Essays on the Intersection of Economics, Public Health Policy and Politics

Siegal, Nicole
Molina, Teresa
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This dissertation consists of three essays on the intersection of economics and public health policy and politics. The first essay evaluates how exposure to increased levels of Deaths-of-Despair (deaths from suicide, drug overdose, alcohol poisoning, and liver disease and cirrhosis) in a community impacts the outcomes in U.S. Presidential elections. Using county-level panel data and two-way fixed effects regressions, I find that a standard deviation increase in this mortality rate led to an increase in the Republican (GOP) vote share of 2.39 percentage points. Prior studies have linked increasing political polarization and conservatism to economic trends such as income inequality, import competition, and financial crises. Controlling for these and other economic and demographic factors, exposure to Deaths-of-Despair maintains a positive and significant impact on GOP vote shares. This impact is larger and only statistically significant in later years (2016-2020), compared to earlier (2004-2012). There were stronger effects in counties that the GOP candidate won in the previous election, and in counties with higher White population percentages. The results are maintained when using an instrumental variables approach to mitigate endogeneity concerns. The second essay, coauthored with Ruben Juarez and Alika Maunakea, studies how after having been affected by the highest increase in COVID-19 cases since the start of the pandemic, Honolulu and Maui counties in Hawaii implemented vaccine passport mandates for select industries in September 2021. The degree to which such mandates impacted COVID-19 mitigation efforts and economics remains poorly understood. We therefore examine the effects of these mandates on changes in three areas using difference-in-difference regression models: (1) business foot traffic; (2) number of COVID-19 cases per 100,000 individuals, and (3) COVID-19 vaccination rates across counties affected or unaffected by the mandates. We observed that although businesses affected by mandates experienced a 6.7\% decrease in foot traffic over the \mbox{14 weeks} after the mandates were implemented, the number of COVID-19 cases decreased by 19.0\%. Notably, the vaccination rate increased by 1.41\% in counties that implemented mandates. In addition, towards the end of the studied period, the level of foot traffic at impacted businesses converged towards the level of that of non-impacted businesses. As such, the trade-off in temporary losses at businesses was met with significant gains in public health and safety. In the third essay coauthored with Teresa Molina, we examine whether and how migration decisions respond to state-level changes in abortion policy in the United States. Using data from Guttmacher Institute and the American Community Survey for information on gestational age limits and interstate migration from 2006-2019, we estimate a gravity model, regressing bilateral migration onto the gestational age restrictions of the origin and destination states, a variety of economic, demographic, and political control variables for both states, as well as state-pair and year fixed effects. Across several different specifications, we find that individuals are less likely to move to states with more restrictive policies.
Economics, abortion policy, COVID-19 vaccine, Deaths-of-Despair, elections, migration, opioid epidemic
77 pages
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