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
The Effects of the Affordable Care Act on Health Insurance Coverage and Labor Market Outcomes Mark Duggan, Gopi Shah Goda, Emilie Jackson

The Effects of the Affordable Care Act on Health Insurance Coverage and Labor Market Outcomes

Author: Mark Duggan, Gopi Shah Goda, Emilie Jackson
Publisher: NBER
Date: 07/2017

The Affordable Care Act (ACA) includes several provisions designed to expand insurance coverage that also alter the tie between employment and health insurance. In this paper, we exploit variation across geographic areas in the potential impact of the ACA to estimate its effect on health insurance coverage and labor market outcomes in the first two years after the implementation of its main features. Our measures of potential ACA impact come from pre-existing population shares of uninsured individuals within income groups that were targeted by Medicaid expansions and federal subsidies for private health insurance, interacted with each state’s Medicaid expansion status. Our findings indicate that the majority of the increase in health insurance coverage since 2013 is due to the ACA and that areas in which the potential Medicaid and exchange enrollments were higher saw substantially larger increases in coverage. While labor market outcomes in the aggregate were not significantly affected, our results indicate that labor force participation reductions in areas with higher potential exchange enrollment were offset by increases in labor force participation in areas with higher potential Medicaid enrollment

State of the Union 2017: Health Rucker C. Johnson

State of the Union 2017: Health

Author: Rucker C. Johnson
Publisher: Stanford Center on Poverty and Inequality
Date: 06/2017

Racial and ethnic minorities experience higher-than-average rates of illness, have higher age-specific death rates throughout the life course, and are more likely to suffer from early onset of illnesses and more severe diseases than whites. In this article, I examine these and other differences in health outcomes for whites and blacks in the United States and show that black-white health disparities are large and appear to widen over the life cycle. I also discuss several policy changes that served to narrow racial health disparities in the past and consider how future policies might help ameliorate racial inequities in health.

Family Ruptures, Stress, and the Mental Health of the Next Generation Petra Persson, Maya Rossin-Slater

Family Ruptures, Stress, and the Mental Health of the Next Generation

Author: Petra Persson, Maya Rossin-Slater
Publisher: NBER
Date: 05/2016

This paper studies how in utero exposure to maternal stress from family ruptures affects later mental health. We find that prenatal exposure to the death of a maternal relative increases take-up of ADHD medications during childhood and anti-anxiety and depression medications in adulthood. Further, family ruptures during pregnancy depress birth outcomes and raise the risk of perinatal complications necessitating hospitalization. Our results suggest large welfare gains from preventing fetal stress from family ruptures and possibly from economically induced stressors such as unemployment. They further suggest that greater stress exposure among the poor may partially explain the intergenerational persistence of poverty.

State of the Union 2016: Health Jason Beckfield, Katherine Morris

State of the Union 2016: Health

Author: Jason Beckfield, Katherine Morris
Publisher:
Date: 02/2016

The U.S. population is not just sicker, on average, than the European population, but also has a higher level of health inequality than the European population. The U.S. states that combine low self-rated health with high health inequality look strikingly similar—in terms of their health profiles—to Central and Eastern European countries.

The Waning Hispanic Health Paradox Francisco Riosmena, Elisabeth Root, Jamie Humphrey, Emily Steiner, Rebecca Stubbs

The Waning Hispanic Health Paradox

Author: Francisco Riosmena, Elisabeth Root, Jamie Humphrey, Emily Steiner, Rebecca Stubbs
Publisher: Stanford Center on Poverty and Inequality
Date: 05/2015

It is well known that Hispanics have been more healthy than other groups in the U.S. with a similar socioeconomic position. Is this "Hispanic Health Paradox" alive and well?

health - CPI Affiliates

Maya Rossin-Slater Assistant Professor of Health Research and Policy
Stanford University

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Health - Other Research

Title Author Media
An Analysis of the Memphis Nurse-Family Partnership Program James J. Heckman, Margaret L. Holland, Kevin K. Makino, Rodrigo Pinto, Maria Rosales-Rueda

An Analysis of the Memphis Nurse-Family Partnership Program

Author: James J. Heckman, Margaret L. Holland, Kevin K. Makino, Rodrigo Pinto, Maria Rosales-Rueda
Publisher: NBER
Date: 07/2017

