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This study examines how the first two years of the COVID-19 pandemic affected life expectancy in California and the relationship between census tract income and life expectancy relative to prepandemic years. In this retrospective analysis of 1, 988, 606 deaths in California during 2015 to 2021, life expectancy declined from 81.40 years in 2019 to 79.20 years in 2020 and 78.37 years in 2021. Life expectancy differences between the census tracts in the highest and lowest income percentiles increased from 11.52 years in 2019 to 14.67 years in 2020 and 15.51 years in 2021. This ecological study of deaths in the state of California demonstrated that life expectancy declines in 2020 increased in 2021 and that the life expectancy gap by income level increased during the first 2 years of the COVID-19 pandemic relative to the prepandemic period.This work has been supported, in part, by the University of California Multicampus Research Programs and Initiatives grants MRP-19-600774 and M21PR3278.

This study examines the effects of a congestion tax in central Stockholm on ambient air pollution and the health of local children. We demonstrate that the tax reduced ambient air pollution by 5-15 percent and the rate of acute asthma attacks among young children. We do not see corresponding changes in accidents or hospitalizations for nonrespiratory conditions. As the change in health was more gradual than the change in pollution, it may take time for the full health effects of changes in pollution to materialize if the mechanism is pollution. Hence, short-run estimates of pollution reduction programs may understate long-run health benefits.

© 2019 American Economic Association. Exploiting geological variation and timing in the initiation of hydraulic fracturing, we find that fracking leads to sharp increases in oil and gas recovery and improvements in a wide set of economic indicators. There is also evidence of deterioration in local amenities, which may include increases in crime, noise, and traffic and declines in health. Using a Rosen-Roback-style spatial equilibrium model to infer the net welfare impacts, we estimate that willingness-to-pay (WTP) for allowing fracking equals about $2,500 per household annually (4.9 percent of household income), although WTP is heterogeneous, ranging from more than $10,000 to roughly 0 across 10 shale regions.

Although there is a large gap between Black and White American life expectancies, the gap fell 48.9% between 1990 and 2018, mainly due to mortality declines among Black Americans. We examine age-specific mortality trends and racial gaps in life expectancy in high- and low-income US areas and with reference to six European countries. Inequalities in life expectancy are starker in the United States than in Europe. In 1990, White Americans and Europeans in high-income areas had similar overall life expectancy, while life expectancy for White Americans in low-income areas was lower. However, since then, even high-income White Americans have lost ground relative to Europeans. Meanwhile, the gap in life expectancy between Black Americans and Europeans decreased by 8.3%. Black American life expectancy increased more than White American life expectancy in all US areas, but improvements in lower-income areas had the greatest impact on the racial life expectancy gap. The causes that contributed the most to Black Americans’ mortality reductions included cancer, homicide, HIV, and causes originating in the fetal or infant period. Life expectancy for both Black and White Americans plateaued or slightly declined after 2012, but this stalling was most evident among Black Americans even prior to the COVID-19 pandemic. If improvements had continued at the 1990 to 2012 rate, the racial gap in life expectancy would have closed by 2036. European life expectancy also stalled after 2014. Still, the comparison with Europe suggests that mortality rates of both Black and White Americans could fall much further across all ages and in both high-income and low-income areas.

This study examines the effects of a congestion tax in central Stockholm on ambient air pollution and the health of local children. We demonstrate that the tax reduced ambient air pollution by 5–15 percent and the rate of acute asthma attacks among young children. We do not see corresponding changes in accidents or hospitalizations for nonrespiratory conditions. As the change in health was more gradual than the change in pollution, it may take time for the full health effects of changes in pollution to materialize if the mechanism is pollution. Hence, short-run estimates of pollution reduction programs may understate long-run health benefits.

Regulatory oversight of toxic emissions from industrial plants and understanding about these emissions' impacts are in their infancy. Applying a research design based on the openings and closings of 1,600 industrial plants to rich data on housing markets and infant health, we find that: toxic air emissions affect air quality only within 1 mile of the plant; plant openings lead to 11 percent declines in housing values within 0.5 mile or a loss of about $4.25 million for these households; and a plant's operation is associated with a roughly 3 percent increase in the probability of low birthweight within 1 mile.

This paper provides estimates of the effects of in utero exposure to contaminated drinking water on fetal health. To do this, we examine the universe of birth records and drinking water testing results for the state of New Jersey from 1997 to 2007. Our data enable us to compare outcomes across siblings who were potentially exposed to differing levels of harmful contaminants from drinking water while in utero. We find small effects of drinking water contamination on all children, but large and statistically significant effects on birth weight and gestation of infants born to less educated mothers. We also show that those mothers who were most affected by contamination were the least likely to move between births in response to contamination.

