IDEAS home Printed from https://ideas.repec.org/a/aea/jecper/v35y2021i3p25-46.html
   My bibliography  Save this article

The Great Unequalizer: Initial Health Effects of COVID-19 in the United States

Author

Listed:
  • Marcella Alsan
  • Amitabh Chandra
  • Kosali Simon

Abstract

We measure inequities from the COVID-19 pandemic on mortality and hospitalizations in the United States during the early months of the outbreak. We discuss challenges in measuring health outcomes and health inequality, some of which are specific to COVID-19 and others that complicate attribution during most large health shocks. As in past epidemics, preexisting biological and social vulnerabilities profoundly influenced the distribution of disease. In addition to the elderly, Hispanic, Black and Native American communities were disproportionately affected by the virus, particularly when assessed using the years of potential life lost metric. We provide a conceptual framework and initial empirical analysis that seek to shed light on contributors to pandemic-related health inequality, and we suggest areas for future research.

Suggested Citation

  • Marcella Alsan & Amitabh Chandra & Kosali Simon, 2021. "The Great Unequalizer: Initial Health Effects of COVID-19 in the United States," Journal of Economic Perspectives, American Economic Association, vol. 35(3), pages 25-46, Summer.
    • Handle: RePEc:aea:jecper:v:35:y:2021:i:3:p:25-46
    DOI: 10.1257/jep.35.3.25
    as

    Download full text from publisher

    File URL: https://www.aeaweb.org/doi/10.1257/jep.35.3.25
    Download Restriction: no
    File URL: https://doi.org/10.3886/E132521V1
    Download Restriction: no
    File URL: https://www.aeaweb.org/doi/10.1257/jep.35.3.25.appx
    Download Restriction: no
    File URL: https://www.aeaweb.org/doi/10.1257/jep.35.3.25.ds
    Download Restriction: no
    File URL: https://libkey.io/10.1257/jep.35.3.25?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    Other versions of this item:

