Death by Robots? Automation and Working-Age Mortality in the United States.

The decline of manufacturing employment is frequently invoked as a key cause of worsening U.S. population health trends, including rising mortality due to "deaths of despair." Increasing automation-the use of industrial robots to perform tasks previously done by human workers-is one structural force driving the decline of manufacturing jobs and wages. In this study, we examine the impact of automation on age- and sex-specific mortality. Using exogenous variation in automation to support causal inference, we find that increases in automation over the period 1993-2007 led to substantive increases in all-cause mortality for both men and women aged 45-54. Disaggregating by cause, we find evidence that automation is associated with increases in drug overdose deaths, suicide, homicide, and cardiovascular mortality, although patterns differ by age and sex. We further examine heterogeneity in effects by safety net program generosity, labor market policies, and the supply of prescription opioids.

Economic influences on population health in the United States: Toward policymaking driven by data and evidence.

Atheendar S. Venkataramani and colleagues discuss economic factors and population health in the United States.

College affirmative action bans and smoking and alcohol use among underrepresented minority adolescents in the United States: A difference-in-differences study.

BACKGROUND: College affirmative action programs seek to expand socioeconomic opportunities for underrepresented minorities. Between 1996 and 2013, 9 US states-including California, Texas, and Michigan-banned race-based affirmative action in college admissions. Because economic opportunity is known to motivate health behavior, banning affirmative action policies may have important adverse spillover effects on health risk behaviors. We used a quasi-experimental research design to evaluate the association between college affirmative action bans and health risk behaviors among underrepresented minority (Black, Hispanic, and Native American) adolescents. METHODS AND FINDINGS: We conducted a difference-in-differences analysis using data from the 1991-2015 US national Youth Risk Behavior Survey (YRBS). We compared changes in self-reported cigarette smoking and alcohol use in the 30 days prior to survey among underrepresented minority 11th and 12th graders in states implementing college affirmative action bans (Arizona, California, Florida, Michigan, Nebraska, New Hampshire, Oklahoma, Texas, and Washington) versus outcomes among those residing in states not implementing bans (n = 35 control states). We also assessed whether underrepresented minority adults surveyed in the 1992-2015 Tobacco Use Supplement to the Current Population Survey (TUS-CPS) who were exposed to affirmative action bans during their late high school years continued to smoke cigarettes between the ages of 19 and 30 years. Models adjusted for individual demographic characteristics, state and year fixed effects, and state-specific secular trends. In the YRBS (n = 34,988 to 36,268, depending on the outcome), cigarette smoking in the past 30 days among underrepresented minority 11th-12th graders increased by 3.8 percentage points after exposure to an affirmative action ban (95% CI: 2.0, 5.7; p < 0.001). In addition, there were also apparent increases in past-30-day alcohol use, by 5.9 percentage points (95% CI: 0.3, 12.2; p = 0.041), and past-30-day binge drinking, by 3.5 percentage points (95% CI: -0.1, 7.2, p = 0.058), among underrepresented minority 11th-12th graders, though in both cases adjustment for multiple comparisons resulted in failure to reject the null hypothesis (adjusted p = 0.083 for both outcomes). Underrepresented minority adults in the TUS-CPS (n = 71,575) exposed to bans during their late high school years were also 1.8 percentage points more likely to report current smoking (95% CI: 0.1, 3.6; p = 0.037). Event study analyses revealed a discrete break for all health behaviors timed with policy discussion and implementation. No substantive or statistically significant effects were found for non-Hispanic White adolescents, and the findings were robust to a number of additional specification checks. The limitations of the study include the continued potential for residual confounding from unmeasured time-varying factors and the potential for recall bias due to the self-reported nature of the health risk behavior outcomes. CONCLUSIONS: In this study, we found evidence that some health risk behaviors increased among underrepresented minority adolescents after exposure to state-level college affirmative action bans. These findings suggest that social policies that shift socioeconomic opportunities could have meaningful population health consequences.

Health Endowment at Birth and Variation in Intergenerational Economic Mobility: Evidence From U.S. County Birth Cohorts.

New estimates of intergenerational economic mobility reveal substantial variation in the spatial distribution of opportunity in the United States. Efforts to explain this variation in economic mobility have conspicuously omitted health despite it being a key pathway for the transmission of economic position across generations. We begin to fill this gap in the literature by examining the relationship between health endowment at birth and intergenerational economic mobility across county birth cohorts in the United States, drawing on estimates from two population-level data sets. Exploiting variation across counties and over time, we find a negative relationship between the incidence of low-weight births and the level of economic mobility as measured in adulthood for the county birth cohorts in our sample. Our results build on a large and growing literature detailing the role of early childhood health in the transmission of economic status across generations and suggest that the incidence of low-weight births is negatively associated with intergenerational economic mobility.

