Publications

Federal courts in Texas are fast becoming known as the graveyards of U.S. health policies.1 Decisions concerning a range of statutes, from the Affordable Care Act (ACA) to the Emergency Medical Treatment and Labor Act, have chipped away at federal powers to protect the public’s health. The latest case in this series, Braidwood Management Inc. v. Becerra,2 targets the ACA’s use of U.S. Preventive Services Task Force (USPSTF) recommendations as a basis for mandating insurance coverage for preventive care. The Braidwood decision not only destabilizes efforts to ensure access to essential insurance benefits but also illustrates an emerging strategy among litigants with antiregulatory agendas: wielding heretofore sleepy doctrines of administrative and constitutional law to undercut health initiatives.

In this cross-sectional study of nearly 800,000 U.S. participants aged 5 to 17 years with family income under 200% of the federal poverty threshold, researchers found that higher family income was significantly associated with a lower prevalence of diagnosed infections, mental health disorders, injury, asthma, anemia, and substance use disorders and lower 10-year mortality. Read the full original investigation in JAMA.

Key policy takeaways from Renée DiResta on the need to understand how platforms moderate content, David Relman and Megan Palmer on strengthening regulations on risky pathogen research, Steven Pifer on the ramifications of the Ukraine-Russia war on the Kremlin, Larry Diamond on the protests in China, Iran, and Russia, Naomi Egel on protecting civilians during war, and Rose Gottemoeller on U.S. nuclear negotiations with Russia.

At SCCEI, we aim to shed some light on what actually is happening in China, and exactly how these happenings might affect the rest of the world. The 2021-2022 academic year was an unprecedented year of growth for our Center. Take a look at our 2021-22 Annual Report to see all of the incredible work and accomplishments we have achieved together. Download your copy or read it online.

In Science magazine, Stanford researchers Megan Palmer and David Relman are among co-authors recommending a reset of U.S. and global policy to address the gaps and challenges of current guidance.

Abstract

This paper analyzes the impact of paid family leave (PFL) policies in California, New Jersey, and New York on the labor market and mental health outcomes of individuals whose spouses or children experience health shocks. We use data from the 1996-2019 restricted-use version of the Medical Expenditure Panel Survey (MEPS), which provides state of residence and the precise timing of hospitalizations and surgeries, our health shock measures. We use difference-in-difference and event-study models to compare the differences in post-health-shock labor market and mental health outcomes between spouses and parents before and after PFL implementation relative to analogous differences in states with no change in PFL access. We find that PFL access leads to a 7.0 percentage point decline in the likelihood that the (healthy) wives of individuals with medical conditions or limitations who experience a hospitalization or surgery report “leaving a job to care for home or family” in the post-health-shock rounds. Impacts of PFL access on women's mental health outcomes and on men whose spouses have health shocks are more mixed, and we find no effects on parents of children with health shocks. Lastly, we show that improvements in job continuity are concentrated among caregivers with 12 or fewer years of education, suggesting that government-provided PFL might reduce disparities in leave access.

During the first year of the pandemic, East Asian countries have reported fewer infections, hospitalizations, and deaths from COVID-19 disease than most countries in Europe and the Americas. Our goal in this paper is to generate and evaluate hypothesis that may explain this striking fact. We consider five possible explanations: (1) population age structure (younger people tend to have less severe COVID-19 disease upon infection than older people); (2) the early adoption of lockdown strategies to control disease spread; (3) genetic differences between East Asian population and European and American populations that confer protection against COVID-19 disease; (4) seasonal and climactic contributors to COVID-19 spread; and (5) immunological differences between East Asian countries and the rest of the world. The evidence suggests that the first four hypotheses are unlikely to be important in explaining East Asian COVID-19 exceptionalism. Lockdowns, in particular, fail as an explanation because East Asian countries experienced similarly good infection outcomes despite vast differences in lockdown policies adopted by different countries to control the COVID-19 epidemic. The evidence to date is consistent with our fifth hypothesis – pre-existing immunity unique to East Asia – but there are still essential parts of this story left for scientists to check.

Key policy takeaways from Michael McFaul on Russia after Putin, Rose Gottemoeller on the New START talks, Nathaniel Persily on the midterm elections and U.S. democracy, Francis Fukuyama on democracy in America, Anna Grzymala-Busse on Hungary's Viktor Orbán and the GOP, Daphne Keller on the European Union's new cyber policies, and Marietje Schaake on Twitter and Elon Musk.

Importance  Statin-associated muscle symptoms (SAMS) are common and may lead to discontinuation of indicated statin therapy. Observational studies suggest that vitamin D therapy is associated with reduced statin intolerance, but no randomized studies have been reported.

