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  • The fact that health outcomes did

    2018-11-02

    The fact that health outcomes did not improve across the board allows us to rule out with some confidence one type of spurious relationship impossible to control for within our model: neighborhood gentrification. Over the time cysteine protease inhibitors of our study, if higher income households replace lower income households within the same neighborhood, we would expect that this would cause all three health outcomes to measurably improve, not just one.
    Conclusion Past research has linked EITC and improved health at the individual level. Our analysis suggests that the EITC’s positive impact on health outcomes spillover beyond such individual-level effects. In our study, we link the NYS and NYC EITC expansions between 1997 and 2010 to improved low birthweight rates in the city’s low-income neighborhoods. We use prior empirical estimates to distinguish compositional effects from contextual effects and find that the magnitude of our estimates suggests ecological, neighborhood-level health effects. This points to an additional channel through which anti-poverty measures can serve as public health interventions: by reducing neighborhood poverty rates. Ours is the only study that we are aware of that conducts a neighborhood-level analysis of EITC’s impact on health.
    Acknowledgements
    Introduction Mortality, morbidity, and physical functioning among older adults vary considerably by socioeconomic status in most, if not all, countries (Bleich, Jarlenski, Bell, & LaVeist, 2012; He, Muenchrath, & Kowal, 2012; Hurst et al., 2013; Marmot, Allen, Bell, Bloomer, & Goldblatt, 2012; Smith & Majmundar, 2012; Toch et al., 2014). Individuals with more education and higher economic status are generally in better health. Although there is persuasive evidence about some of the mechanisms involved, including differential access to health care, early life conditions, environmental exposures, personal health behaviors, and stress (Braveman, Egerter, & Williams, 2011; Marmot & Allen, 2014), the picture is far from complete. This is particularly true for middle and low income countries which are experiencing rapid population aging and for which there is less evidence about the causes of health inequalities. One of the factors that is likely to account for socioeconomic inequalities in health among older adults is work – specifically, the physical and psychosocial conditions of the work done throughout life (Burgard & Lin, 2013; Clougherty, Souza, & Cullen, 2010; Hoven & Siegrist, 2013; Landsbergis, Grzywacz, & LaMontagne, 2014; Marmot et al., 1991). For most adults, work is a major part of life, whether it involves paid employment, self-employment, or housework and child care. Work is highly stratified by socioeconomic status: educational attainment and family background play a large role in determining the type of work that adults do and the work conditions they are exposed to. Furthermore, extensive research on occupational health and safety has demonstrated a strong relationship between physical and psychosocial work conditions and health. Taken together, socioeconomic stratification in work conditions and the strong evidence that work conditions affect health suggest that work conditions are likely to play an important role in the creation of socioeconomic inequality in older adult health. This paper makes three important contributions. First, it contributes to the literature on explanations for socioeconomic inequalities in health by investigating the role of physical work conditions. This literature has typically focused on causal mechanisms such as: the role of early life conditions, adult living standards, access to health care, experiences of discrimination (by race, gender, and other characteristics), health behaviors, and psychosocial conditions at work and in other environments (Adler & Stewart, 2010; Berkman, 2009; Braveman et al., 2011; Elo, 2009; Goldman, 2001; Kawachi, Adler, & Dow, 2010; Marmot & Allen, 2014). Despite the enormous evidence based on the effects of physical work conditions on health (Burton, 2010) and the fact that individuals from less advantaged backgrounds are more likely to work at more strenuous jobs, less attention has been paid in studies of socioeconomic inequalities in health to the role of lifetime physical work conditions in creating these inequalities. Several recent studies which do examine these associations, primarily in Europe, are summarized below.