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1- Department of Emergency and Disaster Health Systems, University of Maryland Baltimore County, 1000 Hilltop Cir, Baltimore, MD 21250, USA. , Jungwon.Yeo@umbc.edu
2- Department of Political Science, College of Charleston, 9 Liberty Street J.C. Long Building, Charleston, SC 29401, USA.
3- Graduate School of Public Administration, Seoul National University, 1 Gwanak-ro, Daehak-dong, Gwanak-gu, Seoul, South Korea.
2- Department of Political Science, College of Charleston, 9 Liberty Street J.C. Long Building, Charleston, SC 29401, USA.
3- Graduate School of Public Administration, Seoul National University, 1 Gwanak-ro, Daehak-dong, Gwanak-gu, Seoul, South Korea.
Abstract: (2 Views)
Background: Based on a critical human security framework, this study examines how state-level policy interventions were associated with health security in the United States during the recent pandemic, with attention to whether associations varied by the proportion of racially and economically marginalized populations.
Materials and Methods: Employing a quasi-experimental design, this study estimated difference-in-differences models using state-level panel data for 2019 and 2021 (N=100 state-years). Specifically, two-way fixed effects models estimated associations between three state-level emergency health policy interventions and health outcomes measured with COVID-19 and drug overdose mortality, with interaction terms assessing moderation by racial minority share and poverty rate of each state. Standard errors were clustered at the state level.
Results: All three policies were negatively associated with COVID-19 mortality across specifications. Expanded access to telehealth services and early prescription refill requirement were also negatively associated with drug overdose mortality, whereas paid sick leave showed no consistent association with overdose deaths. Associations were heterogeneous: estimated mortality reductions were attenuated in higher-poverty states and, for some policies, varied systematically by racial minority composition.
Conclusions: Findings indicate that state emergency health policies were associated with mortality outcomes in context-dependent ways. Rather than uniform effects, associations varied across demographic and socioeconomic environments. These results highlight the importance of equity-informed, context-sensitive policy design to strengthen human security during public health crises.
Materials and Methods: Employing a quasi-experimental design, this study estimated difference-in-differences models using state-level panel data for 2019 and 2021 (N=100 state-years). Specifically, two-way fixed effects models estimated associations between three state-level emergency health policy interventions and health outcomes measured with COVID-19 and drug overdose mortality, with interaction terms assessing moderation by racial minority share and poverty rate of each state. Standard errors were clustered at the state level.
Results: All three policies were negatively associated with COVID-19 mortality across specifications. Expanded access to telehealth services and early prescription refill requirement were also negatively associated with drug overdose mortality, whereas paid sick leave showed no consistent association with overdose deaths. Associations were heterogeneous: estimated mortality reductions were attenuated in higher-poverty states and, for some policies, varied systematically by racial minority composition.
Conclusions: Findings indicate that state emergency health policies were associated with mortality outcomes in context-dependent ways. Rather than uniform effects, associations varied across demographic and socioeconomic environments. These results highlight the importance of equity-informed, context-sensitive policy design to strengthen human security during public health crises.
Keywords: Human security, policy interventions, health outcomes, marginalized populations, COVID-19, difference-in-differences
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This is an open access article distributed under the terms of the Creative Commons Attribution License (CC-By-NC), which permits use, distribution, and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
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