This paper evaluates a randomized controlled trial of the Nurse-Family Partnership (NFP) program conducted in Memphis, TN in 1990. NFP offers home visits conducted by nurses for disadvantaged first-time mothers during pregnancy and early childhood. We test NFP treatment effects using permutation-based inference that accounts for the NFP randomization protocol. Our methodology is valid for small samples and corrects for multiple-hypothesis testing. We also analyze the underlying mechanisms generating these treatment effects. We decompose NFP treatment effects into components associated with the intervention-enhanced parenting and early childhood skills. The NFP improves home investments, parenting attitudes and mental health for mothers of infants at age 2. At age 6, the NFP boosts cognitive skills for both genders and socio-emotional skills for females. These treatment effects are explained by program-induced improvements in maternal traits and early-life family investments. At age 12, the treatment effects for males (but not for females) persist in the form of enhanced achievement test scores. Treatment effects are largely explained by enhanced cognitive skills at age 6. Our evidence of pronounced gender differences in response to early childhood interventions contributes to a growing literature on this topic.

Factors Associated With Ocular Health Care Utilization Among Hispanics/Latinos Laura A. McClure, D. Diane Zheng, Byron L. Lam, Stacey L. Tannenbaum, Charlotte E. Joslin, Sonia Davis, Daniel López-Cevallos, Marston E. Youngblood Jr, Zhu-Ming Zhang, Claudia Pulido Chambers

Factors Associated With Ocular Health Care Utilization Among Hispanics/Latinos

Author: Laura A. McClure, D. Diane Zheng, Byron L. Lam, Stacey L. Tannenbaum, Charlotte E. Joslin, Sonia Davis, Daniel López-Cevallos, Marston E. Youngblood Jr, Zhu-Ming Zhang, Claudia Pulido Chambers
Publisher: JAMA Opthalmology
Date: 03/2016

Our findings suggest that increasing insurance coverage, decreasing the costs of care, and increasing the availability of care for Hispanics/Latinos with poor self-rated eyesight are relevant issues to address to improve ocular health care use among Hispanics/Latinos of diverse backgrounds.

Including Health Insurance in Poverty Measurement: The Impact of Massachusetts Health Reform on Poverty Sanders Korenman, Dahlia K. Remler

Including Health Insurance in Poverty Measurement: The Impact of Massachusetts Health Reform on Poverty

Author: Sanders Korenman, Dahlia K. Remler
Publisher: NBER
Date: 02/2016

We develop and implement what we believe is the first conceptually valid health-inclusive poverty measure (HIPM)—a measure that includes health care or insurance in the poverty needs threshold and health insurance benefits in family resources—and we discuss its limitations. Building on the Census Bureau’s Supplemental Poverty Measure, we construct a pilot HIPM for the under-65 population under ACA-like health reform in Massachusetts. This pilot is intended to demonstrate the practicality, face validity and value of a HIPM. Results suggest that public health insurance benefits and premium subsidies accounted for a substantial, one-third reduction in the poverty rate. Among low-income families who purchased individual insurance, premium subsidies reduced poverty by 9.4 percentage points.

The Great Recession and Mothers' Health Christopher Wimer

The Great Recession and Mothers' Health

Author: Christopher Wimer
Publisher: Russell Sage Foundation
Date: 10/2015

Given the now well known effects of the Great Recession on economic outcomes of individuals and families, researchers have turned to the question of how this major economic downturn affected domains of family life. In a recent paper, Janet Currie of Princeton University and Valentina Duque and Irwin Garfinkel of Columbia University study the health of young mothers in the context of the Great Recession. Two key findings emerged. First, increased unemployment was associated with worsened self-reported health status and increased smoking and drug use. Second, more disadvantaged mothers suffered the greatest effects for self-reported health, while more advantaged mothers sometimes showed improvements in their health and health behaviors in response to the recession.

The Great Recession and Fathers' Health Allison Corr

The Great Recession and Fathers' Health

Author: Allison Corr
Publisher: Russell Sage Foundation
Date: 10/2015

Economic recessions can have detrimental impacts on individual and family wellbeing. New research by Janet Currie of Princeton University and Valentina Duque of Columbia University assesses how the Great Recession affected the health of fathers with young children. The analysis yields two main findings. First, high unemployment was associated with declines in physical health but little change in health-compromising behaviors. Second, changes in physical health were concentrated among fathers in the lower end and middle of the education distribution.

Health - Multimedia