In one of the most provocative books ever published on America's social welfare system, economist Janet Currie argues that the modern social safety net is under attack. Unlike most books about antipoverty programs, Currie trains her focus not on cash welfare, which accounts for a small and shrinking share of federal expenditures on poor families with children, but on the staples of today's American welfare system: Medicaid, Food Stamps, Head Start, WIC, and public housing. These programs, Currie maintains, form an effective, if largely invisible and haphazard safety net, and yet they are the very programs most vulnerable to political attack and misunderstanding. This book highlights both the importance and the fragility of this safety net, arguing that, while not perfect, it is essential to fighting poverty. Currie demonstrates how America's safety net is threatened by growing budget deficits and by an erroneous public belief that antipoverty programs for children do not work and are riddled with fraud. By unearthing new empirical data, Currie makes the case that social programs for families with children are actually remarkably effective. She takes her argument one step further by offering specific reforms--detailed in each chapter--for improving these programs even more. The book concludes with an overview of an integrated safety net that would fight poverty more effectively and prevent children from slipping through holes in the net. (For example, Currie recommends the implementation of a benefit "debit card" that would provide benefits with less administrative burden on the recipient.) A complement to books such as Barbara Ehrenreich's bestselling Nickel and Dimed, which document the personal struggles of the working poor, The Invisible Safety Net provides a big-picture look at the kind of programs and solutions that would help ease those struggles. Comprehensive and authoritative, it will prompt a major reexamination of the current thinking on improving the liv

In one of the most provocative books ever published on America's social welfare system, economist Janet Currie argues that the modern social safety net is under attack. Unlike most books about antipoverty programs, Currie trains her focus not on cash welfare, which accounts for a small and shrinking share of federal expenditures on poor families with children, but on the staples of today's American welfare system: Medicaid, Food Stamps, Head Start, WIC, and public housing. These programs, Currie maintains, form an effective, if largely invisible and haphazard safety net, and yet they are the very programs most vulnerable to political attack and misunderstanding. This book highlights both the importance and the fragility of this safety net, arguing that, while not perfect, it is essential to fighting poverty. Currie demonstrates how America's safety net is threatened by growing budget deficits and by an erroneous public belief that antipoverty programs for children do not work and are riddled with fraud. By unearthing new empirical data, Currie makes the case that social programs for families with children are actually remarkably effective. She takes her argument one step further by offering specific reforms--detailed in each chapter--for improving these programs even more. The book concludes with an overview of an integrated safety net that would fight poverty more effectively and prevent children from slipping through holes in the net. (For example, Currie recommends the implementation of a benefit "debit card" that would provide benefits with less administrative burden on the recipient.) A complement to books such as Barbara Ehrenreich's bestselling Nickel and Dimed, which document the personal struggles of the working poor, The Invisible Safety Net provides a big-picture look at the kind of programs and solutions that would help ease those struggles. Comprehensive and authoritative, it will prompt a major reexamination of the current thinking on improving the liv

In one of the most provocative books ever published on America's social welfare system, economist Janet Currie argues that the modern social safety net is under attack. Unlike most books about antipoverty programs, Currie trains her focus not on cash welfare, which accounts for a small and shrinking share of federal expenditures on poor families with children, but on the staples of today's American welfare system: Medicaid, Food Stamps, Head Start, WIC, and public housing. These programs, Currie maintains, form an effective, if largely invisible and haphazard safety net, and yet they are the very programs most vulnerable to political attack and misunderstanding. This book highlights both the importance and the fragility of this safety net, arguing that, while not perfect, it is essential to fighting poverty. Currie demonstrates how America's safety net is threatened by growing budget deficits and by an erroneous public belief that antipoverty programs for children do not work and are riddled with fraud. By unearthing new empirical data, Currie makes the case that social programs for families with children are actually remarkably effective. She takes her argument one step further by offering specific reforms--detailed in each chapter--for improving these programs even more. The book concludes with an overview of an integrated safety net that would fight poverty more effectively and prevent children from slipping through holes in the net. (For example, Currie recommends the implementation of a benefit "debit card" that would provide benefits with less administrative burden on the recipient.) A complement to books such as Barbara Ehrenreich's bestselling Nickel and Dimed, which document the personal struggles of the working poor, The Invisible Safety Net provides a big-picture look at the kind of programs and solutions that would help ease those struggles. Comprehensive and authoritative, it will prompt a major reexamination of the current thinking on improving the liv

In one of the most provocative books ever published on America's social welfare system, economist Janet Currie argues that the modern social safety net is under attack. Unlike most books about antipoverty programs, Currie trains her focus not on cash welfare, which accounts for a small and shrinking share of federal expenditures on poor families with children, but on the staples of today's American welfare system: Medicaid, Food Stamps, Head Start, WIC, and public housing. These programs, Currie maintains, form an effective, if largely invisible and haphazard safety net, and yet they are the very programs most vulnerable to political attack and misunderstanding. This book highlights both the importance and the fragility of this safety net, arguing that, while not perfect, it is essential to fighting poverty. Currie demonstrates how America's safety net is threatened by growing budget deficits and by an erroneous public belief that antipoverty programs for children do not work and are riddled with fraud. By unearthing new empirical data, Currie makes the case that social programs for families with children are actually remarkably effective. She takes her argument one step further by offering specific reforms--detailed in each chapter--for improving these programs even more. The book concludes with an overview of an integrated safety net that would fight poverty more effectively and prevent children from slipping through holes in the net. (For example, Currie recommends the implementation of a benefit "debit card" that would provide benefits with less administrative burden on the recipient.) A complement to books such as Barbara Ehrenreich's bestselling Nickel and Dimed, which document the personal struggles of the working poor, The Invisible Safety Net provides a big-picture look at the kind of programs and solutions that would help ease those struggles. Comprehensive and authoritative, it will prompt a major reexamination of the current thinking on improving the liv