    References listed on IDEAS

    as
    1. Myeong-Su Yun, 2005. "A Simple Solution to the Identification Problem in Detailed Wage Decompositions," Economic Inquiry, Western Economic Association International, vol. 43(4), pages 766-772, October.
    2. Ann H. Stevens & Douglas L. Miller & Marianne E. Page & Mateusz Filipski, 2015. "The Best of Times, the Worst of Times: Understanding Pro-cyclical Mortality," American Economic Journal: Economic Policy, American Economic Association, vol. 7(4), pages 279-311, November.
    3. Amitabh Chandra & Pragya Kakani & Adam Sacarny, 2020. "Hospital Allocation and Racial Disparities in Health Care," NBER Working Papers 28018, National Bureau of Economic Research, Inc.
    4. Steve Cicala & Stephen P. Holland & Erin T. Mansur & Nicholas Z. Muller & Andrew J. Yates, 2020. "Expected Health Effects of Reduced Air Pollution from COVID-19 Social Distancing," Working Papers 2020-61, Becker Friedman Institute for Research In Economics.
    5. Francine D. Blau & Josefine Koebe & Pamela A. Meyerhofer, 2021. "Who are the essential and frontline workers?," Business Economics, Palgrave Macmillan;National Association for Business Economics, vol. 56(3), pages 168-178, July.
    6. Engy Ziedan & Kosali I. Simon & Coady Wing, 2020. "Effects of State COVID-19 Closure Policy on NON-COVID-19 Health Care Utilization," NBER Working Papers 27621, National Bureau of Economic Research, Inc.
    7. Ben Jann, 2008. "The Blinder–Oaxaca decomposition for linear regression models," Stata Journal, StataCorp LP, vol. 8(4), pages 453-479, December.
    8. Rees-Jones, Alex & D’Attoma, John & Piolatto, Amedeo & Salvadori, Luca, 2022. "Experience of the COVID-19 pandemic and support for safety-net expansion," Journal of Economic Behavior & Organization, Elsevier, vol. 200(C), pages 1090-1104.
    9. Marcella Alsan & Sarah Eichmeyer, 2024. "Experimental Evidence on the Effectiveness of Nonexperts for Improving Vaccine Demand," American Economic Journal: Economic Policy, American Economic Association, vol. 16(1), pages 394-414, February.
    10. Christopher J. Ruhm, 2000. "Are Recessions Good for Your Health?," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 115(2), pages 617-650.
    11. Theresa Andrasfay & Noreen Goldman, 2021. "Reductions in 2020 US life expectancy due to COVID-19 and the disproportionate impact on the Black and Latino populations," Proceedings of the National Academy of Sciences, Proceedings of the National Academy of Sciences, vol. 118(5), pages 2014746118-, February.
    12. Andrey Simonov & Szymon Sacher & Jean-Pierre Dube & Shirsho Biswas, 2020. "The Persuasive Effect of Fox News: Non-Compliance with Social Distancing During the COVID-19 Pandemic," Working Papers 2020-67, Becker Friedman Institute for Research In Economics.
    13. Marcella Alsan & Owen Garrick & Grant Graziani, 2019. "Does Diversity Matter for Health? Experimental Evidence from Oakland," American Economic Review, American Economic Association, vol. 109(12), pages 4071-4111, December.
    14. Maria Polyakova & Geoffrey Kocks & Victoria Udalova & Amy Finkelstein, 2020. "Initial economic damage from the COVID-19 pandemic in the United States is more widespread across ages and geographies than initial mortality impacts," Proceedings of the National Academy of Sciences, Proceedings of the National Academy of Sciences, vol. 117(45), pages 27934-27934, November.
    15. Joseph Doyle & John Graves & Jonathan Gruber, 2019. "Evaluating Measures of Hospital Quality: Evidence from Ambulance Referral Patterns," The Review of Economics and Statistics, MIT Press, vol. 101(5), pages 841-852, December.
    16. Laura Montenovo & Xuan Jiang & Felipe Lozano Rojas & Ian M. Schmutte & Kosali I. Simon & Bruce A. Weinberg & Coady Wing, 2020. "Determinants of Disparities in Covid-19 Job Losses," NBER Working Papers 27132, National Bureau of Economic Research, Inc.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Susan Athey & Kristen Grabarz & Michael Luca & Nils Wernerfelt, 2023. "Digital public health interventions at scale: The impact of social media advertising on beliefs and outcomes related to COVID vaccines," Proceedings of the National Academy of Sciences, Proceedings of the National Academy of Sciences, vol. 120(5), pages 2208110120-, January.
    2. Kunz, Johannes & Propper, Carol, 2022. "Is Hospital Quality Predictive of Pandemic Deaths? Evidence from US Counties," CEPR Discussion Papers 17365, C.E.P.R. Discussion Papers.
    3. Angus Deaton, 2022. "The great divide: education, despair, and death," Business Economics, Palgrave Macmillan;National Association for Business Economics, vol. 57(4), pages 161-168, October.
