Health Disparities

  • Sanjay Basu
  • Mark Cullen
  • Jeremy Freese
  • David Rehkopf

Leaders: Sanjay Basu, Mark Cullen, Jeremy Freese, David Rehkopf 

The affiliates within the Health Disparities RG are using new computer modeling and statistical techniques to examine how poverty affects the health of children and adults and how some anti-poverty programs are reducing those effects. Here’s a sampling of our projects. 

Income, geography, and life expectancy: Using deidentified tax data and Social Security Administration death records, Raj Chetty and his coauthors have shown that the richest 1 percent live 14.6 years longer, on average, than the poorest 1 percent. Although poor people typically have much shorter lives, Chetty also shows that the extent of this disadvantage depends on the place of residence, thus suggesting that there may be opportunities for policy to reduce the gap in life expectancy.

Infant health and poverty: Which poor neighborhoods are associated with very low birth weights? By identifying neighborhoods that are yielding very low birth weights, we can start to target home visiting and related programs.

Biological mechanisms of disadvantage: We all know that poverty “gets under the skin” and creates lasting disadvantage. Is this because children exposed to poverty-induced stress experience epigenetic changes? We’re going to know very soon.

Income and the developing brain: The prevailing view is that poverty is especially likely to shape children’s early development because of the high plasticity and rapid growth of the brain during the first three years of life. It’s high time for a rigorous study of how income affects the brain function and development of infants and toddlers. 

Health - CPI Research

Title Author Media
State of the Union 2019: Health Mark Duggan, Jackie Li

State of the Union 2019: Health

Author: Mark Duggan, Jackie Li
Publisher: State of the Union 2019: Health
Date: 06/2019
  • Millennials benefited from the expansion of health insurance coverage under the Affordable Care Act. The share of adults in their 20s without health insurance fell by more than half from 2009 to 2017. 
  • This expansion led to a reduction in racial and ethnic inequalities in health insurance coverage. 
  • Due primarily to increasing suicides and drug overdoses, mortality rates increased dramatically among young adults from 2008 to 2016. Because the increase was more rapid among non-Hispanic whites than non-Hispanic blacks, racial inequality in mortality rates declined.
Local Food Prices, SNAP Purchasing Power, and Child Health Erin T. Bronchetti, Garret S. Christensen, Hilary W. Hoynes

Local Food Prices, SNAP Purchasing Power, and Child Health

Author: Erin T. Bronchetti, Garret S. Christensen, Hilary W. Hoynes
Publisher: NBER
Date: 06/2018

The Supplemental Nutrition Assistance Program (SNAP, formerly food stamps) is one of the most important elements of the social safety net. Unlike most other safety net programs, SNAP varies little across states and over time, which creates challenges for quasi-experimental evaluation. Notably, SNAP benefits are fixed across 48 states; but local food prices vary, leading to geographic variation in the real value – or purchasing power – of SNAP benefits. In this study, we provide the first estimates that leverage variation in SNAP purchasing power across markets to examine effects of SNAP on child health. We link panel data on regional food prices to National Health Interview Survey data and use a fixed effects framework to estimate the relationship between local purchasing power of SNAP and children’s health and health care utilization. We find that lower SNAP purchasing power leads to lower utilization of preventive health care and more days of school missed due to illness. We find no effect on reported health status.

U.S. Employment and Opioids: Is There a Connection? Janet Currie, Jonas Y. Jin, Molly Schnell

U.S. Employment and Opioids: Is There a Connection?

