Essays in empirical environmental economics and health

In the chapters herein, I explore two issues affecting rural public health in the United States. The first examines the relationship between concentrated livestock farming, pollution, and infant health. The second looks at the effect of a large hospital construction program aimed at poor and rural areas.; The first chapter examines whether increased livestock farming correlates with groundwater and air pollution, as well as decreasing infant health. The past decades have witnessed a major shift in the U.S. livestock industry, with a decline in the number of family farms and a rise in large, specialized operations. Accompanying these changes is a growing concern over the environmental and health consequences of concentrated livestock farming. In this chapter I use detailed county-level data from 1980 to 1999 to examine the effects of livestock farming on air and water quality and infant health. Results from a series of models that control for fixed county-level factors, changing land use and housing characteristics, and the shifting demographics of mothers suggest that a 100,000 animal unit increase in livestock farming in a county leads to 60-80 more infant deaths per 100,000 births. The mortality increases are driven by elevated levels of respiratory diseases and conditions originating in the perinatal period---causes that have been linked to air pollution in the previous literature. Direct evidence that the deaths can be attributed to air or water pollution is limited by weaknesses in the available data on air and water quality. Nevertheless, I find that increases in livestock farming are weakly correlated with increases in nitrogen dioxide and sulfur dioxide in the air. Links with water quality, which have been the primary focus of legislative efforts to regulate large-scale livestock farming, are less systematic.; The second chapter, co-authored with Douglas Almond, Kenneth Chay, Michael Greenstone, and Melissa Thomasson, examines the effect of the Hill-Burton Hospital Construction Program on infant health in the U.S. South. This chapter examines the consequences of the dramatic expansion of the supply of hospitals on infant mortality in the Southern United States in the period after World War II. The 1946 Hospital Survey and Construction Act, also known as the Hill-Burton program, provided matching money to states to build and modernize nonprofit and public hospitals in poor, rural, and otherwise underserved areas. By 1965, one-third of all hospital beds in the United States and an even greater fraction in the South had at least partially been funded by Hill-Burton money. This paper uses data on the location, timing, size, and costs of hospital construction projects funded by the Hill-Burton program to identify effects on birth outcomes, as measured by county-level Vital Statistics data, across counties in the South. In addition, the paper evaluates whether the "separate but equal" clause of the 1946 Act, whereby states could use Hill-Burton funds to build and maintain racially separate hospitals, was associated with differential effects of the hospital construction program by race. The preliminary results suggest that white infant mortality rates dropped significantly in counties that had a hospital built with Hill-Burton money in the late 1940s and early 1950s. However black-white differences in infant mortality rates expanded in such counties.