There is substantial uncertainty about how important early life household and community conditions are for later life chronic disease and aging. While a number of studies of short-term beneficial impacts support the importance of intervening on the early life environment to improve health, data limitations have prevented long- term follow-up studies, thus the extent to which early life policy changes would lead to declines in chronic disease and healthier aging is unclear. In addition, it is rare that the impacts of an actual social policy in childhood are evaluated, an approach which has clearer opportunities for translation of this evidence for informing current social policy. We propose to use four well established cohort studies that have complementary strengths for accomplishing our study objective: 1) the Panel Study of Income Dynamics (PSID), which is a multi-generational nationally representative sample, 2) the Alcoa data, which follows a large geographically diverse and fully insured cohort of manufacturing workers, 3) the Health and Retirement Study (HRS), which follows a nationally representative sample of older Americans, and 4) the Women's Health Initiative (WHI), which follows a large cohort of women. We will use these data sources to examine the effects of New Deal work-relief spending on the long-term health outcomes of children growing up during the Great Depression. Our central hypothesis, based on our prior research, is that employment from New Deal programs will be associated with lower levels of chronic disease and lower mortality for both the children in benefitting households, but also for children in non-benefit households living in areas that received greater amounts of New Deal funding. To test this hypothesis we propose the following specific aims:
Aim 1 : Create sample probability weights for PSID, Alcoa, HRS and WHI data to the 1940 census sample frame to enable comparisons across studies and produce nationally representative estimates, Aim 2: Estimate the association of parental New Deal work-relief participation on their children's later life health and mortality, Aim 3: Determine the spillover effect of area-level New Deal expenditures on children's later life health and mortality, Aim 4: Test the mechanisms through which parental New Deal work-relief participation and area-level New Deal expenditures are associated with later life health and mortality. The timing of our research proposal is critical ? we now have the opportunity to examine the long-term effects of New Deal work-relief on health outcomes as this cohort reaches older ages. It is arguably one of our best opportunities to understand the role that social policy can play in healthy aging over the life course. This evidence will be available at a critical time when new priorities for spending and infrastructure are being considered at local and federal levels, and the chronic disease burden of an aging population poses new challenges for medical care costs.
Understanding how economic policy can improve the environment for child development in ways that increase health throughout life can help to develop cost-effective and impactful approaches to improving health in the United States.