American Recovery and Reinvestment Act and county-level health outcomes

Abstract

ABSTRACTA series of studies have supported the economic benefits from the 2009 American Recovery and Reinvestment Act (ARRA), however, there is little evidence to demonstrate its impact on local health. We test the direct and indirect (through county-level poverty and household income) effects of ARRA expenditures per-capita on five types of county-level health outcomes. Based on Two-Stage Least Squares (2SLS) regression models, a 10% increase in ARRA expenditures per-capita was negatively associated with fair to poor health (0.4 percentage point), number of physically (−0.08 days or 115 min during a 30-day period) or mentally (−0.05 days or 72 min during a 30-day period) unhealthy days in a month, premature death rate (158 deaths per 100,000 population) and adjusted mortality (7.6 deaths per 100,000 population decline). Overall, the direct and indirect association of economic stimulus with health outcomes through poverty and income are positive but effect sizes are small.