Social work has a history of caring about the health of children (Axinn & Stern, 2008; Karger & Stoesz, 2008; Petr, 1998). Trattner (1994) noted that in the late 19th and early 20th centuries, children were seen as deserving of social work intervention given their dependent status and the opportunity to ensure their optimal growth and full participation in society. Children remain of great concern to the social work profession, because they continue to be at risk for negative life outcomes (Annie E. Casey Foundation [AECF], 2007; Petit, 2006, 2008). Today, federal, state, and local governments share financial responsibility for providing programs and services to promote child welfare; most of the funding for these programs and services is raised through tax revenue. Although the responsibility for child welfare has varied among government levels throughout American history, currently state governments are responsible for a large share of programs and services costs. Policy devolution remains politically popular despite the recent economic recession.
The purpose of this study was to address a segment of state tax policy that has not been examined--namely, the impact of the level of state tax code progressivity on selected indicators of children's health outcomes. Progressive taxation often is assumed by some to be good social policy on its merits because it conforms to a distributive social justice perspective. In this manner, taxation should not unfairly burden those in society with the least resources. However, many progressive tax policy advocates do not link tax code structures to measureable outcomes. This study examined whether children living in states with more progressive state tax codes were healthier than children who were living in states with more regressive tax codes. Although many other aspects of state tax policy have been studied by economists, political scientists, and lawyers (for example, Cassou, & Lansing, 2004; Farrelly, 2004; Mehrotra, 2005), the field has not been well-explored by social workers.
Health Outcomes for Children
Child welfare was formalized as a primarily federal responsibility with the Aid to Dependent Children and Mother's Pensions program, passed as part of the Social Security Act of 1935 (2009). Prior to this legislation child welfare was a state or local responsibility. From 1935 until the mid-1980s, federal government involvement in child welfare programs increased. Currently, due to increased devolution of federal government programs, many child welfare policies and programs are becoming, once again, primarily a state and local government responsibility. Federal devolution was not entirely a "push down" from the federal government to unwilling state governments. Many state governors had lobbied for greater control over social programs, believing that state governments could devise more appropriate responses for the needs of their residents than a federal "one size fits all" approach. Former Wisconsin Governor Tommy Thompson led the charge in developing new state programs for families and children that later became the basis for the Personal Responsibility and Work Opportunity Reconciliation Act (Haskins, 2008).
Unfortunately, children's health may be affected by their state of residence. For example, Petit (2008) found that infant mortality rates, child death rates, and the likelihood of a child not having health insurance (among other indicators) vary significantly by state, leading to what he identified as a "child well-being gap." Petit identified several elements that contribute to poorer health outcomes for children. These elements include poverty, race, and education. Children living in states with higher rates of poverty and a higher proportion of children who are from racial and ethnic minority groups tend to have poorer outcomes. Petit also identified a state's political culture, the amount of revenue collected through taxation, and declining federal investment in child welfare policies as contributing elements. …