Health Dynamics and the Evolution of Health Inequality over the Life Course: The Importance of Neighborhood and Family Background

This paper investigates the extent and ways in which childhood family and neighborhood quality influence later-life health outcomes. The study analyzes the health trajectories of children born between 1950 and 1970 followed through 2005. Data from the Panel Study of Income Dynamics (PSID) spanning four decades are linked with information on neighborhood attributes and school quality resources that prevailed at the time these children were growing up.There are several key findings. First, estimates of sibling and child neighbor correlations in health are used to bound the proportion of inequality in health status in childhood through mid-life that are attributable to childhood family and neighborhood quality. Estimates based on four-level hierarchical random effects models (neighborhoods, families, individuals, over time) consistently show a significant scope for both childhood family and neighborhood background (including school quality). The results imply substantial persistence in health status across generations that are linked in part to low intergenerational economic mobility. Sibling correlations are large throughout at least the first 50 years of life: roughly three-fifths of adult health disparities may be attributable to family and neighborhood background. Childhood neighbor correlations in adult health are also substantial (net of the similarity arising from similar family characteristics), suggesting that disparities in neighborhood background account for more than one-third of the variation in health status in mid life.Second, exposure to concentrated neighborhood poverty during childhood has significant deleterious impacts on adult health. The results reveal that even a large amount of selection on unobservable factors does not eliminate the significant effect of child neighborhood poverty on health status later in life. Thus, racial differences in adult health can be accounted for by childhood family, neighborhood, and school quality factors, while contemporaneous economic factors account for relatively little of this gap.