New Deal established with the Social Security Act of 1935; it also abdicated the long-standing guarantee to protect the “health and well-being” of the poor. 2 This was unfortunate, given the indisputable evidence that the poor bear a disproportionate share of the disease burden in this country. 3 Beyond basic data on caseload statistics, numbers of sanctions, and employment trends, the Personal Responsibility and Work Opportunity Reconciliation Act did not require states to report a great deal of information to the federal government. Thus, few national data are available with which to assess any association between the new welfare policies and the health of the target population. 4 One research project that examined health issues among women who had received public assistance in 4 urban areas (Cleveland, Los Angeles, Miami, and Philadelphia) revealed that these women (and their children) had higher rates of physical and mental health problems in comparison with US women overall. 5 Furthermore, working women who had left welfare (“leavers”) continued to experience these health problems and often lacked health insurance. Leavers who were not working had the worst health situations: increased health problems, no health insurance, and unmet health care needs. Another city-level study (conducted in Boston, Chicago, and San Antonio) that collected health-related data showed that a quarter of women remaining on welfare reported health conditions that prevented them from working (as compared with 11% of former recipients and 8% of nonrecipients); also, these women experienced higher levels of depression and domestic violence compared with nonrecipients. 6 Other reports of health-related problems among individuals who have had contact with the welfare system support these findings, although the primary foci of these research efforts have often been economic and, therefore, limited in their health content. 7– 9 In the present study, we examined whether health problems among mothers of chronically ill children affect their ability to comply with the increased emphasis on employment. Data were derived from a study conducted in San Antonio, Tex, a city with a population of just over 1 million people of primarily Hispanic (59%), non-Hispanic White (32%), and African American (7%) ethnicity. 10 Nationally, Texas ranks poorly on many social and health indicators, including overall population living in poverty (10th), school-aged children living in poverty (13th), recipients of Temporary Assistance for Needy Families (TANF) (36th) and food stamps (31st) per 100 people in poverty, number of uninsured children (2nd), and per capita spending on public health (44th). 11 In 1999, Texas had the highest proportion of low-income families in the country. 12 Given these data, it is important to determine whether poor families that have children with chronic illnesses are experiencing other problems as well.