Little is known about the mechanisms underlying the transfer of economic status between generations. This paper addresses the question of whether inter-generational correlations in health contribute to the perpetuation of economic status. We examine inter-generational correlations in birth weight, a key indicator of the health of newborns that we link to future educational attainment and earnings using a unique data set based on California births from 1960s to the present. We use names and birth dates to link the records of mothers and children. We also identify mothers who are siblings. We show that there is a strong intergenerational correlation in the birth weight of mothers and children, but that a measure of household income at the time of the mother's birth is also predictive of low birth weight and that there is an interaction between maternal low birth weight and poverty in the production of low birth weight. Together these findings suggest that intergenerational correlations in health could play a role in the intergenerational transmission of income. Parent's income affects child health, and health at birth affects future income.

Little is known about the mechanisms underlying the transfer of economic status between generations. This paper addresses the question of whether inter-generational correlations in health contribute to the perpetuation of economic status. We examine inter-generational correlations in birth weight, a key indicator of the health of newborns that we link to future educational attainment and earnings using a unique data set based on California births from 1960s to the present. We use names and birth dates to link the records of mothers and children. We also identify mothers who are siblings. We show that there is a strong intergenerational correlation in the birth weight of mothers and children, but that a measure of household income at the time of the mother's birth is also predictive of low birth weight and that there is an interaction between maternal low birth weight and poverty in the production of low birth weight. Together these findings suggest that intergenerational correlations in health could play a role in the intergenerational transmission of income. Parent's income affects child health, and health at birth affects future income.

This paper offers a review of recent literature regarding the take up of social programs in the U.S. and U.K. A few general conclusions are drawn: First, take up is enhanced by automatic or default enrollment and lowered by administrative barriers, although removing individual barriers does not necessarily have much effect, suggesting that one must address the whole bundle. Second, although it may be impossible to devise a definitive test of the stigma hypothesis', other, more concrete types of transactions costs are probably a good deal more important. Third, although people generally have means-tested programs in the United States in mind when they discuss take up, low take up is also a problem in many non means-tested social insurance programs and in other countries. Historically, economists have paid little attention to rules about eligibility, and virtually no attention to how these rules are enforced or made known to eligibles. Hence, the marginal return to new data about these features of programs is likely to be high in terms of understanding take up. In an era of social experiments, it might also prove useful to consider experimental manipulations of factors thought to influence take up.

We examine the impact of air pollution on infant death in California over the 1990s. Our work offers several innovations: First, many previous studies examine populations subject to far greater levels of pollution. In contrast, the experience of California in the 1990s is clearly relevant to current debates over the regulation of pollution. Second, many studies examine a few routinely monitored pollutants in isolation, generally because of data limitations. We examine four criteria' pollutants in a common framework. Third, we develop an identification strategy based on within zip code variation in pollution levels that controls for potentially important unobserved characteristics of high pollution areas. Fourth, we use rich individual-level data to investigate effects of pollution on infant mortality, fetal deaths, low birth weight and prematurity in a common framework. We find that the reductions in carbon monoxide (CO) and particulates (PM10) over the 1990s in California saved over 1,000 infant lives. However, we find little consistent evidence of pollution effects on fetal deaths, low birth weight or short gestation.

We examine U.S. and Canadian children with symptoms of Attention Deficit Hyperactivity Disorder (ADHD), the most common child mental health problem. ADHD increases the probability of delinquency and grade repetition, reduces future reading and mathematics scores, and increases the probability of special education. The estimated effects are remarkably similar in the two countries, and are robust to many specification changes.Moreover, even moderate symptoms have large negative effects relative to the effects of poor physical health. The probability of treatment increases with income in the U.S., but not in Canada. However, in models of outcomes, interactions between income and ADHD scores are statistically insignificant in the U.S. (except for delinquency), while in Canada these interactions indicate that higher income is protective. The U.S. results are consistent with a growing psychological literature which suggests that conventional treatments for ADHD improve behavior, but have inconsistent effects on cognitive performance.

This paper offers a review of recent literature regarding the take up of social programs in the U.S. and U.K. A few general conclusions are drawn: First, take up is enhanced by automatic or default enrollment and lowered by administrative barriers, although removing individual barriers does not necessarily have much effect, suggesting that one must address the whole bundle. Second, although it may be impossible to devise a definitive test of the stigma hypothesis', other, more concrete types of transactions costs are probably a good deal more important. Third, although people generally have means-tested programs in the United States in mind when they discuss take up, low take up is also a problem in many non means-tested social insurance programs and in other countries. Historically, economists have paid little attention to rules about eligibility, and virtually no attention to how these rules are enforced or made known to eligibles. Hence, the marginal return to new data about these features of programs is likely to be high in terms of understanding take up. In an era of social experiments, it might also prove useful to consider experimental manipulations of factors thought to influence take up.

