Research

• Do Conditional Cash Transfers Reduce Hypertension?

with Emma Aguila, William H. Dow, Felipe Menares, Susan W. Parker, Jorge Peniche, and Soomin Ryu

Economics and Human Biology, 2024

Progresa, an anti-poverty conditional cash transfer program, has been a model for similar programs in more than 60 countries. Numerous studies have found positive impacts on schooling, the nutritional and health status of children and adolescents, and household consumption. However, the effects on the health of older adult beneficiaries have been particularly understudied. In this paper we analyze the effects of Progresa on middle-aged and older adult health, focusing on a high prevalence chronic condition: hypertension. Our results show that Progresa had significant benefits in terms of improved hypertension diagnosis and use of treatment drugs. However, we did not find significant changes in uncontrolled hypertension as measured by systolic and diastolic blood pressure biomarkers in household survey data. Thus, while cash transfer programs may facilitate financial access to healthcare visits and the ability to buy prescribed medicines, by itself the program might not improve hypertension outcomes without complementary healthcare system follow-up to ensure dosage titration and medication adherence.

• The Impact of Standardized Disease-Specific Healthcare Coverage

with Pablo Muñoz
Revision requested at the Journal of Public Economics

We study the impact of a healthcare reform that standardized procedures and guaranteed the timely coverage of a set of diseases. Using Chile’s universe of death records and a difference-in-differences research design, we show that mortality from the diseases covered by this reform decreased by 4.4% and that the impact was larger on diseases more amenable to health care. This effect is not explained by disease-specific shocks or a resource shift from non-covered to covered diseases. Evidence from polytraumatized inpatients suggests that the reform equalized utilization rates as it reduced the dispersion of risk-adjusted surgery rates and spending across hospitals.

• Long-Term Effects of Social Insurance on Adult Mortality: Evidence From the Progresa Program in Mexico

with Emma Aguila, William H. Dow, Felipe Menares, Susan W. Parker, Jorge Peniche, and Soomin Ryu 

Research on the mortality effects of income-support social insurance programs for older adults has generated conflicting results, but this work has primarily focused on short-run effects. We analyze the older adult mortality effects of Mexico’s pathbreaking Progresa conditional cash transfer social insurance program. We employ difference-in-differences models that exploit the geographic variation in program expansion to estimate lagged effects from one to ten years after increased coverage, focusing on high-poverty municipalities. We find that Progresa substantially reduced mortality in the short-run, particularly among females, with the largest effects after three years. All-cause mortality effects attenuated at increasing lag lengths, with no sustained benefit in ten-year lag models. Results varied by cause of death, though, with long-term benefits of earlier cash transfers sustained for female diabetes mortality even after a ten-year lag.

• Cash Transfers Effect on Older Adult Mortality in Mexico

with William H. Dow and Kevin Feeney

We study the impact of an unconditional cash transfer to alleviate the rural poverty of the older adult population ages 70 and over. Using Mexico’s universe of death records and a triple difference-in-differences research design, we show that mortality from among age-eligible population in localities covered by this program increased by 4.7%. We also find that mortality increase is significantly larger among the poorer population as proxied by being ineligible for formal employment sector social insurance at 7.6% increase in deaths. Work-in-progress is testing the hypothesis that this unexpected result is partly driven by an increase in cardiovascular disease-related deaths, potentially due to increased consumption of obesogenic foods. 

• The “Staircase” Pattern of Schooling on Longevity: New Evidence for the Absence of a Causal Link

with Ryan D. Edwards and Josh R. Goldstein

We exploit the statistical power of large-scale mortality data to revisit patterns of income and longevity above age 65 by single years of schooling in the U.S. male population born in the early 20th century. We document that each year of education produces a steady monotonic rise in income, but improvements in longevity appear only among people who complete each stage of schooling. The "staircase"’ pattern emerges with large, flat steps rising at 8, 12, and 16 years of attainment and is robust to several model specifications. We further address this pattern by exploring the heterogeneity of this relationship by occupation, finding no evidence that labor market composition could have led to the "staircase" shape. The absence of a clear dose-response relationship suggests the association between education and longevity may be more reflective of the selective factors of who is able to complete their level of schooling rather than the causal effect of being in the classroom. 

• The Long-Term Health Impact of World War II on Draftees' Wives 

This research aims to provide causal evidence on the impact of income shock due to the absence of breadwinners on women's long-term health. We plan to use cohorts of women married before WWII to compare the outcomes of those who got married to men who served in the conflict against those who did not. We will use the CenSoc WWII Army Enlistment Dataset, a cleaned and harmonized version of the National Archives and Records Administration’s Electronic Army Serial Number Merged File, ca. 1938 – 1946 (2002). It contains enlistment records for over 9 million men and women who served in the United States Army, including the Army Air Corps, Women’s Army Auxiliary Corps, and Enlisted Reserve Corps. It is a rich source of data on enlistee sociodemographic information, military service, and anthropometry.