How Salutary
Explaining the Widening Divides in US Midlife Mortality: Is There a Smoking Gun?
Christopher Foote et al.
NBER Working Paper, December 2025
Abstract:
The education-mortality gradient has increased sharply in the last three decades, with the life-expectancy gap between people with and without a college degree widening from 2.6 years in 1992 to 6.3 years in 2019 (Case and Deaton 2023). During the same period, mortality inequality across counties rose 30 percent, accompanied by an increasing rural health penalty. Using county- and state-level data from the 1992-2019 period, we demonstrate that these three trends arose due to a fundamental shift in the geographic patterns of mortality among college and non-college populations. First, we find a sharp decline in both mortality rates and geographic inequality for college graduates. Second, the reverse was true for people without a college degree; spatial inequality became amplified. Third, we find that rates of smoking play a key role in explaining all three empirical puzzles, with secondary roles attributed to income, other health behaviors, and state policies. Less well-understood is why "place effects" matter so much for smoking (and mortality) for those without a college degree.
A Danger to Self and Others: Health and Criminal Consequences of Involuntary Hospitalization
Natalia Emanuel, Valentin Bolotnyy & Pim Welle
Federal Reserve Working Paper, July 2025
Abstract:
Involuntary hospitalization of people experiencing a mental health crisis is a widespread practice, 2.4 times as common as death from cancer and as common in the U.S. as incarceration in state and federal prisons. The intent of involuntary hospitalization is to prevent individuals from harming themselves or others through incapacitation, stabilization, and medical treatment over a short period of time. Does involuntary hospitalization achieve its goals? We leverage quasi-random assignment of the evaluating physician and administrative data from Allegheny County, Pennsylvania, to estimate the causal effects of involuntary hospitalization on harm to self (proxied by death by suicide or overdose) and harm to others (proxied by violent crime charges). For individuals whose cases are judgment calls, where some physicians would hospitalize but others would not, we find that hospitalization nearly doubles both the probability of dying by suicide or overdose and also nearly doubles the probability of being charged with a violent crime in the three months after evaluation. We provide evidence of earnings and housing disruptions as potential mechanisms. Our results suggest that, on the margin, the system we study is not achieving the intended effects of the policy.
Housing Quality Improvement and Health Care Utilization: A Regression Discontinuity Study
Kacie Dragan
Journal of Policy Analysis and Management, Winter 2026
Abstract:
Low-income housing is often of substandard quality. Health care payers like Medicaid and Medicare are piloting reimbursement for housing quality improvement with the rationale of reducing expenses from acute care use, but little is known about whether housing quality interventions can alter health utilization. I evaluate a large-scale policy mandating remediation of NYC's worst buildings in a regression discontinuity design to estimate the causal effect of housing improvements on health utilization. I do not find evidence of impacts on any metric of short-run acute care use or health expenditures, even among vulnerable subgroups. Exploratory longer-run event studies show some evidence of moderate (10%-15%) reductions in emergency department visits 3-4 years later but no evidence of impacts on expenditures. The policy succeeded at reducing housing violation rates in treated buildings by half. Yet, this only corresponded to a move from the 98th percentile to the 96th percentile of all buildings, underscoring the dire conditions tenants continue to live in -- and suggesting one potential explanation for muted findings on health care use. The theory that housing quality interventions can directly translate to reductions in health use and spending may not be borne out empirically, particularly if interventions cannot completely address substandard conditions.
PFAS-contaminated drinking water harms infants
Robert Baluja et al.
Proceedings of the National Academy of Sciences, 16 December 2025
Abstract:
There is evidence of widespread human exposure to per- and polyfluoroalkyl substances (PFAS) but limited evidence of the human health impacts of this exposure. Using data on New Hampshire births from 2010-2019, we show that mothers receiving water that had flowed beneath a PFAS-contaminated site, as opposed to comparable mothers receiving water that had flowed toward a PFAS-contaminated site, had 191% [95% CI: 83-298%] higher first-year infant mortality (611 [268-955] additional first-year deaths per 100k births); 168% [42-294%] more births before 28 wk of gestational age (466 [116-817] additional such births per 100k births); and 180% [57-302%] more births with weight below 1,000 g (607 [192-1022] additional such births per 100k births). Extrapolating to the contiguous U.S., PFAS contamination imposes annual social costs of approximately $8 billion. These health costs are substantially larger than current outside estimates of the cost of removing PFAS from the public water supply.
Concussed: Unintended Consequences of the Guardian Cap Mandate in the NFL
Kerianne Lawson Rubenstein & Todd Nesbit
Southern Economic Journal, forthcoming
Abstract:
Guardian Caps are padded shells worn over American football helmets to cushion impacts and reduce concussion risks. In 2022, the NFL mandated their use for specific position groups during preseason practices, later expanding this requirement. While the league praised the Caps for enhancing player safety, skeptics argue they may promote riskier tackles and create a false sense of security. This article explores the unintended consequences of the NFL's Guardian Cap mandate, revealing that these Caps do not significantly lower concussion rates. In fact, concussions in the position groups using Guardian Caps increased after the mandate was implemented.