Institutional Trust and Preventative Health Behaviors

• In Event: Policies to Incentivize Engagement in Healthy Behaviors

Abstract

Trust plays a pivotal role in healthcare markets, particularly for facilitating preventative health behaviors. We examine two plausibly trust-eroding events in the United States -- trade-induced economic shocks and the prescription opioid epidemic -- to explain variation in the take-up of COVID-19 vaccines. We assemble a county-level panel of restricted access survey and administrative data from 1990 to 2019 and a shift-share design which captures exposure to Chinese import competition. We provide evidence that the intensity of the opioid crisis increased with trade shock exposure, but only in states without triplicate laws that had deterred contemporaneous opioid marketing efforts. We then examine whether these exogenous economic and public health disruptions explain variation in vaccine hesitancy during the COVID-19 pandemic. Counties most exposed to trade shocks and the ensuing opioid crisis reported 14 percent higher rates of vaccine hesitancy and 16 percent lower rates of COVID-19 vaccination during our study window. These findings highlight the importance of trust in healthcare markets and the need for targeted public health interventions to restore and maintain confidence in public health institutions.

Author

• Shyam Raman, Williams College
  Presenting Author