Has the opening of Amazon fulfillment centers affected demand for disability insurance?

An estimated 17.6% of blue-collar, manufacturing jobs were lost in the United States between 1970 and 2016. These jobs, often union-represented, provided relatively generous pay and benefits, creating a path to the middle class for individuals without a four-year college degree. Evidence suggests the closure of manufacturing facilities and resulting decline in economic opportunity increased demand for disability insurance (SSDI) among blue-collar workers. In recent years, the opening of Amazon Fulfillment Centers (FCs) has accelerated around the country, driving a wave of blue-collar job creation. We estimated the extent to which the opening of FCs affected SSDI application rates, including rates of approvals and denials, using a synthetic control group approach. We found that FC openings were associated with a 1.4% reduction in the SSDI application rate over the subsequent three years, translating to 5,528 fewer applications per year across commuting zones with an FC opening. Our findings are consistent with FC openings improving economic opportunities in local labor markets, though our confidence intervals were wide and included the null.

Structural racism, economic opportunity and racial health disparities: Evidence from U.S. counties.

In this study, we introduce the 'racial opportunity gap' as a place-based measure of structural racism for use in population health research. We first detail constructing the opportunity gap using race-sex specific estimates of intergenerational economic mobility outcomes for a recent cohort. We then illustrate its utility in examining spatial variation in the racial mortality gap. First we demonstrate a correlation between the racial opportunity gap and the racial mortality gap across U.S. counties; where the gap in the adult earnings of black and white children born to families at the same income level is greater so, too, is the gap in mortality. Second, we show in a multivariable framework that the racial opportunity gap is associated with the racial mortality gap net of differences in the socioeconomic composition of the two groups. In so doing, we aim to provide population health researchers with a new empirical tool and analytic framework for examining the role of structural racism in generating racial health disparities.

Association Between Automotive Assembly Plant Closures and Opioid Overdose Mortality in the United States: A Difference-in-Differences Analysis.

Importance: Fading economic opportunity has been hypothesized to be an important factor associated with the US opioid overdose crisis. Automotive assembly plant closures are culturally significant events that substantially erode local economic opportunities. Objective: To estimate the extent to which automotive assembly plant closures were associated with increasing opioid overdose mortality rates among working-age adults. Design, Setting, and Participants: A county-level difference-in-differences study was conducted among adults aged 18 to 65 years in 112 manufacturing counties located in 30 commuting zones (primarily in the US South and Midwest) with at least 1 operational automotive assembly plant as of 1999. The study analyzed county-level changes from January 1, 1999, to December 31, 2016, in age-adjusted, county-level opioid overdose mortality rates before vs after automotive assembly plant closures in manufacturing counties affected by plant closures compared with changes in manufacturing counties unaffected by plant closures. Data analyses were performed between April 1, 2018, and July 20, 2019. Exposure: Closure of automotive assembly plants in the commuting zone of residence. Main Outcomes and Measures: The primary outcome was the county-level age-adjusted opioid overdose mortality rate. Secondary outcomes included the overall drug overdose mortality rate and prescription vs illicit drug overdose mortality rates. Results: During the study period, 29 manufacturing counties in 10 commuting zones were exposed to an automotive assembly plant closure, while 83 manufacturing counties in 20 commuting zones remained unexposed. Mean (SD) baseline opioid overdose rates per 100 000 were similar in exposed (0.9 [1.4]) and unexposed (1.0 [2.1]) counties. Automotive assembly plant closures were associated with statistically significant increases in opioid overdose mortality. Five years after a plant closure, mortality rates had increased by 8.6 opioid overdose deaths per 100 000 individuals (95% CI, 2.6-14.6; P = .006) in exposed counties compared with unexposed counties, an 85% higher increase relative to the mortality rate that would have been expected had exposed counties followed the same outcome trends as unexposed counties. In analyses stratified by age, sex, and race/ethnicity, the largest increases in opioid overdose mortality were observed among non-Hispanic white men aged 18 to 34 years (20.1 deaths per 100 000; 95% CI, 8.8-31.3; P = .001) and aged 35 to 65 years (12.8 deaths per 100 000; 95% CI, 5.7-20.0; P = .001). We observed similar patterns of prescription vs illicit drug overdose mortality. Estimates for opioid overdose mortality in nonmanufacturing counties were not statistically significant. Conclusions and Relevance: From 1999 to 2016, automotive assembly plant closures were associated with increases in opioid overdose mortality. These findings highlight the potential importance of eroding economic opportunity as a factor in the US opioid overdose crisis.