Objective  To test whether vitamin D supplementation was associated with prevention of SAMS and a reduction of statin discontinuation.

We evaluated the protection conferred by mRNA vaccines and previous infection against infection with the omicron variant in two high-risk populations: residents and staff in the California state prison system. We used a retrospective cohort design to analyze the risk of infection during the omicron wave using data collected from December 24, 2021, through April 14, 2022. Weighted Cox models were used to compare the effectiveness (measured as 1 minus the hazard ratio) of vaccination and previous infection across combinations of vaccination history (stratified according to the number of mRNA doses received) and infection history (none or infection before or during the period of B.1.617.2 [delta]–variant predominance). A secondary analysis used a rolling matched-cohort design to evaluate the effectiveness of three vaccine doses as compared with two doses.

We use linked survey and administrative data to document and decompose the striking differences across demographic groups in both economic and health impacts of the first year of the COVID-19 pandemic in the United States. The impacts of the pandemic on all-cause mortality and on employment were concentrated in the same racial, ethnic, and education groups, with non-White individuals and those without a college degree experiencing higher excess all-cause mortality as well as a greater employment loss. Observable differences in living arrangements and the nature of work – which likely affected exposure to the virus and to economic contractions – can explain 15 percent of the Hispanic-White difference in excess mortality, almost one-quarter of the non- Hispanic Black-White difference, and almost half of the difference between those with and without a Bachelor’s degree; they can also explain 35 to 40 percent of the differences in economic damages between these groups. These findings underscore the importance of non-medical factors in contributing to the disparate impacts of public health shocks.

We use linked administrative data that combines the universe of California birth records, hospitalizations, and death records with parental income from Internal Revenue Service tax records and the Longitudinal Employer-Household Dynamics file to provide novel evidence on economic inequality in infant and maternal health. We find that birth outcomes vary nonmonotonically with parental income, and that children of parents in the top ventile of the income distribution have higher rates of low birth weight and preterm birth than those in the bottom ventile. However, unlike birth outcomes, infant mortality varies monotonically with income, and infants of parents in the top ventile of the income distribution---who have the worst birth outcomes---have a death rate that is half that of infants of parents in the bottom ventile. When studying maternal health, we find a similar pattern of non-monotonicity between income and severe maternal morbidity, and a monotonic and decreasing relationship between income and maternal mortality. At the same time, these disparities by parental income are small when compared to racial disparities, and we observe virtually no convergence in health outcomes across racial and ethnic groups as income rises. Indeed, infant and maternal health in Black families at the top of the income distribution is markedly worse than that of white families at the bottom of the income distribution.Lastly, we benchmark the health gradients in California to those in Sweden, finding that infant and maternal health is worse in California than in Sweden for most outcomes throughout the entire income distribution.

Key policy takeaways from Michael McFaul on Russia after Putin, Francis Fukuyama on democracy in America, Daphne Keller on the global impact of the European Union's new digital policy, Marietje Schaake on Elon Musk's first days at Twitter, XXXXXX

An Asia Policy roundtable co-edited by Arzan Tarapore, including an essay by Oriana Skylar Mastro.

Putin's menacing rhetoric has alarmed the West, but lessons learned 60 years ago in the Cuban Missile Crisis provide some reassurance

This paper empirically investigates the labor market effects of China’s 2007 VAT reform, which significantly reduced the tax cost of capital investment. Employing city-by-year variation in the reform, we demonstrate that the tax cuts increased the earnings of skilled workers and left the earnings of the unskilled workers unaffected. Moreover, we find limited impacts of the reform on employment for both skill groups. These results suggest that the tax incentives increased the relative demand for skills, thus resulting in a higher income inequality between skilled and unskilled workers.

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Abstract

Professions play a key role in determining the division of labor and the returns to skilled work. This paper studies the productivity difference between physicians and nurse practitioners (NPs), two health care professions performing overlapping tasks but with stark differences in background, training, and pay. Using data from the Veterans Health Administration and quasi-experimental variation in the patient probability of being treated by physicians versus NPs in the emergency department, we find that, compared to physicians, NPs significantly increase resource utilization but achieve worse patient outcomes. We find evidence suggesting mechanisms relating to lower human capital among NPs relative to physicians and worker-task assignment responding to the lower skill of NPs. Counterfactual analysis suggests a net increase in medical costs with NPs, even when accounting for NPs’ wages that are half as much as physicians’. Despite large productivity differences between professions, we find even larger productivity differences within professions and substantial productivity overlap between professions. Yet there is little overlap in wages between NPs and physicians and, within professions, no significant correlation between productivity and wages.

Background

A population health approach to depression screening using patient portals may be a promising strategy to proactively engage and identify patients with depression.