We examine the impact of air pollution on infant death in California over the 1990s. Our work offers several innovations: First, many previous studies examine populations subject to far greater levels of pollution. In contrast, the experience of California in the 1990s is clearly relevant to current debates over the regulation of pollution. Second, many studies examine a few routinely monitored pollutants in isolation, generally because of data limitations. We examine four criteria' pollutants in a common framework. Third, we develop an identification strategy based on within zip code variation in pollution levels that controls for potentially important unobserved characteristics of high pollution areas. Fourth, we use rich individual-level data to investigate effects of pollution on infant mortality, fetal deaths, low birth weight and prematurity in a common framework. We find that the reductions in carbon monoxide (CO) and particulates (PM10) over the 1990s in California saved over 1,000 infant lives. However, we find little consistent evidence of pollution effects on fetal deaths, low birth weight or short gestation.

We examine U.S. and Canadian children with symptoms of Attention Deficit Hyperactivity Disorder (ADHD), the most common child mental health problem. ADHD increases the probability of delinquency and grade repetition, reduces future reading and mathematics scores, and increases the probability of special education. The estimated effects are remarkably similar in the two countries, and are robust to many specification changes.Moreover, even moderate symptoms have large negative effects relative to the effects of poor physical health. The probability of treatment increases with income in the U.S., but not in Canada. However, in models of outcomes, interactions between income and ADHD scores are statistically insignificant in the U.S. (except for delinquency), while in Canada these interactions indicate that higher income is protective. The U.S. results are consistent with a growing psychological literature which suggests that conventional treatments for ADHD improve behavior, but have inconsistent effects on cognitive performance.

Critics of Head Start contend that many programs spend too much money on programs extraneous to education. On the other hand, Head Start advocates argue that severely disadvantaged children need a broad range of services. Given the available evidence, it has been impossible to assess the validity of these claims. In this study, we match detailed administrative data with data on child outcomes from the National Longitudinal Survey of Youth 1979, including test scores, behavior problems, and grade repetition. We find that former Head Start children have higher reading scores and are less likely to have been retained in grade where Head Start spending was higher. Holding per capita expenditures constant, children in programs that devoted higher shares of their budgets to education and health have fewer behavior problems and are less likely to have been retained in grade. However, when we examine specific educational inputs holding per capita expenditures constant, only pupil/teacher ratios matter.

Critics of Head Start contend that many programs spend too much money on programs extraneous to education. On the other hand, Head Start advocates argue that severely disadvantaged children need a broad range of services. Given the available evidence, it has been impossible to assess the validity of these claims. In this study, we match detailed administrative data with data on child outcomes from the National Longitudinal Survey of Youth 1979, including test scores, behavior problems, and grade repetition. We find that former Head Start children have higher reading scores and are less likely to have been retained in grade where Head Start spending was higher. Holding per capita expenditures constant, children in programs that devoted higher shares of their budgets to education and health have fewer behavior problems and are less likely to have been retained in grade. However, when we examine specific educational inputs holding per capita expenditures constant, only pupil/teacher ratios matter.

Case, Lubotsky, and Paxson (2001) show that the well-known relationship between socio- economic status (SES) and health exists in childhood and grows more pronounced with age. However, in cross-sectional data it is difficult to distinguish between two possible explanations. The first is that low-SES children are less able to respond to a given health shock. The second is that low SES children experience more shocks. We show, using panel data on Canadian children that: 1) the gradient we estimate in the cross section is very similar to that estimated previously using U.S. children; 2) both high and low-SES children recover from past health shocks to about the same degree; and 3) that the relationship between SES and health grows stronger over time mainly because low-SES children receive more negative health shocks. In addition, we examine the effect of health shocks on math and reading scores. We find that health shocks affect test scores and future health in very similar ways. Our results suggest that public policy aimed at reducing SES-related health differentials in children should focus on reducing the incidence of health shocks as well as on reducing disparities in access to palliative care.

We estimate the effect of maternal education on birth outcomes using data from the Vital Statistics Natality files for 1970 to 1999. We also assess the importance of four potential channels through which maternal education may improve birth outcomes: use of prenatal care, smoking behavior, marriage, and fertility. In an effort to account for unobserved characteristics of women that could induce spurious correlation, we pursue two distinct empirical strategies. First, we construct panel data by linking women in different years of the Vital Statistics records and examine the effects of changes in education on changes in birth outcomes. Second, we have compiled a new data set on openings of two and four year colleges between 1940 and 1990. We use data about the availability of colleges in the woman's county in her 17th year as an instrument for maternal education Our findings using the two approaches are similar. Higher maternal education improves infant health, as measured by birthweight and gestational age. It also increases the probability that a new mother is married, reduces parity, increases use of prenatal care, and reduces smoking, suggesting that these are important pathways for the ultimate effect on health.