Early-life Medicaid Coverage and Intergenerational Economic Mobility.

New data reveal significant variation in economic mobility outcomes across U.S. localities. This suggests that social structures, institutions, and public policies-particularly those that influence critical early-life environments-play an important role in shaping mobility processes. Using new county-level estimates of intergenerational economic mobility for children born between 1980 and 1986, we exploit the uneven expansions of Medicaid eligibility across states to isolate the causal effect of this specific policy change on mobility outcomes. Instrumental-variable regression models reveal that increasing the proportion of low-income pregnant women eligible for Medicaid improved the mobility outcomes of their children in adulthood. We find no evidence that Medicaid coverage in later childhood years influences mobility outcomes. This study has implications for the normative evaluation of this policy intervention as well as our understanding of mobility processes in an era of rising inequality.

Prenatal exposure to air pollution and intergenerational economic mobility: Evidence from U.S. county birth cohorts.

New estimates reveal intergenerational economic mobility varies substantially across U.S. counties. The potential role of local environmental health exposures in structuring mobility outcomes has been thus far unexamined, despite mounting evidence that early life exposure to environmental pollutants has lasting impacts for individual human capital development and labor market performance. This study aims to fill this gap by estimating the impact of exposure to air pollution in the birth year on the average intergenerational mobility outcomes of children from low-income families as measured in adulthood. We do so by linking measures of intergenerational economic mobility for U.S. county-cohorts born between 1980 and 1986 to the county average concentration of total suspended particulates (TSP) in the birth year. We then estimate multivariate linear regression models that adjust for birth-cohort fixed effects, county-fixed effects and time-varying county-level covariates to address potential confounding. We find higher levels of TSP in birth year is associated with less upward economic mobility for children from low-income families: a one standard deviation increase in TSP levels is associated with a 0.14 point reduction in average income percentile ranking as measured in adulthood. Notably, we find no association for children from high income families. Our findings indicate early life exposure to air pollution may reduce the prospects children from low-income families will achieve upward economic mobility and suggest variation in environmental quality may help explain observed variation in mobility outcomes.

Redistribution and the New Fiscal Sociology: Race and the Progressivity of State and Local Taxes.

States redistribute wealth through two mechanisms: spending and taxation. Yet studies of the social determinants of redistribution typically focus exclusively on government spending. This article explores how one determinant of social spending-racial composition-influences preferences for, and the structure of, tax systems. First, analyses of state and local tax burden data indicate that an increasing proportion of Latinos within states is associated with more regressive tax systems. Second, evidence from a nationally representative survey experiment suggests that individual preferences for taxation may be influenced by changes in the racial composition of communities. Finally, analyses reveal that in-group solidarity is a key mechanism through which racial threat shapes preferences for taxation. In demonstrating a relationship between racial change, tax preferences, and tax structures, this article contributes to our under-standing of the determinants of redistribution as well as the broader project of the new fiscal sociology.

Health consequences of the US Deferred Action for Childhood Arrivals (DACA) immigration programme: a quasi-experimental study.

BACKGROUND: The effects of changes in immigration policy on health outcomes among undocumented immigrants are not well known. We aimed to examine the physical and mental health effects of the Deferred Action for Childhood Arrivals (DACA) programme, a 2012 US immigration policy that provided renewable work permits and freedom from deportation for a large number of undocumented immigrants. METHODS: We did a retrospective, quasi-experimental study using nationally representative, repeated cross-sectional data from the US National Health Interview Survey (NHIS) for the period January, 2008, to December, 2015. We included non-citizen, Hispanic adults aged 19-50 years in our analyses. We used a difference-in-differences strategy to compare changes in health outcomes among individuals who met key DACA eligibility criteria (based on age at immigration and at the time of policy implementation) before and after programme implementation versus changes in outcomes for individuals who did not meet these criteria. We additionally restricted the sample to individuals who had lived in the USA for at least 5 years and had completed high school or its equivalent, in order to hold fixed two other DACA eligibility criteria. Our primary outcomes were self-reported overall health (measured on a 5 point Likert scale) and psychological distress (Kessler 6 [K6] scale), the latter was administered to a random subset of NHIS respondents. FINDINGS: Our final sample contained 14 973 respondents for the self-reported health outcome and 5035 respondents for the K6 outcome. Of these individuals, 3972 in the self-reported health analysis and 1138 in the K6 analysis met the DACA eligibility criteria. Compared with people ineligible for DACA, the introduction of DACA was associated with no significant change among DACA-eligible individuals in terms of self-reported overall health (b=0·056, 95% CI -0·024 to 0·14, p=0·17) or the likelihood of reporting poor or fair health (adjusted odds ratio [aOR] 0·98, 95% CI 0·66-1·44, p=0·91). However, DACA-eligible individuals experienced a reduction in K6 score compared with DACA-ineligible individuals (adjusted incident risk ratio 0·78, 95% CI 0·56-0·95, p=0·020) and were less likely to meet screening criteria for moderate or worse psychological distress (aOR 0·62, 95% CI 0·41-0·93, p=0·022). INTERPRETATION: Economic opportunities and protection from deportation for undocumented immigrants, as offered by DACA, could confer large mental health benefits to such individuals. Health consequences should be considered by researchers and policy makers in evaluations of the broader welfare effects of immigration policy. FUNDING: None.

