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Economics of the Health Gradient

Paper Session

Saturday, Jan. 3, 2026 2:30 PM - 4:30 PM (EST)

Philadelphia Convention Center, 308
Hosted By: American Economic Association
  • Chair: Karen Eggleston, Stanford University

Workplace Stratification and Racial Health Disparities

Kurt Lavetti
,
Ohio State University
Jonathan Holmes
,
University of Ottawa
Long Hong
,
Arizona State University
Trevon Logan
,
Ohio State University

Abstract

We provide the first US-based evidence on the relationship between relative workplace rank
and health status for the near population of workers in one US state. Using a new linkage of
commercial all-payer health insurance data to administrative earnings records for workers in
Utah from 2013-2015, we quantify the impact of relative workplace rank on health status, the
incidence of specific chronic diseases, and racial health disparities. We show that about 70%
of SES-health gradient that is commonly interpreted as an income gradient actually operates
through relative rank. For an average worker, moving from the 90th to the 10th percentile
of within-firm rank holding fixed income, age, location, and health insurance characteristics is
associated with a 16.5% increase in morbidity. The racial segregation of jobs in the US leads
minority workers to be over-represented in lower-ranked jobs within firms, which in turn exacerbates racial health disparities.

The Long Run Economic Effects of Medical Innovation and the Role of Opportunities

Sonia Bhalotra
,
University of Warwick
Damian Clarke
,
Universidad de Chile
Atheendar Venkataramani
,
University of Pennsylvania

Abstract

We leverage the introduction of the first antibiotic therapies in 1937 to examine the long-run effects of early-childhood pneumonia on adult educational attainment, employment, income, and work-related disability. Using census data, we document large average improvements across all outcomes, alongside substantial heterogeneity by gender and race. Among women, health gains led to changes in marriage and fertility that partially offset their labor market improvements. Among Black Americans, we uncover a pronounced gradient linked to systemic racial discrimination in the pre–Civil Rights era: individuals born in more discriminatory Jim Crow states realized much smaller gains than those born in less discriminatory states. There is no similar gradient among white Americans. Together, these findings highlight the central role of institutional environments in shaping whether investments in early-life health translate into long run socioeconomic gains.

Lifecycle scarring and cohort longevity: health, income, and neighborhoods

Kevin Milligan
,
University of British Columbia

Abstract

We argue for the usefulness of a cohort-based measure of longevity and demonstrate that our methodology can produce reliable and sensible results for cohorts as recent as the 1965 year of birth. Using Canadian administrative tax data, we recreate and extend income gradient findings from earlier work, showing that longevity improvements in Canada arise across the income distribution—at sharp contrast to the increasing inequality found in the United States. We then introduce six lifecycle scars that we are able to measure in our data for ages 35-54, including health shocks, benefit income receipt, and low-income neighborhood residency. Our results reveal a very large drop in longevity for those who claim a disability pension or the disability tax credit, modest longevity effects for benefit income receipt, and very modest impacts for living in a low-income neighborhood. For the Canada Quebec Pension Plan disability pension, men with no exposure at ages 45-54 live 12 years longer than men with heavy exposure. For women, the gap is 9 years. Looking at both the timing and intensity of shocks, arriving at older ages with a disability appears to have by far the largest impact on later-life survival.

Health Gradients and Intergenerational Transmission by SES: Evidence from China

Carol Shiue
,
University of Colorado-Boulder
Wolfgang Keller
,
University of Colorado-Boulder
Karen Eggleston
,
Stanford University

Abstract

That individuals of higher socioeconomic status (SES) enjoy longer lives has been well documented for many populations globally since the 20th century. However, little is known about whether this health-SES gradient existed earlier in any part of the world outside Europe, or the extent to which intergenerational transmission of status played a role in the emergence and strengthening of the association between SES and health.

To help fill this gap, we analyze unique genealogical data from central China spanning multiple generations from about 1400 to 1900 (i.e., the Ming and Qing dynasties), with most of the approximately 40,000 individuals living in the 17th to 19th centuries. Our primary measure of health is the lifespan. We also study maternal mortality, estimated as maternal death within 12 months of a recorded birth. Status is measured primarily with the educational attainment of the male head of household, based on performance in the civil service examination system. We first probe data quality, using the best-coded clan data with complete vital statistics for the 1700s, and then explore robustness for earlier periods and compared with European lifetable data for the early 1800s.

We find a significantly positive association between higher status and longer lifespan evident by the early 1700s. The estimated magnitude is such that an increase in status from 25th to 75th percentile around the year 1800 is associated with approximately 10-year longer lifespan conditional on survival to age 15. Slightly more than 1% of mothers died within 12 months of a birth, with higher-status households providing some protection against this source of mortality. Parental lifespan matters, as do grandparents and great-grandparents, although intergenerational rank-rank transmission of health is weaker than intergenerational transmission of status. The steepening of the status-health gradient in late Imperial China is accompanied by increasing intergenerational status mobility.

Discussant(s)
Joseph Price
,
Brigham Young University
Kevin Milligan
,
University of British Columbia
Atheendar Venkataramani
,
University of Pennsylvania
Yuli Xu
,
Stanford University
Raquel Fonseca
,
Université du Québec à Montréal
JEL Classifications
  • I1 - Health
  • J1 - Demographic Economics