    4. John Brownstein & Jonathan H. Cantor & Benjamin Rader & Kosali I. Simon & Christopher M. Whaley, 2022. "If You Build it, Will They Vaccinate? The Impact of COVID-19 Vaccine Sites on Vaccination Rates and Outcomes," NBER Working Papers 30429, National Bureau of Economic Research, Inc.
    5. Pathak, Prakash & Schündeln, Matthias, 2022. "Social hierarchies and the allocation of development aid: Evidence from the 2015 earthquake in Nepal," Journal of Public Economics, Elsevier, vol. 209(C).
    6. Hasan, Iftekhar & Krause, Thomas & Manfredonia, Stefano & Noth, Felix, 2022. "Banking market deregulation and mortality inequality," Bank of Finland Research Discussion Papers 14/2022, Bank of Finland.
    7. Rishi Patel, 2023. "The Transformation of the Healthcare Business through the COVID-19 Pandemic (2020–2021)," JRFM, MDPI, vol. 16(7), pages 1-13, July.
    8. Anneliese N. Luck & Irma T. Elo & Samuel H. Preston & Eugenio Paglino & Katherine Hempstead & Andrew C. Stokes, 2023. "COVID-19 and All-Cause Mortality by Race, Ethnicity, and Age Across Five Periods of the Pandemic in the United States," Population Research and Policy Review, Springer;Southern Demographic Association (SDA), vol. 42(4), pages 1-29, August.
    9. Amy Finkelstein & Geoffrey Kocks & Maria Polyakova & Victoria Udalova, 2022. "Heterogeneity in Damages from A Pandemic," NBER Working Papers 30658, National Bureau of Economic Research, Inc.
    10. Wolfgang Frimmel & Gerald J. Pruckner, 2024. "The COVID-19 pandemic and health care utilization: Evidence from Austrian register data," Economics working papers 2024-03, Department of Economics, Johannes Kepler University Linz, Austria.
    11. Max Nathan, 2023. "Critical Commentary: The city and the virus," Urban Studies, Urban Studies Journal Limited, vol. 60(8), pages 1346-1364, June.
    12. Cafferata, Alessia & Cerruti, Gianluca & Mazzone, Giulio, 2023. "Taxation, health system endowment and institutional quality: ‘Social media’ perceptions across Europe," Journal of Economic Behavior & Organization, Elsevier, vol. 215(C), pages 224-243.
    13. Kairon Shayne D. Garcia & Benjamin W. Cowan, 2022. "The Impact of U.S. School Closures on Labor Market Outcomes during the COVID-19 Pandemic," NBER Working Papers 29641, National Bureau of Economic Research, Inc.
    14. Susan Athey & Kristen Grabarz & Michael Luca & Nils Wernerfelt, 2022. "The Effectiveness of Digital Interventions on COVID-19 Attitudes and Beliefs," Papers 2206.10214, arXiv.org.
    15. Duffy, Katie & Connolly, Sheelah & Maitre, Bertrand & Anne Nolan, 2022. "Unequal chances? Inequalities in mortality in Ireland," Research Series, Economic and Social Research Institute (ESRI), number RS145.
    16. Feng Huang & Hong Liu, 2023. "The impact of the COVID‐19 pandemic and related policy responses on non‐COVID‐19 healthcare utilization in China," Health Economics, John Wiley & Sons, Ltd., vol. 32(3), pages 620-638, March.
    17. Tamás Hajdu & Judit Krekó & Csaba G. Tóth, 2023. "Inequalities in regional excess mortality and life expectancy during the COVID-19 pandemic in Europe," CERS-IE WORKING PAPERS 2316, Institute of Economics, Centre for Economic and Regional Studies.
    18. Kunz, Johannes S. & Propper, Carol, 2023. "JUE Insight: Is hospital quality predictive of pandemic deaths? Evidence from US counties," Journal of Urban Economics, Elsevier, vol. 133(C).
    19. Engy Ziedan & Kosali I. Simon & Coady Wing, 2022. "Mortality Effects of Healthcare Supply Shocks: Evidence Using Linked Deaths and Electronic Health Records," NBER Working Papers 30553, National Bureau of Economic Research, Inc.
    20. Kairon Shayne D. Garcia & Benjamin W. Cowan, 2024. "Childcare Responsibilities and Parental Labor Market Outcomes During the COVID-19 Pandemic," Journal of Labor Research, Springer, vol. 45(2), pages 153-200, June.
    21. Anne Case & Angus Deaton, 2021. "Mortality Rates by College Degree Before and During COVID-19," NBER Working Papers 29328, National Bureau of Economic Research, Inc.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Sumedha Gupta & Kosali I. Simon & Coady Wing, 2020. "Mandated and Voluntary Social Distancing During The COVID-19 Epidemic: A Review," NBER Working Papers 28139, National Bureau of Economic Research, Inc.
    2. Lídia Farré & Francesco Fasani & Hannes Mueller, 2018. "Feeling useless: the effect of unemployment on mental health in the Great Recession," IZA Journal of Labor Economics, Springer;Forschungsinstitut zur Zukunft der Arbeit GmbH (IZA), vol. 7(1), pages 1-34, December.
