The COVID-19 US State Policy Database: A Tool for Assessing How Policies Shape Population Health & Health Equity

Historical and modern-day policies shape how the COVID-19 pandemic and its economic ramifications have affected American society. Policy decisions widened existing racial and ethnic disparities in wealth, income, and disease over the last 16 months, and shaped a context in which food and housing insecurity are now widespread.

At the same time, the COVID-19 pandemic offers an unprecedented moment for policy change and for policy evaluation. The US government sent payments directly to American families through stimulus checks and recurring payments via child tax credits. Federal and state governments also took decisive action to freeze evictions. These policies are layered on top of a proliferation of state policy changes, from physical distancing and mask requirements to prevent COVID-19, to expanding eligibility for social safety net programs such as unemployment insurance. As policymakers navigate next steps in supporting a vulnerable American public, there is a continued need for rapid-response research to inform policies that simultaneously reduce COVID-19, economic precarity, and mental distress.

Fortunately for researchers, there are also data like never before. The Household Pulse Survey and Understanding America Study (UAS) are two sources that provide biweekly, nationally representative data. These surveys measure the social and economic effects as well as attitudes and behaviors around the COVID-19 pandemic among American households. A team at the Brookings Institution used Household Pulse Survey data to show that, although food insecurity increased after the start of the pandemic, Congress’s Pandemic EBT program reduced food hardship experienced by low-income families with children. Members of our research team conducted a study with UAS data and found an association between receipt of unemployment insurance and reduced food insecurity among people who lost employment during the COVID-19 pandemic.

To further inform policymakers and the public and to facilitate rapid research, we created the COVID-19 US State Policy (CUSP) database.

To further inform policymakers and the public and to facilitate rapid research, we created the COVID-19 US State Policy (CUSP) database. We recorded when each US state implemented new policies to prevent COVID-19 and economic precarity, plus we included data on existing health and social policies and information on state characteristics. CUSP provides the dates of policy changes and links to original source documentation. Below we share a few examples of how researchers may use the CUSP data.

• Drs. Wei Lyu and George Wehby linked data from CUSP with data from The New York Times to evaluate the relationship between state-level face mask mandates and COVID-19 growth rates in Health Affairs’ most-read article of 2020. By their estimates, more than 200,000 COVID-19 cases were averted by May 22, 2020 as a result of the implementation of statewide face mask mandates. As most states no longer require face masks to be worn in public spaces, CUSP now also tracks the dates these state mandates were lifted.
• Dr. Kathryn Leifheit et al. found that lifting eviction moratoria was associated with increased COVID-19 incidence and mortality, based on Johns Hopkins University COVID-19 time series data. The CUSP team collaborates with a team of legal researchers, led by attorney Emily Benfer at Wake Forest University, to track the dates of eviction moratoria at each stage of the eviction process. 
• CUSP data can also be linked to economic outcomes in the context of the pandemic. A team of researchers led by Yevgeniy Feyman found that state-level childcare facility closures documented in CUSP were associated with greater reductions in employment among women compared with men. Employment and demographic data were obtained from the Current Population Survey, and COVID-19 mortality data were reported by the Johns Hopkins Coronavirus Resource Center.
• Dr. Jonathan Jay led a research team in linking policy data from CUSP to SafeGraph mobility data to assess the relationship between neighborhood income and physical distancing during the pandemic. Their findings highlighted structural barriers to physical distancing among people in lower-income neighborhoods, like low wealth and savings to withstand a period without work.

As people in the United States and around the world continue to face the dual crises of COVID-19 and its economic ramifications, the health and economic policy responses implemented now will have enormous implications for health for decades to come. As state and local governments consider COVID-19 prevention policies and as Congress makes imminent decisions on policies that will be part of the Infrastructure Framework and the Family and Medical Insurance Leave (FAMILY) Act, we hope researchers and policy analysts can use CUSP to help policymakers and the public be as well informed as possible. Evaluating which policies most affect population health and health equity can provide essential information, particularly to support low-income people, essential workers, and children who continue to face the worst of the COVID-19 pandemic and economic crisis.