PURPOSE:Distance to health service providers is related to increased mortality risk and decreased service utilization. However, existing studies of distance to services often rely either on aggregated measures of distance or small samples of survey respondents. Nationwide individual data from 200 million Americans are used to assess various demographic groups' distances to open acute hospitals. METHODS:We gathered the exact location of every open acute hospital from the UNC Cecil G. Sheps Center and the Department of Health and Human Services. We merged this information with data on 200 million voters from the L2 voter file for 2020. We calculate each registered voters' distance to the nearest open hospital in kilometers by demographic, region, and state Medicaid expansion status. RESULTS:The average American adult is 5 miles from the nearest hospital. Native Americans and rural White Americans face the longest distances to medical services. Lower-income adults face longer distances than higher-income adults. Those over 65 are roughly 10% farther away in comparison to those 18-40. Registered Republicans are 30% farther than registered Democrats. Recent hospital closures in states that have yet to expand Medicaid have contributed to all of these disparities. CONCLUSIONS:Lower-income and older Americans, groups that tend to have worse health overall, face the longest travel distances to hospitals-perhaps contributing to income and age-based health disparities. Native Americans and rural whites, who themselves experience considerable health hardship, also have significant travel burdens to receive hospital care. Registered Republicans have longer travels to emergency care than Democrats, adding to recent research on partisan health disparities.

How do patterns of racial inequality shape policing behavior in the United States? We investigate whether police engage in boundary maintenance at geographic points of racial difference. Critical race scholars suggest that police explicitly serve this function. Yet empirical studies are rare and limited to snapshots of a single city, making it hard to distinguish practices employed across departments from agency- and officer-level idiosyncrasies. We leverage high resolution data on police activity in seven U.S. cities to evaluate how police engage with racial boundaries. We find evidence that police activity is elevated in racial boundary zones relative to non-boundary zones, exceeds observed crime, and that racialized outcomes are as much a product of policing practices as they are of conflict between private citizens. We reorient the study of boundaries around top-down processes that lead to their regulation and identify an agenda for future research.

The murder of George Floyd in May 2020 sparked a wave of Black Lives Matter protests in many cities throughout the United States. Protesters’ demands ranged from constraints on police use of force to defunding and disbanding the police altogether. These have led some to worry about the possibility of a “Ferguson Effect,” where police withdraw from policing, and in particular discretionary stops and searches, with deleterious consequences for crime. Drawing on data from four cities, we evaluate whether the 2020 BLM protests impacted police behavior, and whether changes in policing negatively impacted public safety. Regression discontinuity-in-time estimates suggest that although depolicing followed the BLM protests, in some respects the quality of policing improved, and public safety was not clearly impacted. Our findings have important implications for research on policing, social movements, and structural inequality in cities.

For decades, a central element of the Republican Party brand has been to call for fiscal responsibility through balanced budgets. We investigate the extent to which the party has actually implemented those ideological principles. To do so, we combine a multitude of datasets and exploit Congressional Budget Office reports to study legislative behavior on specific bills from 1997 to 2020. Evidence of Republican politicians behaving in ways that would suggest a systematic commitment to balanced budgets is scarce, with some evidence of decline across time. Finally, we explore possible explanatory mechanisms for this phenomenon.

In the aftermath of the Great Recession, populist parties rose to prominence across Europe, campaigning on the promise to do something about growing economic inequality by funding social welfare programs. We investigate if the pro-welfare reputation of European populist parties, either on the left or the right, is well deserved. We draw on a dataset of questions asked by members of parliament from nine European democracies over three decades. We want to know if members of populist parties spend more of their question time asking about social welfare than members of mainstream parties. Empirical analyses reveal no meaningful difference: populist parties ask about welfare but do not devote a larger share of their questions to the topic than non-populist parties, and rising economic inequality does nothing to change this dynamic. If anything, populist parties ask about welfare less. Our results suggest that populists talk the talk but - once elected - do not walk the walk.

