WWS Reacts: Family Health During a Global Pandemic
Access to comprehensive, quality health care is critical for promoting and maintaining health and well-being. Yet, under normal circumstances, health care accessibility is an issue for many in the United States. Covid-19 brings new challenges for low-income families, expecting mothers, and others at higher risk for serious illness.
We asked faculty expert Janet Currie, Henry Putnam Professor of Economics and Public Affairs at Princeton University’s Woodrow Wilson School of Public and International Affairs and co-director of the Center for Health and Wellbeing, to take a deeper look at how the global pandemic has impacted mothers and children, its disproportionate effects on low-income populations, and both the positive implications and gaps of the Coronavirus Aid, Relief, and Economic Security (CARES) Act.
Currie is a pioneer in the economic analysis of child development. Her current research focuses on the socioeconomic differences in health and access to health care, environmental threats to health, and the important role of mental health.
Q. The head of the International Monetary Fund (IMF) has said the world is now in a global recession. How might a recession impact the health and wellbeing of U.S. families?
Currie: The latest from the IMF is that we are likely to experience a contraction as bad as the Great Depression. Research shows that we can expect this to have severe short- and long-term effects on health. Babies in utero are especially vulnerable. We don't know yet what effect Covid-19 has on the developing fetus, but evidence of the effects of the seasonal flu are worrying. We know, for example, that flu causes many cases of premature delivery every year in the U.S., and that babies who are premature are more likely to have health effects ranging from asthma and attention deficit hyperactivity disorder to long-term disability. Maternal stress during pregnancy also has been shown to have negative effects on the fetus — for instance, in work on babies born to mothers who lived along projected hurricane paths in Texas, I showed that affected babies were 60% more likely to have abnormal conditions than their own siblings who were not affected in-utero by hurricanes.
And there seem to be spikes in domestic violence associated with people being locked down. In ongoing research with Michael Mueller Smith of the University of Michigan and Maya Rossin-Slater of Stanford Medicine, we show using birth records and crime records in New York City that assaults during pregnancy directly cause very premature births, with negative future implications for the children affected. Some of these increases in domestic violence may be linked to changes in health behaviors such as increases in drinking, smoking, and use of drugs. In work on the Great Recession using data from the Princeton-led Fragile Families & Child Wellbeing Study, we show that higher unemployment during the Great Recession increased these behaviors among mothers, with larger effects on poor, minority, and less-educated mothers.
The lockdown also is making it difficult for people to get preventive care. Work I have done in New Jersey shows that small changes in access, such as the opening and closing of retail clinics in CVS drug stores, are associated with changes in emergency room visits for preventable conditions like urinary tract infections, and also with changes in hospitalizations for influenza and diabetes. If even small changes in access have large effects, then the large changes in access we are experiencing are likely to have very negative effects for some.
The foreclosure crisis that precipitated the Great Recession in 2008 had significant health impacts: Using data for five states, I was able to show that places that experienced more foreclosures per capita had increases in stress-related hospitalizations such as those for heart attacks. There were also increases in mental health-related visits such as for anxiety attacks and suicide attempts.
Q. What did the CARES Act get right? How could it have been improved?
Currie: The CARES Act did a number of things that are important for health care access. First, it prohibited states from throwing people off of Medicaid. The Trump administration has made changes to Medicaid regulations allowing states to impose work requirements and other changes in Medicaid rules, which have caused hundreds of thousands of people to lose Medicaid coverage in the last few years. The CARES Act implicitly recognizes the importance of Medicaid by stopping this practice, at least temporarily.
CARES will also reimburse providers for Covid-19 testing, diagnosis, and inpatient hospital care related to Covid-19 at Medicare rates. So suddenly, we have “Medicare for All [Covid-19 patients].” It is remarkable what can be accomplished in a crisis. However, CARES does not fund outpatient care for Covid-19 patients, which is a major gap.
And we still don't have the widespread testing that we need to be able to get people back to work. We need more testing for the virus, more contact tracing, more testing for antibodies, and more follow-up of people who have recovered, so we can learn more about how long they will be immune for and what lingering health effects they may suffer.
Q. How is this crisis impacting those who receive health coverage through Medicaid and/or CHIP? Are families able to access routine child health care such as vaccines; and if not, what are the long-term implications of these gaps?
Currie: Unfortunately, the crisis seems to be negatively impacting access to routine care for everyone. This could have particularly disastrous consequences for vaccinations. Already, there were many “hotspots” in the U.S. where the fraction of children vaccinated was too low, and we have seen outbreaks of diseases like measles. I hate to think about a generation of children being at risk for diseases such as whooping cough as well.
Q. With uneven access to health care, food insecurity, and housing insecurity, what effects on health and well-being can we expect the lowest income families to endure?
Currie: There has been a lot of attention to the fact that low-income families are the most likely to be in “essential” jobs, which makes them more likely to be exposed to the virus, and at the same time these families typically have poorer access to health care, less space in which to socially distance, fewer resources to buy gloves and masks, and so on. So, it is not surprising that the Covid-19 virus is hitting poor and minority families the hardest. It has been stunning how quickly the overall health inequalities that we see in our society are replicating themselves in the midst of this crisis.
Q. Many hospitals across the country are creating or revising policies for the safe delivery of newborns during the Covid-19 outbreak. What are the implications for mothers and their infants?
Currie: In addition to what I shared above on fetal effects, I believe that many babies are being delivered by C-section in an attempt to prevent them from being infected with Covid-19 at birth. This practice hasn't really been evaluated yet, so we don’t know if it actually prevents infection.
WWS Reacts is a news-focused series featuring faculty who present their views on current events.