Can access to health care mitigate the effects of temperature on mortality?

• 成果类型: Article
• 署名作者: Mullins, Jamie T.; White, Corey
• 署名单位: University of Massachusetts System; University of Massachusetts Amherst; Monash University; California State University System; California Polytechnic State University San Luis Obispo; IZA Institute Labor Economics
• 刊物名称: JOURNAL OF PUBLIC ECONOMICS
• ISSN/ISSBN: 0047-2727
• DOI: 10.1016/j.jpubeco.2020.104259
• 发表日期: 2020
• 关键词: Health care; access; climate; temperature; environment

摘要

Understanding the sources of heterogeneity in the health effects of environmental exposure is critical for optimal policy design. Differential access to health care is commonly cited as a potential source of such heterogeneity. We test this hypothesis in a causal framework by combining randomyear-to-year fluctuations in local temperatures with variation in access to primary care services resulting from the idiosyncratic roll-out of Community Health Centers (CHCs) across US counties in the 1960s and 1970s. We find that the improved access to primary care services provided by CHCsmoderates the heat-mortality relationship by 14.2%, but we find little evidence that CHC access mitigates the harmful effects of cold. In a supplementary analysiswe find evidence that acute care - in contrast to primary care - may be especially effective at mitigating the cold-mortality relationship. Our results suggest that differential access to health care does contribute to observed heterogeneity in environmental health damages, and that improving access to primary care may be a useful means of mitigating harm from a warming climate. (c) 2020 Elsevier B.V. All rights reserved.