We investigate how hardships affect rural politics, considering the case of hospital closures. In the last two decades, more than two hundred rural hospitals have closed their doors or drastically reduced their services. Drawing from resource models of voting, our hypothesis is that personal- and community-level deprivations brought about by hospital closures should reduce election turnout. Empirical tests pair geographic information on the location of open and closed hospitals with data from state voter files to create a panel of over 10 million rural residents for the 2016, 2018, and 2020 national elections. Results show that individuals whose nearest hospital closed prior to the proximate election were less likely to vote than their unaffected counterparts. These effects are strongest for older and lower-income residents, but they decay over time so that voting likelihood resembles a pre-closure baseline within 12 months.

We analyze the consequences of using driver consent as a basis for initializing a traffic stop-and-search compared to those searches based on probable cause. We find that consent searches are less likely to result in contraband recovery than are probable cause searches. Moreover, police agencies with a relatively higher reliance on consent searches find similar amounts of contraband and make a similar number of arrests as agencies doing much less searching but with a greater reliance on probable cause. These patterns are amplified along racial lines, and there is no discernible relationship between the use of consent searches and crime. We also provide causal evidence that corroborate these observational findings by examining the consequences of a Texas Highway Patrol policy, which suddenly increased the consent search rate in two South Texas counties. We show the contraband recovery rate discontinuously decreases when the consent search rate discontinuously increases.

Established theories of the policy process recognize the challenges governments face in processing information. We examine how the ways in which public problems develop over time condition subsequent policy actions. We contend that policymakers will become routinized to and consequently under-respond to the accumulating signals of slowly-developing problems (i.e., those featuring long runs of relatively small changes). Event history analyses leverage variation across the United States in the development of the COVID-19 pandemic and the subsequent implementation of social distancing policies. Looking across the 50 states and Washington DC, we find that regions that saw protracted deterioration in their health situation were slower to respond with social distancing than those that saw an abrupt deterioration to the same point. These results highlight the risks associated with problems that worsen only gradually over time.

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We investigate the motivations driving members of the US Congress to introduce bills that require new federal spending, testing a classic “party matters” hypothesis that spending is motivated by partisanship with Democrats spending more on social programs and Republicans more on defense and social order. To test this hypothesis, we introduce a new dataset that codes Congressional Budget Office reports, allowing us to link cost estimates to over 7,000 congressional bills. Overall, we find very little evidence that partisanship or ideology can reliably predict the cost of bills. Bills introduced by Democrats call for similar levels of new spending as those introduced by Republicans, even on policy topics where partisan divisions are thought to be pronounced. These results raise the possibility that when it comes to spending rank-and-file members are less motivated by abstract partisan commitments than traditionally thought.

Racial disparities in traffic stop outcomes are widespread and well documented. Less well understood is how racial disparities may be amplified or muted in different contexts. Here we focus on one such situational factor: whether the initial traffic stop was related to a traffic safety violation or a (broadly defined) investigatory purpose. This is a salient contextual characteristic as stop type relates to different levels of assumed discretion and purpose. While all traffic stops involve some officer discretion, investigatory stops are more easily used as justifications to conduct a search based on an officer's diffuse suspicion; traffic safety stops are more often just what they seem. Using millions of traffic stops from several states, we show that black male drivers are more likely to be searched and less likely to be found with contraband and that this relationship is amplified where the initial stop purpose is investigatory. One implication of this is that one path to alleviating disparities in traffic stops for agencies is emphasizing traffic safety, rather than using stops as a supplemental investigatory tool.

Previous research shows that how the state conducts itself influences citizen attitudes and behaviors through direct and proximal contact; we show the actions of state agents ripple out even further. Joining bureaucratic data on a publicly observable state behavior—racial disparities in investigatory traffic stops—with survey data, this article shows that residing in a place with extreme racial disparities in traffic stops is associated with depressed confidence in the police even in the absence of more direct forms of contact. This relationship does not extend to participatory behaviors, however, in which only personal stop history and proximal contact are predictors. Racially disparate policing practices, then, may undermine law enforcement legitimacy in a community as a whole, but mobilization to change policy appears limited to individuals who more directly experience the carceral state.