We use data from the National Health Interview Surveys to measure the effects of the growth of Medicaid managed care on children. We examine both the probability that individual children were Medicaid-covered and their utilization of care. We find that managed care penetration has significant effects on the composition of the Medicaid caseload. Poor white and Hispanic children are more likely to be enrolled in Medicaid where Medicaid managed care organizations are more prevalent, whereas black children are less likely to be enrolled. Also, toddlers are less likely to be enrolled than school age children. These lower enrollment rates are linked to increases in the numbers of black children and toddlers who go without any doctor visits in a year. Our results are consistent with cream-skimming by Medicaid managed care organizations along the lines of race and age.

This paper uses data from the 1990s to examine changes in the wages, employment, and effort of nurses in California hospitals following takeovers by large chains. The market for nurses has been described as a classic monopsony, so that one might expect increases in firm market power to be associated with declines in wages. However, we show that if one extends the monopsony model to consider effort, or if we apply a basic contracting model to the data, then we would expect to see effects on effort rather than on wages. This prediction is bourne out by the data nurses see few declines in wages following takeovers, but see increases in the number of patients per nurse, our measure of effort. We also find that these changes are similar in the largest for-profit and non-profit chains, suggesting that market forces are more more important than institutional form.

Case, Lubotsky, and Paxson (2001) show that the well-known relationship between socio- economic status (SES) and health exists in childhood and grows more pronounced with age. However, in cross-sectional data it is difficult to distinguish between two possible explanations. The first is that low-SES children are less able to respond to a given health shock. The second is that low SES children experience more shocks. We show, using panel data on Canadian children that: 1) the gradient we estimate in the cross section is very similar to that estimated previously using U.S. children; 2) both high and low-SES children recover from past health shocks to about the same degree; and 3) that the relationship between SES and health grows stronger over time mainly because low-SES children receive more negative health shocks. In addition, we examine the effect of health shocks on math and reading scores. We find that health shocks affect test scores and future health in very similar ways. Our results suggest that public policy aimed at reducing SES-related health differentials in children should focus on reducing the incidence of health shocks as well as on reducing disparities in access to palliative care.

We estimate the effect of maternal education on birth outcomes using data from the Vital Statistics Natality files for 1970 to 1999. We also assess the importance of four potential channels through which maternal education may improve birth outcomes: use of prenatal care, smoking behavior, marriage, and fertility. In an effort to account for unobserved characteristics of women that could induce spurious correlation, we pursue two distinct empirical strategies. First, we construct panel data by linking women in different years of the Vital Statistics records and examine the effects of changes in education on changes in birth outcomes. Second, we have compiled a new data set on openings of two and four year colleges between 1940 and 1990. We use data about the availability of colleges in the woman's county in her 17th year as an instrument for maternal education Our findings using the two approaches are similar. Higher maternal education improves infant health, as measured by birthweight and gestational age. It also increases the probability that a new mother is married, reduces parity, increases use of prenatal care, and reduces smoking, suggesting that these are important pathways for the ultimate effect on health.

We use data from the National Health Interview Surveys to measure the effects of the growth of Medicaid managed care on children. We examine both the probability that individual children were Medicaid-covered and their utilization of care. We find that managed care penetration has significant effects on the composition of the Medicaid caseload. Poor white and Hispanic children are more likely to be enrolled in Medicaid where Medicaid managed care organizations are more prevalent, whereas black children are less likely to be enrolled. Also, toddlers are less likely to be enrolled than school age children. These lower enrollment rates are linked to increases in the numbers of black children and toddlers who go without any doctor visits in a year. Our results are consistent with cream-skimming by Medicaid managed care organizations along the lines of race and age.

This paper uses data from the 1990s to examine changes in the wages, employment, and effort of nurses in California hospitals following takeovers by large chains. The market for nurses has been described as a classic monopsony, so that one might expect increases in firm market power to be associated with declines in wages. However, we show that if one extends the monopsony model to consider effort, or if we apply a basic contracting model to the data, then we would expect to see effects on effort rather than on wages. This prediction is bourne out by the data nurses see few declines in wages following takeovers, but see increases in the number of patients per nurse, our measure of effort. We also find that these changes are similar in the largest for-profit and non-profit chains, suggesting that market forces are more more important than institutional form.

Evaluations of changes to the Medicaid program have focused on increases in the generosity of income cutoffs for eligibility. Previous research shows that despite dramatic increases in the number of births paid for by Medicaid, many eligible women are still getting inadequate prenatal care. States have addressed this problem by adopting administrative measures designed to simplify the Medicaid application process and encourage the use of prenatal care. At the same time, recent declines in welfare caseloads may have caused many women to lose their Medicaid coverage by effectively increasing administrative barriers to obtaining care. We examine the effects of changes in income eligibility, administrative reforms, and welfare caseloads on the use of prenatal care and infant health using data from birth certificates covering all U.S. births between 1990 and 1996. We find that increases in income cutoffs were associated with increased use of prenatal care among whites, while decreases in welfare caseloads were associated with reduced use of prenatal care, especially among blacks. Reduced form estimates suggest that changes in income cutoffs were associated with a reduced probability of fetal death among blacks and disadvantaged whites. None of the administrative reforms we consider had consistently positive effects. These results suggest that the administrative reforms undertaken to date have been insufficient to break the close link between participation in welfare and access to prenatal care under the Medicaid program.

