Addressing Racial Health Disparities: Looking Back to Point the Way Forward

This article investigates the influence of family background and neighborhood conditions during childhood on health later in life, with a focus on hypertension. To document the proportion of current adult racial health disparities rooted in early-life factors, I use nationally representative longitudinal data from the Panel Study of Income Dynamics (PSID) spanning four decades. The results indicate that racial differences in early life neighborhood conditions and family background characteristics play a substantial role in explaining racial disparities in hypertension through at least age 50. Contemporaneous socioeconomic factors account for relatively little of the racial disparities in this health condition in adulthood. Second, I match the PSID data to county-level data on Medicaid expenditures during these cohorts’ childhoods, and provide new causal evidence on the long-run returns to childhood Medicaid spending: Medicaid-induced increases in access to public health insurance led to significant reductions in the likelihood of low birth weight, increased educational attainment and adult income, and reduced adult mortality and the annual incidence of health problems.