Essays on Health, Environment, and Public Policy

Abstract

In this dissertation, I examine the impact of public policies on health and well-being across three different contexts. My research explores how elements of the physical and policy environment influence health and educational outcomes. In Chapter 1, I study a policy that reduced air pollution and its effects on cognitive performance among schoolchildren. Using detailed administrative data covering the universe of public school students in Texas and North Carolina, I examine if reducing pollution from diesel-powered school buses affects student academic outcomes. To do so, I leverage variation from the installation of emissions control devices called retrofits, of which over 9,000 were installed between 2004-2014. I find that installing retrofits increased math and reading test scores by 0.02 standard deviations for the average retrofitting district. By scaling these estimates by the fraction of the bus fleet retrofitted, I estimate that improving air quality by this margin for all school bus riders would raise district-average test scores by 0.05 standard deviations, which is equivalent to an improvement in teacher quality of half a standard deviation. Treatment effects are stronger for students who live farther from school and grow with years of exposure. I also compare installing retrofits with other investments studied in the education literature, such as reduced class sizes or intensive tutoring programs. I show that retrofitting buses was a very cost-effective investment in terms of gains in academic achievement per dollar spent. These results suggest that school bus retrofits were an effective intervention that had substantive benefits beyond improvements in health. I close with a discussion on how these results can be extended to the transition to electric school buses. In Chapter 2, I study the relationship between income and health in the context of tax policy targeted at low-income mothers. While the correlation between income and health has been well established, the causal relationship is not well understood. In this chapter, I estimate the long-run effects of the Earned Income Tax Credit (EITC) on outcomes for low-income mothers in the United States. Using variation from federal and state expansions over three decades, I examine a range of health and economic outcomes observed up to 15 years after becoming a parent. In general, I find little evidence of long-run broad-based effects of EITC benefits for adults, in contrast to previously documented positive long-run effects for children. I find suggestive evidence of long-run mental health improvements, but estimates are imprecise. I also find some evidence of long-run improvements in physical health and economic outcomes for Black mothers. Despite fade-out of short-run effects of the EITC, improvements in maternal health may still be an important mechanism for how safety net programs create long-lasting benefits for children. In Chapter 3, Michel Boudreaux and I study a statewide health policy on initiation of contraceptive methods. Delaware Contraceptive Access Now (DelCAN) was a statewide initiative implemented in 2015-2019, which executed a coordinated bundle of reforms to improve access to all types of contraception, particularly long-acting reversible contraceptives (LARCs). While most program components targeted publicly subsidized patients such as Medicaid and Title X, some components were applicable to all patients, such as clinical training and a public awareness campaign. In this study, which was published in PLOS ONE, we examine the impact of DelCAN on LARC initiation among privately insured women using a national commercial claims database and a difference-in-differences design. We estimate that DelCAN increased the probability of a LARC insertion among privately insured women in Delaware age 15-44 by 0.4 percentage points in an average year, a 13% increase from baseline. We also estimate that DelCAN increased LARC adoption in the immediate postpartum setting by 0.3 percentage points per year, which is a large increase relative to baseline. Treatment effects were stronger among individuals under age 30. Our study population had free access to all types of contraceptives via the ACA mandate, but our results suggest that clinical training and public awareness play important roles in ensuring access to the full range of contraceptives. These results help inform current and future policymakers in states engaged in similar contraceptive access policies.