Providing Empirical Data Behind Health Disparities – Dr. Prabal K. De 

by Edgar Llivisupa

A development economist by training, Dr. Prabal K. De’s early research analyzed the economic issues of developing countries. His Ph.D. thesis at New York University focused on international migration and its effects on developing countries which included health issues such as the cost of providing care, infant and maternal mortality rates, and life expectancy.  

Now a professor of economics at the Colin Powell School at City College and a doctoral faculty member at the Graduate Center, Dr. De eventually learned that those same issues were prevalent in the U.S. and directed some of his research efforts to analyze health inequality and disparities.  

Economics has a tradition of researching discrimination, so I wanted to see if one of the reasons that minority groups have lower health outcomes was because of discrimination. I realized that there’s little data on that and documenting health disparities, while pervasive, is harder to explain why. Why do certain sections of society have worse health outcomes or access? 

Two innovative studies reported on local discrimination by utilizing data from the 2016 New York City Community Health survey that asked participants about any discrimination they had encountered. The questions on personal discrimination were one of a kind that year and were removed in future surveys. One of the challenges Dr. De faces in researching health disparities is that many surveys obscure respondents’ location for privacy and confidentiality purposes, posing further challenges to address contextual questions.   

In a 2019 article, “Is Perceived Stigma in Clinical Setting Associated With Poor Health Status Among New York City’s Residents of Color?,” Dr. De and his co-authors found that perceived stigma was associated with poorer physical and mental health even in a diverse city. Hispanic residents were found to have the highest rate of perceived stigma. He hypothesized that stigma could be higher in non-diverse areas, affecting the health of BIPOC and LGTQ+ minorities in those communities.   

In a 2020 article, “Beyond race: Impacts of non-racial perceived discrimination on health access and outcomes in New York City,” Dr. De found that 34% of residents reported discrimination based on their insurance status. Coupled with income (12%), and other reasons of discrimination (27%), these non-racial discriminations were significantly associated with residents not receiving care when needed. This could prevent people with Medicaid from accessing certain practices because of the socio-economic status associated with their insurance plan. 

You can make any number of conjectures but without data and evidence, you can’t say your educated guesses are scientifically sound. You need to hypothesize, collect data and test your hypothesis. Then you’d infer from your results to see whether your initial hypothesis can be rejected or not.

Featured previously in the inaugural issue of the RICC, Dr. De, along with his graduate student Taylor Price, studied socio-economic variables and whether they contributed to COVID-19 exposure early in the pandemic. In the article, titled “Pre-existing Economic Conditions and COVID-19 Infections and Mortality in New York City,” Dr. De utilized demographic and economic variables from the U.S. Census Bureau’s American Community Survey, coupled with zip-code level testing, infection, and mortality data, to determine that commute time, occupation type and household crowdedness strongly correlated with COVID-19 positivity rates. 

As COVID-19 ravaged and persisted in the U.S., health disparities and inequality sharply entered the public consciousness, further catapulting Dr. De’s interest in investigating the topic. Dr. De continues to study economic factors associated with the pandemic, noting that while the Spring 2020 spike was never replicated until the recent Omicron wave, the socio-economic factors observed in his paper remain.  

In collaboration with Graduate Center students, their study will look at how stay at home orders affect employment and sick leave, utilizing data from the Bureau of Labor Statistics. a separate study, undertaken with University of Alabama Birmingham associate professor Dr. Henna Budhwani, will examine how COVID-19 impacted mental health with data from the Center for Disease Control. 

The pandemic caused a lot of labor-market issues when the economy shut down following state and local administrative orders. College-educated New Yorkers that work in offices weren’t disturbed and shifted to remote work. But workers in other segments faced a stark choice either in protecting their lives by staying home or their livelihood by going to work. It’s not a surprise that economists, like me, would be more engaged in health issues.


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