Author: Janet Currie, Jonas Y. Jin, Molly Schnell
Publisher: NBER
Date: 03/2018

This paper uses quarterly county-level data to examine the relationship between opioid prescription rates and employment-to-population ratios from 2006–2014. We first estimate models of the effect of opioid prescription rates on employment-to-population ratios, instrumenting opioid prescriptions for younger ages using opioid prescriptions to the elderly. We also estimate models of the effect of employment-to-population ratios on opioid prescription rates using a shift-share instrument. We find that the estimated effect of opioids on employment-to-population ratios is positive but small for women, but there is no relationship for men. These findings suggest that although they are addictive and dangerous, opioids may allow some women to work who would otherwise leave the labor force. When we examine the effect of employment-to-population ratios on opioid prescriptions, our results are more ambiguous. Overall, our findings suggest that there is no simple causal relationship between economic conditions and the abuse of opioids. Therefore, while improving economic conditions in depressed areas is desirable for many reasons, it is unlikely to curb the opioid epidemic.

State of the Union 2018: Health Mark Duggan, Valerie Scimeca

State of the Union 2018: Health

Author: Mark Duggan, Valerie Scimeca
Publisher: Stanford Center on Poverty and Inequality
Date: 03/2018

The male-female life expectancy gap, which favors females, fell from 7.6 years in 1970 to 4.8 years in 2010, a reduction of more than one-third. Most of this convergence was caused by asubstantial decline from 1990 to 2000 in HIV-AIDS mortality and in the homicide rate. Because HIV-AIDS and homicide affect men more than women, a decline in these underlying rates had the effect of reducing the male-female life expectancy gap. Life expectancy has stagnated for the last several years for men and women, primarily due to increases in drug poisoning deaths and in the suicide rate. 

The Kids Are All Right Janet M. Currie

The Kids Are All Right

Author: Janet M. Currie
Publisher: Stanford Center on Poverty and Inequality
Date: 01/2018

In this article, we pose the following question: Has the overall set of changes to the safety net since PRWORA improved outcomes for children? To answer that question, we look at several measures of child well-being—mortality rates, teen pregnancy, drug use, and high school graduation rates—and find that across all these measures, poor children are much better off today.

health - CPI Affiliates

David Rehkopf's picture David Rehkopf Health Disparities Research Group Leader, Assistant Professor of Medicine
Stanford University
Jeremy Freese's picture Jeremy Freese Health Disparities Research Group Leader, Professor of Sociology
Stanford University
Mark Cullen's picture Mark Cullen Health Disparities Research Group Leader, Director of Stanford Center for Population Health Sciences, Professor of Medicine
Stanford University
Fernando Riosmena's picture Fernando Riosmena Associate Professor, Population Program, Institute of Behavioral Science and Geography Department
University of Colorado at Boulder
Jack Shonkoff's picture Jack Shonkoff Director, Center on the Developing Child, Julius B. Richmond FAMRI Professor of Child Health and Development, Professor of Pediatrics, Harvard Medical School and Boston Children’s Hospital
Harvard University

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Health - Other Research

Title Author Media
XX>XY?: The Changing Female Advantage in Life Expectancy Claudia Goldin, Adriana Lleras-Muney

XX>XY?: The Changing Female Advantage in Life Expectancy

Author: Claudia Goldin, Adriana Lleras-Muney
Publisher: NBER
Date: 06/2018

Females live longer than males in most parts of the world today. Among OECD nations in recent years, the difference in life expectancy at birth is around four to six years (seven in Japan). But have women always lived so much longer than men? The answer is that they have not. We ask when and why the female advantage emerged. We show that reductions in maternal mortality and fertility are not the reasons. Rather, we argue that the sharp reduction in infectious disease in the early twentieth century played a role. The primary reason is that those who survive most infectious diseases carry a health burden that affects organs, such as the heart, as well as impacting general well-being. We use new data from Massachusetts containing information on causes of death from 1887 to show that infectious diseases disproportionately affected females between the ages of 5 and 25. Increased longevity of women, therefore, occurred as the burden of infectious disease fell for all. Our explanation does not tell us why women live longer than men, but it does help understand the timing of the increase.