    3. Wang, Huixia & Wang, Chenggang & Halliday, Timothy J., 2018. "Health and health inequality during the great recession: Evidence from the PSID," Economics & Human Biology, Elsevier, vol. 29(C), pages 17-30.
    4. Brahim Boudarbat & Marie Connolly, 2013. "The gender wage gap among recent post‐secondary graduates in Canada: a distributional approach," Canadian Journal of Economics/Revue canadienne d'économique, John Wiley & Sons, vol. 46(3), pages 1037-1065, August.
    5. Arthi, Vellore & Parman, John, 2021. "Disease, downturns, and wellbeing: Economic history and the long-run impacts of COVID-19," Explorations in Economic History, Elsevier, vol. 79(C).
    6. Adam Pilny, 2017. "Explaining Differentials in Subsidy Levels Among Hospital Ownership Types in Germany," Health Economics, John Wiley & Sons, Ltd., vol. 26(5), pages 566-581, May.
    7. Colombo, Emilio & Rotondi, Valentina & Stanca, Luca, 2018. "Macroeconomic conditions and health: Inspecting the transmission mechanism," Economics & Human Biology, Elsevier, vol. 28(C), pages 29-37.
    8. Federico Belotti & Joanna Kopinska & Alessandro Palma & Andrea Piano Mortari, 2022. "Health status and the Great Recession. Evidence from electronic health records," Health Economics, John Wiley & Sons, Ltd., vol. 31(8), pages 1770-1799, August.
    9. Azam Mehtabul & Han Luyi, 2020. "Accounting for Differences in Female Labor Force Participation between China and India," The B.E. Journal of Economic Analysis & Policy, De Gruyter, vol. 20(2), pages 1-17, April.
    10. Vassilis Monastiriotis & Angelo Martelli, 2021. "Crisis, Adjustment and Resilience in the Greek Labor Market: An Unemployment Decomposition Approach," International Regional Science Review, , vol. 44(1), pages 85-112, January.
    11. Chenggang Wang & Huixia Wang & Timothy J. Halliday, 2017. "Health and Health Inequality during the Great Recession: Evidence from the PSID," Working Papers 201703, University of Hawaii at Manoa, Department of Economics.
    12. Pinar Mine Gunes & Magda Tsaneva, 2022. "Labour market conditions and adult health in Mexico," Canadian Journal of Economics/Revue canadienne d'économique, John Wiley & Sons, vol. 55(1), pages 106-137, February.
    13. Powers, Daniel A. & Yun, Myeong-Su, 2009. "Multivariate Decomposition for Hazard Rate Models," IZA Discussion Papers 3971, Institute of Labor Economics (IZA).
    14. Niels-Hugo Blunch & Maitreyi Bordia Das, 2015. "Changing norms about gender inequality in education: Evidence from Bangladesh," Demographic Research, Max Planck Institute for Demographic Research, Rostock, Germany, vol. 32(6), pages 183-218.
    15. Bryan, Mark & Bryce, Andrew & Rice, Nigel & Roberts, Jennifer & Sechel, Cristina, 2022. "Exploring mental health disability gaps in the labour market: the UK experience during COVID-19," Labour Economics, Elsevier, vol. 78(C).
    16. Abel Brodeur & David Gray & Anik Islam & Suraiya Bhuiyan, 2021. "A literature review of the economics of COVID‐19," Journal of Economic Surveys, Wiley Blackwell, vol. 35(4), pages 1007-1044, September.
    17. Erdal Tekin & Chandler McClellan & Karen Jean Minyard, 2013. "Health and Health Behaviors during the Worst of Times," NBER Working Papers 19234, National Bureau of Economic Research, Inc.
    18. Zhu, Rong, 2016. "Wage differentials between urban residents and rural migrants in urban China during 2002–2007: A distributional analysis," China Economic Review, Elsevier, vol. 37(C), pages 2-14.
    19. Lívia Madeira Triaca & Paulo de Andrade Jacinto & Marco Túlio Aniceto França & César Augusto Oviedo Tejada, 2020. "Does greater unemployment make people thinner in Brazil?," Health Economics, John Wiley & Sons, Ltd., vol. 29(10), pages 1279-1288, October.
    20. Huixia Wang & Chenggang Wang & Timothy Halliday, 2016. "Money and Credit: Health and Health Inequality during the Great Recession: Evidence from the PSID," Working Papers 201615, University of Hawaii at Manoa, Department of Economics.

    More about this item

    JEL classification:

    • D63 - Microeconomics - - Welfare Economics - - - Equity, Justice, Inequality, and Other Normative Criteria and Measurement
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I14 - Health, Education, and Welfare - - Health - - - Health and Inequality
    • J15 - Labor and Demographic Economics - - Demographic Economics - - - Economics of Minorities, Races, Indigenous Peoples, and Immigrants; Non-labor Discrimination

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:aea:jecper:v:35:y:2021:i:3:p:25-46. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Michael P. Albert (email available below). General contact details of provider: https://edirc.repec.org/data/aeaaaea.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.