In western countries, accidents are the leading cause of death and injury among children, far surpassing diseases as a health threat. We examine the effect of maternal employment and child care policy on rates of accidental injury using both micro data from the National Longitudinal Survey of Youth (NLSY) and Vital Statistics records. We find that the effects of maternal employment on unintentional injuries to children vary by demographic group, with the effects being positive for blacks and negative for whites in models that control for child-specific fixed effects. Estimates from both individual-level NLSY and Vital Statistics data suggest that the effects of maternal employment may be mediated by child care regulations. Most notably, requiring training beyond high school for caregivers reduces the incidence of both fatal and non-fatal accidents. Other types of regulation have mixed effects on unintentional injuries, suggesting that child care regulations create winners and losers. In particular, while some children may benefit from safer environments, others that appear to be squeezed out of the more expensive regulated sector and are placed at higher risks of injury.

Many observers have blamed HMOs for increasing financial pressures on private hospitals and causing them to cut back on the provision of charity care. We examine this issue using data on all hospital discharges in California between 1988 and 1996. We find that public hospitals in counties with higher HMO penetration do take on a larger share of the county's charity caseload. However, these public hospitals also take on larger shares of most other types of patients. At the hospital level, we find little evidence that either for-profit or non-profit private hospitals respond to HMO penetration by turning away uninsured and Medicaid patients. On the contrary, in the for-profit sector higher HMO penetration is linked to reductions in the share of privately insured patients in the caseload, and corresponding increases in the share of Medicare patients and Medicaid births. Since HMO penetration reduces the price paid by privately insured patients they may be less attractive to for-profit hospitals relative to the publicly insured.

Evaluations of changes to the Medicaid program have focused on increases in the generosity of income cutoffs for eligibility. Previous research shows that despite dramatic increases in the number of births paid for by Medicaid, many eligible women are still getting inadequate prenatal care. States have addressed this problem by adopting administrative measures designed to simplify the Medicaid application process and encourage the use of prenatal care. At the same time, recent declines in welfare caseloads may have caused many women to lose their Medicaid coverage by effectively increasing administrative barriers to obtaining care. We examine the effects of changes in income eligibility, administrative reforms, and welfare caseloads on the use of prenatal care and infant health using data from birth certificates covering all U.S. births between 1990 and 1996. We find that increases in income cutoffs were associated with increased use of prenatal care among whites, while decreases in welfare caseloads were associated with reduced use of prenatal care, especially among blacks. Reduced form estimates suggest that changes in income cutoffs were associated with a reduced probability of fetal death among blacks and disadvantaged whites. None of the administrative reforms we consider had consistently positive effects. These results suggest that the administrative reforms undertaken to date have been insufficient to break the close link between participation in welfare and access to prenatal care under the Medicaid program.

In western countries, accidents are the leading cause of death and injury among children, far surpassing diseases as a health threat. We examine the effect of maternal employment and child care policy on rates of accidental injury using both micro data from the National Longitudinal Survey of Youth (NLSY) and Vital Statistics records. We find that the effects of maternal employment on unintentional injuries to children vary by demographic group, with the effects being positive for blacks and negative for whites in models that control for child-specific fixed effects. Estimates from both individual-level NLSY and Vital Statistics data suggest that the effects of maternal employment may be mediated by child care regulations. Most notably, requiring training beyond high school for caregivers reduces the incidence of both fatal and non-fatal accidents. Other types of regulation have mixed effects on unintentional injuries, suggesting that child care regulations create winners and losers. In particular, while some children may benefit from safer environments, others that appear to be squeezed out of the more expensive regulated sector and are placed at higher risks of injury.

Many observers have blamed HMOs for increasing financial pressures on private hospitals and causing them to cut back on the provision of charity care. We examine this issue using data on all hospital discharges in California between 1988 and 1996. We find that public hospitals in counties with higher HMO penetration do take on a larger share of the county's charity caseload. However, these public hospitals also take on larger shares of most other types of patients. At the hospital level, we find little evidence that either for-profit or non-profit private hospitals respond to HMO penetration by turning away uninsured and Medicaid patients. On the contrary, in the for-profit sector higher HMO penetration is linked to reductions in the share of privately insured patients in the caseload, and corresponding increases in the share of Medicare patients and Medicaid births. Since HMO penetration reduces the price paid by privately insured patients they may be less attractive to for-profit hospitals relative to the publicly insured.

Evaluations of changes to the Medicaid program have focused on increases in the generosity of income cutoffs for Medicaid eligibility. Previous research shows that despite dramatic increases in the number of births paid for by the Medicaid program, women often enroll in Medicaid at the point of birth rather than before. States have addressed this problem by adopting administrative measures designed to simplify the Medicaid application process and encourage the use of prenatal care. At the same time, recent declines in welfare caseloads may effectively increasing administrative barriers to obtaining care. We examine the effects of these three types of policies (changes in income eligibility, administrative reforms, and changes in welfare caseloads) on the use of prenatal care and infant health using data from birth certificates covering all U.S. births between 1990 and 1996. We find that increases in income cutoffs increased the use of prenatal care, while decreases in welfare caseloads reduced the use of prenatal care, especially among blacks. The administrative reforms we consider had little effect. The changes in the utilization of prenatal care that were induced by increases in income eligibility cutoffs and decreases in welfare rates led to small but statistically significant reductions in the incidence of very low birthweight among whites.

