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Social Determinants of Health Disparities

Paper Session

Sunday, Jan. 5, 2020 1:00 PM - 3:00 PM (PDT)

Marriott Marquis, Grand Ballroom 4
Hosted By: American Economic Association
  • Chair: Janet Currie, Princeton University

Does Diversity Matter for Health? Experimental Evidence from Oakland

Marcella Alsan
,
Stanford University
Owen Garrick
,
Bridge Clinical Research
Grant Graziani
,
University of California-Berkeley

Abstract

We study the effect of physician workforce diversity on the demand for preventive care among African-American men. In an experiment in Oakland, California, we randomize black men to black or non-black male medical doctors. We use a two-stage design, measuring decisions before (pre-consultation) and after (post-consultation) meeting their assigned doctor. Subjects select a similar number of preventives in the pre-consultation stage, but are much more likely to select every preventive service, particularly invasive services, once meeting with a racially concordant doctor. Our findings suggest black doctors could reduce the black-white male gap in cardiovascular mortality by 19%.

Perinatal Health among One Million Chinese-Americans

Douglas Almond
,
Columbia University
Yi Cheng
,
Columbia University

Abstract

“Missing girls” suggest a net preference for sons in China and among Chinese immigrants to the West. We consider health at delivery of surviving girls born in the US and find higher rates of low birth weight, congenital anomalies, maternal hypertension, and lower APGAR scores among Chinese Americans (relative to the non-Chinese gender gap). Hospitals spend more on Chinese-American girls, keep them longer following delivery, and perform more medical procedures than expected. Nevertheless, stillbirth and death on the first day of life are more common and Chinese daughters are less likely to be brought back to the hospital following delivery. To the best of our knowledge, we are the first to find that son preference may compromise health at birth.

What to Expect When It Gets Hotter: The Impacts of Prenatal Exposure to Extreme Heat on Maternal Health

June Kim
,
Purdue University-Fort Wayne
Ajin Lee
,
Michigan State University
Maya Rossin-Slater
,
Stanford University

Abstract

We use temperature variation within narrowly-defined geographic and demographic cells to show that exposure to extreme heat during the first trimester increases the risk of maternal hospitalization during pregnancy. We find that this effect is driven by women residing in historically cooler rather than hotter counties, suggesting that adaptation plays a role in mitigating the health impacts of weather shocks. We also find that the heat-induced deterioration in maternal pregnancy health is larger for black than for white mothers, suggesting that projected increases in extreme heat over the next century may further exacerbate the black-white maternal health gap.

The Impact of Car Pollution on Infant and Child Health: Evidence from Emissions Cheating

Diane Alexander
,
Federal Reserve Bank of Chicago
Hannes Schwandt
,
Northwestern University

Abstract

Abstract Car exhaust is a major source of air pollution, but little is known about its impacts on population health due to socioeconomic selection, measurement error, and avoidance behaviors. We exploit the dispersion of emissions-cheating diesel cars—which secretly polluted up to 150 times as much as gasoline cars—across the United States from 2008-2015 as a unique opportunity to overcome these empirical challenges and measure the health impacts of car pollution. Using the universe of vehicle registrations, we demonstrate that a 10 percent cheating-induced increase in car exhaust increases rates of low birth weight and acute asthma attacks among children by 1.9 and 8.0 percent, respectively. These health impacts occur at all pollution levels and across the entire socioeconomic spectrum.
Discussant(s)
Adam Sacarny
,
Columbia University
Jessamyn Schaller
,
University of Arizona
Bhash Mazumder
,
Federal Reserve Bank of Chicago
Nicholas J. Sanders
,
Cornell University
JEL Classifications
  • I1 - Health