Health Effects of the 1960s Food Stamp Program

Year: 2005

Research Center: The Harris School of Public Policy Studies, University of Chicago

Investigator: Almond, Douglas, and Kenneth Chay

Institution: Columbia University and National Bureau of Economic Research

Project Contact:
Douglas Almond
Columbia University and National Bureau of Economic Research
Department of Economics
807B International Affairs Building, MC 3308
420 West 118th Street
New York, NY 10027
Phone: 212-854-8059


The 1960s were a time of dramatic health improvement in the United States, especially for African-Americans. In the late 1960s, the mortality rate among Black infants—a common bellwether of population health—fell from more than 40 deaths per 1,000 live births to 30. In the process, the rate of infant death among Black infants converged on the lower mortality rate among Whites. The late 1960s was the only period of convergence in the mortality gap between Black and White infants in the post-World War II period.

Conditions of fetal and early-life health may exert a large effect on subsequent adult health. A previous study focused on the role of fetal undernutrition in “programming” chronic health conditions in adulthood, such as heart disease. A natural question, therefore, is whether the large improvement in infant health among Blacks improved adult health during the 1980s and 1990s. This pattern is indeed observed. When the authors use a dataset of mothers giving birth in the United States, they find that both health and education of African-Americans born in the late 1960s is substantially improved relative to health and education of infants born in the early 1960s. The improvement by birth cohort is much smaller among White mothers and is not observed for Black mothers who were not born in the United States. Therefore, infant health substantially improved in the late 1960s as did the adult health of the same infants 20-35 years later.

What lead to the historic improvement in Black health during the late 1960s? This question is difficult to answer given the sweeping policy and social changes of this period. These changes include the inception of both Medicare and Medicaid, as well as the passage of the 1964 Food Stamp Act, which provided $300 million to improve nutrition among the poor.

The goal of this paper is to assess the causal impact of the Food Stamp Program (FSP) on health, with a particular focus on the infant health of African-Americans. As the late 1960s witnessed major policy changes that could confound estimates of FSP effects, the major empirical challenge is to identify unique and exogenous FSP variation. Two basic approaches are used to evaluate impacts of the FSP. Both of these approaches analyze the initial rollout of the program by individual U.S. counties and compare health outcomes immediately before and after introduction of the FSP.

The first approach looks at health outcomes before passage of the national FSP in 1964. In the early 1960s, the first official act of the Kennedy Administration was to establish FSP pilot projects. Health outcomes in the eight counties that received a pilot project in 1962 are compared with (1) health outcomes in 1961 in the same eight counties and (2) health outcomes in counties neighboring the eight pilot counties that did not receive a pilot project. The result is a conventional “differences in differences” estimate of the effect of FSP pilot programs on health. The initiation of projects during this period permits control for fixed factors that might affect infant health in different counties (i.e., county-fixed effects).

Analysis of pilot projects permits isolation of the effects of the FSP from Federal health initiatives that began during the subsequent Johnson Administration. However, the small scale of the pilot programs makes analysis of relatively rare events, like infant mortality, difficult. Therefore, this second approach focuses on the national rollout of the FSP. To distinguish FSP impacts from concurrent programs of the “Great Society,” the discrete timing of program initiation by county is used. In particular, the study uses data collected in previous research to identify the month FSP began in each U.S. county. This second approach evaluates whether exposure to FSP during the prenatal period has an effect on infant mortality.

The two analytic approaches revealed that infant mortality fell with FSP exposure, especially for deaths occurring within the first month of life. Moreover, mortality reductions were larger among Black infants than among White infants. The study of pilot projects includes 33 counties in both 1961 and 1962. Neonatal mortality fell nearly 2 deaths per 1,000 live births with initiation of the FSP. This estimate is significant at the 10- percent level of significance, while effects for the post-neonatal period are approximately one-tenth as large and not significant at conventional levels. A preponderant effect on neonatal mortality is consistent with a primary role of improved prenatal conditions.

Data from the national rollout of the FSP permits analysis of the discrete timing of program initiation. Effects are again found for measures of newborn health, and birthweight in particular. Both White and Black infants were less likely to be born at low birthweights (below 2,500 grams) once the FSP began operation. The likelihood of low birthweight fell about 2 percent for Black infants and slightly under 1 percent for White infants.

Analysis of the FSP has been hampered by its regularity. Other major entitlement programs, notably AFDC, varied substantially at the State level, permitting analysis of State experiments with the program. The FSP program, by contrast, is relatively monolithic. From a research perspective, it is fortunate that the initial rollout of the FSP was not so regular. Counties had to wait until Congress raised the FSP appropriation to levels sufficient for nationwide coverage. In this process, counties queued for their turn. This gradual phase-in of the modern FSP generated ready “treatment” and “control” groups to the benefit of empirical analysis.

The modern FSP began at a time when many of America’s poorest were starving. As late as 1964, 1,400 people died each year from hunger in the United States. Results of this study indicate that the FSP had substantial health benefits in reducing mortality, particularly among African-Americans infants. This success is more notable given the persistently high levels of infant mortality among African-American infants.

Moreover, the fetal-origins hypothesis predicts that the improved infant health generated by the FSP would have persistent effects on the adult health of the 1960s birth cohorts to this day, suggesting that the FSP has additional “multiplier” effects that have yet to be measured. Future research should identify datasets of adult health outcomes with information on the county and date of birth and analyze these potential long-term effects using the then-staggered phase-in of the modern FSP.