Evaluations of changes to the Medicaid program have focused on increases in the generosity of income cutoffs for Medicaid eligibility. Previous research shows that despite dramatic increases in the number of births paid for by the Medicaid program, women often enroll in Medicaid at the point of birth rather than before. States have addressed this problem by adopting administrative measures designed to simplify the Medicaid application process and encourage the use of prenatal care. At the same time, recent declines in welfare caseloads may effectively increasing administrative barriers to obtaining care. We examine the effects of these three types of policies (changes in income eligibility, administrative reforms, and changes in welfare caseloads) on the use of prenatal care and infant health using data from birth certificates covering all U.S. births between 1990 and 1996. We find that increases in income cutoffs increased the use of prenatal care, while decreases in welfare caseloads reduced the use of prenatal care, especially among blacks. The administrative reforms we consider had little effect. The changes in the utilization of prenatal care that were induced by increases in income eligibility cutoffs and decreases in welfare rates led to small but statistically significant reductions in the incidence of very low birthweight among whites.

Scholars have been examining the relationship between fertility and unemployment for more than a century. Most studies find that fertility falls with unemployment in the short run, but it is not known whether these negative effects persist, because women simply may postpone childbearing to better economic times. Using more than 140 million US birth records for the period 1975–2010, we analyze both the short- and long-run effects of unemployment on fertility. We follow fixed cohorts of US-born women defined by their own state and year of birth, and relate their fertility to the unemployment rate experienced by each cohort at different ages. We focus on conceptions that result in a live birth. We find that women in their early 20s are most affected by high unemployment rates in the short run and that the negative effects on fertility grow over time. A one percentage point increase in the average unemployment rate experienced between the ages of 20 and 24 reduces the short-run fertility of women in this age range by six conceptions per 1,000 women. When we follow these women to age 40, we find that a one percentage point increase in the unemployment rate experienced at ages 20–24 leads to an overall loss of 14.2 conceptions. This long-run effect is driven largely by women who remain childless and thus do not have either first births or higher-order births.

A ubiquitous and largely unquestioned assumption in studies of housing markets is that there is perfect information about local amenities. This paper measures the housing market and health impacts of 1,600 openings and closings of industrial plants that emit toxic pollutants. We find that housing values within one mile decrease by 1.5 percent when plants open, and increase by 1.5 percent when plants close. This implies an aggregate loss in housing values per plant of about $1.5 million. While the housing value impacts are concentrated within 1/2 mile, we find statistically significant infant health impacts up to one mile away.

A large literature describes relationships between month of birth, birth weight, and gestation. These relationships are hypothesized to reflect the causal impact of seasonal environmental factors. However, recent work casts doubt on this interpretation by showing that mothers with lower socioeconomic status are more likely to give birth in months that are associated with poorer birth outcomes. Seasonality in the numbers of conceptions in different months can also induce a mechanical correlation between preterm birth and month of birth. This paper analyzes the seasonality of health at birth using a large sample of 647,050 groups of US siblings representing 1,435,213 children. By following the same mother over time, we eliminate differences in fixed maternal characteristics as an explanation for seasonal differences in health at birth. We find a sharp trough in gestation length among babies conceived in May, which corresponds to an increase in prematurity of more than 10%. Birth weight conditional on gestation length, however, is found to be strongly hump-shaped over the year, with 8–9 additional g for summer conceptions. We examine several potential mechanisms for explaining seasonality in birth outcomes that have generally been dismissed in the literature on seasonality in rich countries, notably disease prevalence and nutrition. The May trough in gestation length coincides with a higher influenza prevalence in January and February, when these babies are nearing full term, whereas the hump shape in birth weight is associated with a similar pattern in pregnancy weight gain.

A ubiquitous and largely unquestioned assumption in studies of housing markets is that there is perfect information about local amenities. This paper measures the housing market and health impacts of 1,600 openings and closings of industrial plants that emit toxic pollutants. We find that housing values within one mile decrease by 1.5 percent when plants open, and increase by 1.5 percent when plants close. This implies an aggregate loss in housing values per plant of about $1.5 million. While the housing value impacts are concentrated within 1/2 mile, we find statistically significant infant health impacts up to one mile away.

