Essays on Prescription Drug Policy and Education as Determinants of Health

Abstract

Education and access to legal drugs are two key issues that are influenced by public policy and that may have effects on population health among all ages. I use a variety of data sources to examine examples of these effects on US residents. Using unique data gathered from twins born in Minnesota between 1936 and 1955, I present evidence that increased schooling has a beneficial effect on mortality among males. On average, each additional year of schooling among male twins results in a 3.1 percentage point drop in probability of death during the 20-year window that began in 1994. Education particularly affects the likelihood of being overweight among men, and the observed mortality effects are concentrated on ages 59 to 78. A comparison of patterns of educational investment between monozygotic versus dizygotic twin pairs shows that families tend to use such investments to compensate for health endowment gaps between siblings. Using data on legal drug distribution and mortality rates, I examine the effects of a 2008 Louisiana law that required frequent and unanticipated drug testing of pain clinic patients who receive opioid prescriptions for the treatment of chronic pain. Evidence shows that the policy led to significant decreases in the quantity of opioids used and the rate of death from prescription opioid overdose. I then analyze data on foster care entry and child maltreatment reports and demonstrate that the rate of adverse events among children is positively correlated with measures of drug overdose frequency but negatively correlated with the quantity of legal opioids distributed. This finding suggests that policies to reduce the impact of opioid abuse on children should focus on preventing addiction rather than simply reducing the quantity of legal opioids supplied.