Geography of the U.S. Health Care Safety Net and Racial/Ethnic Disparities in Mortality, 1996-2017

Emily Parker, Rutgers University

Health disparities vary widely across communities in the U.S., in large part due to the fragmented distribution of public policy and safety net infrastructure. This study examines the impact of one such policy—the Community Health Center (CHC) program—on racial/ethnic disparities in mortality. Emerging from the 1965 War on Poverty, the CHC program is a key means through which the federal government has attempted to remedy inequities in health by funding clinics in low-income, medically underserved communities. Is this longstanding safety net policy associated with racial/ethnic differences in mortality across places? I link administrative data on CHC funding from 1996-2016 with county-level mortality and demographic data from CDC Wonder, the Census, and other sources from 1990 through 2017. Leveraging variation across time, place, and program eligibility, I find that the CHC program is associated with sizable reductions in Hispanic age-adjusted mortality rates across a range of model specifications. Though bivariate results show a reduction in the non-Hispanic Black and American Indian/Alaskan-Native mortality rates, these associations are null once reweighting for the propensity that an eligible county received funding. I argue that the legal, structural exclusion of many Hispanics from public programs like Medicaid may be one mechanism explaining the robust association between safety net clinics and mortality only for this group. Overall, the results have implications for scholarship on the Hispanic health paradox and the role of the state in the health of disadvantaged populations, as well as advancing research on how safety net policy shapes population health disparities.

No extended abstract or paper available

 Presented in Session 126. Public Health and the American Welfare State