This article asks if investigative police stops (1) help officers find contraband, and (2) serve as a bulwark against violent crime. We focus on the experiences of Fayetteville, North Carolina, which in 2012 mandated that police officers obtain written permission from motorists before conducting searches absent any probable cause. The effect of these mandates was a dramatic reduction in the use of so-called "consent searches." Using traffic stops data available from the North Carolina Department of Justice, we show that after these reforms went into effect officers made fewer overall searches, but contraband continued to be recovered at pre-reform levels, indicating a reduction in low-quality searches with minimal substantive impact. Moreover, we find that homicide rates are statistically indistinguishable between the pre- and post-reform periods. Thus, Fayetteville local government was able to implement community pleasing police reforms without jeopardizing community safety.

We investigate a possible linkage between municipal reliance on fines, fees, and forfeitures as a revenue source and policing behavior. With a dataset of four million traffic stops made by North Carolina municipalities, we demonstrate that a regular reliance on fines, fees, and forfeitures has powerful, predictable, and racially distinct impacts on black and white drivers, and that fiscal stress exacerbates these differences. A greater regular reliance on fines, fees, and forfeitures is linked to a decrease in the probability of white, but not black, drivers being searched; and increased odds of finding contraband among those white drivers who are searched, but no such change for black drivers. We validate the North Carolina tests with aggregate analyses of municipalities across four states.

Racial disparities in citizen interactions with police are ubiquitous concerns in American communities. What difference does electoral representation make? We demonstrate that black descriptive representation in local government affects police activity and scrutiny in a given community. We use a new dataset comprised of over 79 municipal police departments spanning 6 states, based on tens of millions of individual-level traffic stops. In cities and towns with majority-black city councils, traffic stops are less likely to result in a search. This decline in search rates affects both white and black drivers, though the decline is larger for black drivers. Even after controlling for socioeconomic factors, segregation, and crime rates, descriptive representation still matters. A city council composed of a majority of black members is associated with important differences in policing, affecting both white and black residents.

Economically powerful individuals are assumed to have greater capacity to influence politics than those with lower incomes. This might imply that as economic inequality increases, we should see a growing representation gap between rich and poor. Yet as Derek A. Epp and Enrico Borghetto explain, previous research has produced a mixed picture, with lobbyists that have the most financial backing often failing to secure policy victories. Drawing on a new study, they suggest the influence of inequality may be more visible when it comes to keeping issues off the political agenda: they find evidence that higher levels of inequality are associated with less legislative attention being directed toward the policies most likely to generate a downward redistribution of wealth.

This article investigates the relationship between economic inequality and legislative agendas. It argues that rising inequality makes agenda setting especially vulnerable to the influence of economic elites, and that elites use their influence to keep redistributive policies from receiving governmental attention. Empirical tests use data on public laws and bills introduced in the legislatures of five European countries between 1981 and 2012, and the United States between 1948 and 2015. As inequality becomes more acute, we observe a migration in legislative attention away from issues dealing with the social safety-net. These effects are more pronounced earlier in the policy process, which is consistent with the idea that elites can act as gatekeepers of legitimate policy ideas. These findings suggest that economic stratification shapes the policymaking debate in ways that make redistribution less likely.

Abstract Evidence that racial minorities are targeted for searches during police traffic stops is widespread, but observed differences in outcomes following a traffic stop between white drivers and people of color could potentially be due to factors correlated with driver race. Using a unique dataset recording over 5 million traffic stops from 90 municipal police departments, we control for and evaluate alternative explanations for why a driver may be searched. These include: (1) the context of the stop itself, (2) the characteristics of the police department including the race of the police chief, and (3) demographic and racial composition of the municipality within which the stop occurs. We find that the driver's race remains a robust predictor: black male drivers are consistently subjected to more intensive police scrutiny than white drivers. Additionally, we find that all drivers are less likely to be subject to highly discretionary searches if the police chief is black. Together, these findings indicate that race matters in multiple and varied ways for policing outcomes.