Mortality and morbidity associated with the distribution of monthly welfare payments

The impact of major social policy decisions on community health is rarely considered or analyzed. This article describes the association of major community and health resource use in relation to the distribution of monthly welfare payments.

A descriptive, retrospective study was performed using existing accessible databases in the city of Vancouver, British Columbia (BC), and St. Paul's Hospital, a tertiary care, downtown institution. The mean numbers of admissions or responses per week and per day related to the monthly welfare check issue day in 1993 were collected from the following health agencies: the BC Ambulance Service, the Vancouver Fire Department, the BC Coroner's Office, the Vancouver Detox Center, the Vancouver City Police Jail for public drunkenness, and St. Paul's Hospital ED.

Comparison of weekly events for non-payweeks vs the week starting on welfare payday (mean +/- SD) are; St. Paul's ED, 949 +/- 51 vs 993 +/- 81 (p = 0.10); Detox Center observation admissions, 29 +/- 5.6 vs 40 +/- 7.3 (p < 0.001); Vancouver Fire Department medical responses, 453 +/- 44 vs 527 +/- 45 (p < 0.001); BC Ambulance Service responses, 3,338 +/- 101 vs 3,634 +/- 85 (p < 0.001); and coroner-reported deaths, 8.8 +/- 3.0 vs 13.6 +/- 2.6 (p < 0.0001).

As measured in multiple independent databases, there is a significant increase in morbidity and mortality in the week after the distribution of monthly welfare paychecks.