Health Disparities: Evidence and Policy Implications
Paper Session
Friday, Jan. 5, 2024 10:15 AM - 12:15 PM (CST)
- Chair: Adriana Lleras-Muney, University of California-Los Angeles
Maternal and Infant Health Inequality: New Evidence from Linked Administrative Data
Abstract
We use linked administrative data that combines the universe of California birth records, hospitalizations, and death records with parental income from Internal Revenue Service tax records and the Longitudinal Employer-Household Dynamics file to provide novel evidence on economic inequality in infant and maternal health. We find that birth outcomes vary non-monotonically with parental income, and that children of parents in the top ventile of the income distribution have higher rates of low birth weight and preterm birth than those in the bottom ventile. However, unlike birth outcomes, infant mortality varies monotonically with income, and infants of parents in the top ventile of the income distribution---who have the worst birth outcomes---have a death rate that is half that of infants of parents in the bottom ventile. When studying maternal health, we find a similar pattern of non-monotonicity between income and severe maternal morbidity, and a monotonic and decreasing relationship between income and maternal mortality. At the same time, these disparities by parental income are small when compared to racial disparities, and we observe virtually no convergence in health outcomes across racial and ethnic groups as income rises. Indeed, infant and maternal health in Black families at the top of the income distribution is markedly worse than that of white families at the bottom of the income distribution. Lastly, we benchmark the health gradients in California to those in Sweden, finding that infant and maternal health is worse in California than in Sweden for most outcomes throughout the entire income distribution.Equity and Efficiency in Technology Adoption: Evidence from Digital Health
Abstract
Digital technologies are bringing vast improvements to modern society, but also carry the risk of exacerbating relative disparities if adopted at lower rates by underserved communities. We investigate the efficiency and equity aspects of technological advancement in digital health by studying an original intervention of remote patient monitoring that enabled patients to transmit real-time clinical data for timely treatment. From an efficiency standpoint, we find significant and persistent reductions in cardiovascular risk, which were notable across all subgroups of gender, age, race/ethnicity, and geographic affluence. But from an equity standpoint, we find that the new technology is systematically adopted at lower rates by Black/Hispanic patients and by patients from disadvantaged geographic communities, who are less likely to take up or to adhere to the program. Our analysis highlights the simultaneous promise and hazards of digital technologies, as it places across-the-board improvements in health against the drawback of uneven adoption that can deepen relative health disparities. Evidence suggests that physicians can have a promising role in promoting more equitable adoption of new technologies in digital health.Can Relief Programs Compensate Affected Populations? Evidence from the Great Depression and the New Deal
Abstract
This paper explores the short- and long-run effects of the Great Depression and the New Deal on the well-being of the US population, measured by longevity. We constructed a novel dataset that allows us to track a large number of individuals alive in 1930 until their deaths and match it to information on the severity of the economic crisis and the extent of transfers provided by the New Deal at county level. First, we document the dynamic effects of the Great Depression on survival rates and longevity and show that individuals—in particular, young men—living in the most severely af- fected locations lived substantially shorter lives as a result of the Great Depression. Second, we assess whether the New Deal compensated individuals for the negative ef- fects of the Depression. To identify the causal effects of New Deal programs, we leverage variation across counties in New Deal spending that was politically motivated. More specifically, we use an instrumental variable strategy that allows us to compare the outcomes of individuals in counties that were equally affected by the Great Depression but who received more money as a result of politicians’ desire to be reelected. We find that the New Deal increased longevity and more than offset the negative effects of the Depression. In the absence of the New Deal, on average, individuals would have lived 6 months less. The benefits of the New Deal were larger for men and for those aged 15-25 in 1930.JEL Classifications
- I1 - Health
- J1 - Demographic Economics