We are the first to examine the effect of Superfund cleanups on infant health rather than focusing on proximity to a site. We study singleton births to mothers residing within 5km of a Superfund site between 1989-2003 in five large states. Our "difference in differences" approach compares birth outcomes before and after a site clean-up for mothers who live within 2,000 meters of the site and those who live between 2,000-5,000 meters of a site. We find that proximity to a Superfund site before cleanup is associated with a 20 to 25% increase in the risk of congenital anomalies., National Institutes of Health (U.S.) (NIH grant HD055613-02), John D. and Catherine T. MacArthur Foundation

This paper explores the consequences of the expiration of charity care requirements imposed on private hospitals by the Hill-Burton Act. We examine delivery care and the health of newborns using the universe of Florida births from 1989 to 2003 combined with hospital data from the American Hospital Association. We find that charity care requirements were binding on hospitals, but that private hospitals under obligation cream skimmed the least risky maternity patients. Conditional on patient characteristics, they provided less intensive maternity services but without compromising patient health. When obligations expired, private hospitals quickly reduced their charity caseloads, shifting maternity patients to public hospitals. The results in this paper suggest, perhaps surprisingly, that requiring private providers to serve the underinsured can be effective., authorCount :3

We are the first to examine the effect of Superfund cleanups on infant health rather than focusing on proximity to a site. We study singleton births to mothers residing within 5km of a Superfund site between 1989-2003 in five large states. Our “difference in differences” approach compares birth outcomes before and after a site clean-up for mothers who live within 2,000 meters of the site and those who live between 2,000- 5,000 meters of a site. We find that proximity to a Superfund site before cleanup is associated with a 20 to 25% increase in the risk of congenital anomalies., NIH grant #HD055613-02 and the MacArthur Foundation

We are the first to examine the effect of Superfund cleanups on infant health rather than focusing on proximity to a site. We study singleton births to mothers residing within 5km of a Superfund site between 1989-2003 in five large states. Our “difference in differences” approach compares birth outcomes before and after a site clean-up for mothers who live within 2,000 meters of the site and those who live between 2,000- 5,000 meters of a site. We find that proximity to a Superfund site before cleanup is associated with a 20 to 25% increase in the risk of congenital anomalies., NIH grant #HD055613-02 and the MacArthur Foundation

Reforms to the Joint and Several Liability rule (JSL) are one of the most common tort reforms and have been implemented by most US states. JSL allows plaintiffs to claim full recovery from one of the defendants, even if that defendant is only partially responsible for the tort. We develop a theoretical model that shows that the efficiency of the JSL rule depends critically on both whether the care taken by potential tortfeasors is observed, and on how the actions of the potential tortfeasors interact to cause the harm. We then provide evidence that reforms of the JSL rule have been accompanied by reductions in the accidental death rate in the U. S. This result is consistent with the hypothesis that the reform of JSL causes potential tortfeasors to take more care.

Reforms to the Joint and Several Liability rule (JSL) are one of the most common tort reforms and have been implemented by most US states. JSL allows plaintiffs to claim full recovery from one of the defendants, even if that defendant is only partially responsible for the tort. We develop a theoretical model that shows that the efficiency of the JSL rule depends critically on both whether the care taken by potential tortfeasors is observed, and on how the actions of the potential tortfeasors interact to cause the harm. We then provide evidence that reforms of the JSL rule have been accompanied by reductions in the accidental death rate in the U. S. This result is consistent with the hypothesis that the reform of JSL causes potential tortfeasors to take more care.

We use the National Health and Nutritional Examination Survey (NHANES) III to examine the effect of the availability of the school breakfast program (SBP). Our work builds on previous research in four ways: First, we develop a transparent difference-in-differences strategy to account for unobserved differences between students with access to SBP and those without. Second, we examine serum measures of nutrient in addition to intakes based on dietary recall data. Third, we ask whether the SBP improves the diet by increasing/or decreasing the intake of nutrients relative to meaningful threshold levels. Fourth, we examine the effect of the SBP on other members of the family besides the school-aged child. We have three main findings. First, the SBP helps students build good eating habits: SBP increases scores on the healthy eating index, reduces the percentage of calories from fat, and reduces the probability of low fiber intake. Second, the SBP reduces the probability of serum micronutrient deficiencies in vitamin C, vitamin E, and folate, and it increases the probability that children meet USDA recommendations for potassium and iron intakes. Since we find no effect on total calories these results indicate that the program improves the quality of food consumed. Finally, in households with school-aged children, both preschool children and adults have healthier diets and consume less fat when the SBP is available. These results suggest that school nutrition programs may be an effective way to combat both nutritional deficiencies and excess consumption among children and their families.

Poor and uneducated patients may not know what health care is desirable and, if fully insured, have little incentive to minimize the costs of their care. Partly in response to these concerns, most states have moved a substantial portion of their Medicaid caseloads out of traditional competitive fee-for-service (FFS) care, and into mandatory managed care (MMC) plans that severely restrict the choice of provider. We use a unique longitudinal data base of California births in order to examine the impact of this policy on pregnant women and infants. California phased in MMC creating variation in the timing of MMC. We identify the effects of MMC using changes in the regime faced by individual mothers between births. Some counties adopted single-carrier plans, while others adopted regimes with at least two carriers. Hence, we also ask whether competition between at least two carriers improved MMC outcomes. We find that MMC reduced the quality of prenatal care and increased low birth weight, prematurity, and neonatal death. Our results suggest that the competitive FFS system provided better care than the new MMC system, and that requiring the participation of at least two plans did not improve matters.