Association for Public Policy Analysis & Management

A large and growing literature has documented that health in early life can have large consequences on adult health and achievement; however, little evidence exists on the impact of public policies aimed at improving early life health and their long-term consequences. This fundamental gap in the literature persists despite the fact that public programs in the United States have made major investments in prenatal and infant health. The major barrier to conducting long-term evaluations of public investments is the lack of data that links information on early life exposure to public programs, health at birth, and later life outcomes.

This study aims to document the relationship between health at birth and later life outcomes, while evaluating the returns to policy-driven early health investments. To this end, we propose linking individual-level birth certificate data from California, which has information on health at birth, to Census, Census-held, and IRS data containing information on later life outcomes related to educational attainment, labor force participation, income, self-reported disability, and participation in public programs.

First, we will use within family variation in birth weight to estimate the effect of health at birth on adult health and productivity. By comparing siblings born within the same family but with different birth weights, our analysis will control for any family-specific characteristics that may influence both birth weight and later life outcomes.

Second, we will analyze two specific health investments that target the prenatal and neonatal periods. First, we will look at investments in the health of “very low birth weight” (VLBW) infants. To conduct this analysis, we will use a regression discontinuity design to compare the long-term outcomes of infants born just above and below the VLBW threshold. Previous research has documented that infants born just below this threshold receive more medical care and have better health and cognitive development than infants born just above this threshold. Our analysis will evaluate whether these improvements in health at birth translate into higher achievement and improved health later in life.

The second health policy we will evaluate is the Comprehensive Perinatal Services Program (CPSP), a landmark program providing enhanced pregnancy-related care for low-income pregnant women in California. CPSP providers receive financial incentives to ensure timely prenatal care, completion of risk assessments and individualized care plans, and delivery of appropriate support services, education, and prescribed prenatal vitamins and mineral supplements. We will evaluate the impact of this program on health at birth and later life outcomes using a difference-in-differences design that takes advantage of the staggered implementation of this program across counties in California.

This project will provide policymakers with information needed to assess the costs and benefits of interventions that target early life health. Given the many large social programs that exist in the U.S. to promote the health of pregnant women and infants, additional information on the relationship between public policy, health at birth, and later life outcomes will add substantial value to ongoing policy debates.