Between 80% and 90% of the modifiable contributors to population health are social determinants of health: health-related behaviors, socio-economic factors, and environmental factors, in other words, the conditions in which people are born, grow, live, work and age. (Hood et al. 2016; Magnan 2017). These circumstances are, at least in part, political constructions (Rodriguez 2019). At the macro-level, political factors include the character, ideology, and policies of political regimes and governing political parties (Beckfield and Krieger 2009; Rodriguez 2019; Torche and Rauf 2021). Yet even in the absence of policy implementation, politics influences health (Brown, Solazzo, and Gorman 2021; Gemmill et al. 2019; Lauderdale 2006; Morey et al. 2021; Samari et al. 2020; Torche and Sirois 2019). In this dissertation I study the link between three political determinants of population health in the U.S. and infant health and mortality: Donald Trump’s election in November 2016, Trump’s 2015-2016 presidential campaign rallies, and U.S. states’ prioritization of carceral spending from 1980-2008. In the first dissertation chapter, I investigate whether rates of and disparities in adverse birth outcomes between racialized and nativity groups changed after Donald Trump’s November 2016 election, a period characterized by an increase in xenophobic and racist messages, policies, and actions in the U.S. Using data from 15,568,710 U.S. births between November 2012 and November 2018, we find that adverse birth outcomes increased after Trump’s election among U.S.- and foreign-born mothers racialized as Black, Hispanic, and Asian & Pacific Islander, compared to the period encompassing the two Obama presidencies. Results for Whites suggest no change or a slight decrease in adverse outcomes following Trump’s election, yet this finding was not robust to checks for seasonality. Black-White, Hispanic-White, and API-White disparities in adverse birth outcomes widened among both U.S.- and foreign-born mothers after Trump’s election. Findings suggest that Trump’s election was a racist and xenophobic macro-level political.
In the second dissertation chapter, I provide estimates for the causal effect of Donald Trump’s presidential campaign rallies on infant health by using a staggered difference-in-difference research design using data of geocoded Trump rallies linked to monthly, county-level data from U.S. birth records collected between June 2014 and November 2017. I find that Trump rallies led to increases in very low birthweight among infants born to foreign-born Hispanic birthing parents and in low birthweight among infants born to foreign-born Asian and Pacific Islander birthing parents. This effect was not observed among U.S.-born women or foreign-born White and Black women. These ethnicity and race-specific health effects suggest that Trump's presidential rallies constituted a significant stressor for Hispanic and API foreign-born groups residing in the U.S. Further, this study underscores a significant finding: political events, and not just policy changes, have adverse effects on human health.
In the third dissertation chapter, I examine the association between a state prioritization of carceral spending over welfare expenditure and Black and White death rates in 42 U.S. states between 1980 and 2008. Using fixed-effects models and controlling for confounders, I find that U.S. states’ fiscal prioritization of carceral systems to the exclusion of health and support is associated with an increased number of both Black and White deaths. The association between a states’ carceral prioritization and Black death is larger than its association with White death, meaning that penal states increase racial inequality in mortality. Further, these negative consequences are concentrated in the South for both groups and in the West for White groups. My findings suggest that a penal-welfare regime that prioritizes punitive control over welfare support is a racializing tool used by U.S. states harms population health and disproportionately harms the health of Black groups living in the South.
