Race and Ethnicity: Discrimination in Healthcare Markets, Disparate Impacts of Policy, Outcomes
Paper Session
Friday, Jan. 6, 2023 8:00 AM - 10:00 AM (CST)
- Chair: Marcella Alsan, Harvard University
State Recreational Cannabis Laws and Racial Disparities in the Criminal Justice System
Abstract
The prohibition of cannabis is considered one of the most costly and destructive aspects of America’s failed war on drugs. The toll comprises street violence from the creation of an illegal drug market, years of life lost behind bars, children growing up without parents, criminal records crippling access to jobs, loans, housing and benefits, and billions of dollars wasted in law enforcement. In 2018, police officers made about 663,000 cannabis arrests, 92% for possession and 8% for sales, which accounted for 40% of all drug arrests and exceeded arrests for all violent crimes combined.Racial disparities in law enforcement of cannabis prohibition are widespread and longstanding, with Black communities being disproportionately affected. Even though White and Black persons use cannabis at roughly the same rate, Black persons are over 3 times more likely to be arrested for cannabis possession. Black persons are also incarcerated at dramatically higher rates than White persons and account for almost half of all prisoners incarcerated with a sentence of more than one year for a drug-related offense.
The legalization of cannabis may be an effective step towards correcting the damage of cannabis prohibition on racial disparities in the criminal justice system and other consequences related to street violence. As of 2021, 18 states have passed recreational cannabis laws (RCLs), allowing individuals ages 21+ to possess, use, and supply limited amounts of cannabis for recreational purposes. Elucidating the impact of RCLs on racial disparities is important for designing successful regulation that works in reparative ways.
This study generates quasi-experimental estimates of the effect of RCLs on racial disparities in the criminal justice system. Outcomes included the per capita rate of drug arrests, incarcerations, and homicides, stratified by White, Black, and Other Race (Asian, Native American, Native Hawaiian/Other Pacific Islander). When available, we further stratified outcomes
Capacity Strain and Racial Disparities in Hospital Mortality
Abstract
A growing literature has documented racial disparities in health outcomes. We argue that racial disparities may be magnified when hospitals operate at capacity, when behavioral and structural conditions associated with poor patient outcomes (e.g., limited provider cognitive bandwidth or reliance on ex ante biased care algorithms) are aggravated. Using detailed, time-stamped electronic health record data from two major hospitals, we document a 20\% relative increase in mortality for Black compared to White patients when hospitals operate at capacity, driven entirely by patients with more medical comorbidities. Put differently, 8.5\% of Black patient deaths in our sample could have been avoided if Black patients had experienced the same capacity-mortality relationship as White patients. In terms of potential mechanisms, Black patients experienced longer wait times, lower likelihoods of ICU admissions, and had shorter lengths of stay and charges, though this was true at all levels of capacity strain. Dynamic decomposition analyses suggest that these findings are most likely driven by additional biases in provider behavior, hospital processes, and/or allocation of care resources that emerge or worsen as strain increases, which then interact with already lower intensities of care to produce differential mortality risks.The Changing Relationship Between Local Income and Racial Disparities in Infant Mortality
Abstract
In this paper, I examine the differential impact of local personal income levels on infant mortality for white and non-white infants in the United States from 1962 through 2016 using county level mortality data. Non-whites have higher infant mortality rates than whites on average, but also see greater reduction in infant mortality rates associated with residence in a state with higher average non-white per capita income, as well as a state or county with higher average per capita income overall. My analysis shows the increases in average incomes in this period would be expected to be associated with about half of the observed decline in the infant mortality gap. Without the increases in average incomes, the expected gap would be twice as large. Further, without the differential impact of local personal income levels on non-white infant mortality, specifically the greater reduction of non-white infant mortality rates from higher average incomes, the expected gap would be more than three times as large. Over the full period, states with 1000 USD (in 1967 dollars; >8000 2022 USD) more in state average non-white per capita income see about 2 fewer non-white infant deaths per thousand live births. This association is strongest at the start of the study period, beginning in the early 1960s, where states with 1000 USD (in 1967 dollars) more in average non-white per capita income saw 4 fewer non-white infant deaths per thousand live births. Observing this association over rolling time windows, the relationship weakens in the mid to late 1960s. In the later periods the association shrinks to approximately 1 fewer non-white infant death per thousand live births.Discussant(s)
Angelica Meinhofer
,
Cornell University
EK Green
,
University of Arizona
Alex Chan
,
Stanford University
Manasvini Singh
,
University of Massachusetts Amherst
JEL Classifications
- I1 - Health
- I1 - Health