Tracking Health Inequalities from High School to Midlife Jamie M. Carroll, Chandra Muller, Eric Grodsky, John Robert Warren

Tracking Health Inequalities from High School to Midlife

Author: Jamie M. Carroll, Chandra Muller, Eric Grodsky, John Robert Warren
Publisher: Social Forces
Date: 12/2017

Educational gradients in health status, morbidity, and mortality are well established, but which aspects of schooling produce those gradients is only partially understood. We draw on newly available data from the midlife follow-up of the High School and Beyond sophomore cohort to analyze the relationship between students’ level of coursework in high school and their long-term health outcomes. We additionally evaluate the mediating roles of skill development, postsecondary attendance and degree attainment, and occupational characteristics. We find that students who took a medium- to high-level course of study in high school have better self-reported health and physical functioning in midlife, even net of family background, adolescent health, baseline skills, and school characteristics. The association partially operates through pathways into postsecondary education. Our findings have implications for both educational policy and research on the educational gradient in health.

Exploding Asthma and ADHD Caseloads: The Role of Medicaid Managed Care Anna Chorniy, Janet Currie, Lyudmyla Sonchak

Exploding Asthma and ADHD Caseloads: The Role of Medicaid Managed Care

Author: Anna Chorniy, Janet Currie, Lyudmyla Sonchak
Publisher: NBER
Date: 10/2017

In the U.S., nearly 11% of school-age children have been diagnosed with ADHD, and approximately 10% of children suffer from asthma. In the last decade, the number of children diagnosed with these conditions has inexplicably been on the rise. This paper proposes a novel explanation of this trend. First, the increase is concentrated in the Medicaid caseload nationwide. Second, nearly 80% of states transitioned their Medicaid programs from fee-for-service (FFS) reimbursement to managed care (MMC) by 2016. Using Medicaid claims from South Carolina, we show that this change contributed to the increase in asthma and ADHD caseloads. Empirically, we rely on exogenous variation in MMC enrollment due a change in the “default” Medicaid plan from FFS or MMC, and an increase in the availability of MMC. We find that the transition from FFS to MMC explains most of the rise in the number of Medicaid children being treated for ADHD and asthma. These results can be explained by the incentives created by the risk adjustment and quality control systems in MMC.

The Non-Market Benefits of Education and Ability James J. Heckman, John Eric Humphries, Gregory Veramendi

The Non-Market Benefits of Education and Ability

Author: James J. Heckman, John Eric Humphries, Gregory Veramendi
Publisher: NBER
Date: 10/2017

This paper analyzes the non-market benefits of education and ability. Using a dynamic model of educational choice we estimate returns to education that account for selection bias and sorting on gains. We investigate a range of non-market outcomes including incarceration, mental health, voter participation, trust, and participation in welfare. We find distinct patterns of returns that depend on the levels of schooling and ability. Unlike the monetary benefits of education, the benefits to education for many non-market outcomes are greater for low-ability persons. College graduation decreases welfare use, lowers depression, and raises self-esteem more for less-able individuals.

Multi-Generational Impacts of Childhood Access to the Safety Net: Early Life Exposure to Medicaid and the Next Generation's Health Chloe N. East, Sarah Miller, Marianne Page, Laura R. Wherry

Multi-Generational Impacts of Childhood Access to the Safety Net: Early Life Exposure to Medicaid and the Next Generation's Health

Author: Chloe N. East, Sarah Miller, Marianne Page, Laura R. Wherry
Publisher: NBER
Date: 09/2017

We examine multi-generational impacts of positive in utero and early life health interventions. We focus on the 1980s Medicaid expansions, which targeted low-income pregnant women, and were adopted differently across states and over time. We use Vital Statistics Natality files to create unique data linking individuals’ in utero Medicaid exposure to the next generation’s health outcomes at birth. We find strong evidence that the health benefits associated with treated generations’ in utero access to Medicaid extend to later offspring in the form of higher average birth weight and decreased incidence of very low birth weight. Later childhood exposure to Medicaid does not lead to persistent health effects across generations. The return on investment is substantially larger than suggested by evaluations of the program that focus only on treated cohorts.