Economic opportunity, health behaviours, and health outcomes in the USA: a population-based cross-sectional study.

BACKGROUND: Inequality of opportunity, defined as differences in the prospects for upward social mobility, might have important consequences for health. Diminished opportunity can lower the motivation to invest in future health by reducing economic returns to health investments and undermining hope. We estimated the association between county-level economic opportunity and individual-level health in young adults in the general US population. METHODS: In this population-based cross-sectional study, we used individual-level data from the 2009-12 United States Behavioral Risk Factor Surveillance Surveys. Our primary outcomes were current self-reported overall health and the number of days of poor physical and mental health in the last month. Economic opportunity was measured by the county-averaged national income rank attained by individuals born to families in the lowest income quartile. We restricted our sample to adults aged 25-35 years old to match the data used to assign exposure. Multivariable ordinary least squares and probit models were used to estimate the association between the outcomes and economic opportunity. We adjusted for a range of demographic and socioeconomic characteristics, including age, sex, race, education, income, access to health care, area income inequality, segregation, and social capital. FINDINGS: We assessed nearly 147 000 individuals between the ages of 25 years and 35 years surveyed from 2009 to 2012. In models adjusting for individual-level demographics and county-level socioeconomic characteristics, increases in county-level economic opportunity were associated with greater self-reported overall health. An interdecile increase in economic opportunity was associated with 0·76 fewer days of poor mental health (95% CI -1·26 to -0·25) and 0·53 fewer days of poor physical health (-0·96 to -0·09) in the last month. The results were robust to sensitivity analyses. INTERPRETATION: Economic opportunity is independently associated with self-reported health and health behaviours. Policies seeking to expand economic opportunities might have important spillover effects on health. FUNDING: Robert Wood Johnson Foundation Health and Society Scholars Program.

Monetizing illness: the influence of disability assistance priming on how we evaluate the health symptoms of others.

For low-income families in the United States disability assistance has emerged as a critical income support program in the post-welfare reform era. This article explores how this monetization of illness-tying receipt of government assistance to a physical or mental condition-influences how individuals evaluate the severity of another individual's health symptoms. Using data collected through a nationally representative survey experiment of adults in the United States (n = 1005) in May 2013, I find that respondents who are primed to consider the existence of disability assistance are less likely to rate the symptoms described in a hypothetical vignette as severe relative to the control group. I find evidence that this effect holds for both physical (back pain) and mental (depression) conditions for adults and behavioral conditions (ADHD) in children. Moreover, respondents in the experimental group were more likely to blame the individual for her health condition and this measure was found to partially mediate the effect of the disability assistance prime. These findings have important implications for researchers, policymakers and medical practitioners by illustrating how premising state assistance on a health condition may in turn shape how individuals evaluate the health symptoms of others.

Leveraging Psychological Insights to Encourage the Responsible Use of Consumer Debt.

U.S. consumers currently hold $880 billion in revolving debt, with a mean household credit card balance of approximately $6,000. Although economic factors play a role in this societal issue, it is clear that psychological forces also affect consumers' decisions to take on and maintain unmanageable debt balances. We examine three psychological barriers to the responsible use of credit and debt. We discuss the tendency for consumers to (a) make erroneous predictions about future spending habits, (b) rely too heavily on values presented on billing statements, and (c) categorize debt and saving into separate mental accounts. To overcome these obstacles, we urge policymakers to implement methods that facilitate better budgeting of future expenses, modify existing credit card statement disclosures, and allow consumers to easily apply government transfers (such as tax credits) to debt repayment. In doing so, we highlight minimal and inexpensive ways to remedy the debt problem.