Affirmative Action Affects Health

By Atheendar Venkataramani:

In the United States, affirmative action programs have been used to remediate long-standing inequalities that raise the risk of lifetime poverty among underrepresented minorities (URMs). The best-known affirmative programs consider race and ethnicity in college admissions decisions. These programs have faced a great deal of criticism, stemming from concerns about their efficacy and fairness. Consequently, college affirmative action programs (most recently, Harvard University) have faced numerous legal challenges. Since the 1990s, nine states (including California, Texas, and Michigan) have banned the consideration of race in college admission decisions.

College affirmative action bans reduce the likelihood of a URM high school student attending a top college. We wondered whether they led URM high school students to engage in riskier health behaviors, such as smoking and drinking.

This question might seem out of the blue, but it arose as part of our broader work looking at the relationship between economic opportunity and health. While typically not considered in discussions about the social determinants of health, economic opportunity–defined as one’s ability to ascend the socioeconomic ladder regardless of life circumstances–may have dramatic implications for health outcomes. For starters, higher lifetime economic opportunity could raise the incentive for young people to stay healthy, as doing so allows them to better access these opportunities and reap their awards. In addition, economic opportunities may affect beliefs about future well-being, which may directly affect mental and physical health through increasing stress.

In earlier work, we found that counties with higher economic opportunity tended to have better health behaviors and outcomes, even after accounting for other social and economic factors. However, these results don’t tell us whether economic opportunity causes health.