Early Life Healthcare Access and Later-life Mortality: Evidence Using Openings of County Health Departments

This paper examines the long-term effects of early-life exposure to county health departments (CHDs), a public health initiative aimed at providing affordable healthcare access to disadvantaged and underserved areas during the early decades of the 20th century, on later-life longevity. We employ Social Security Administration death records linked with the 1940 census and implement a difference-in-differences estimation strategy to compare the longevity of individuals exposed at different ages to the county-specific year of CHD establishment. We find that exposure to a CHD opening in the county of birth during fetal development and early years of life is associated with a 1-4-month increase in longevity. We observe considerable heterogeneity in the results, such that the effects are more concentrated among non-white individuals and individuals with lower-educated parents. Contemporaneous fertility and infant mortality data suggest reductions in infant mortality rates and increases in birth rates following CHD openings. Additionally, we find significant improvements in educational attainment, socioeconomic status, and income in early adulthood. We argue that enhancements in the fetal environment, improved fetal survival, and better early life health capital resulting from CHD exposure contribute to improvements in human capital during adulthood, with potential implications for later-life longevity.