, Volume 49, Issue 2, pp 499–524 | Cite as

The Income and Health Effects of Tribal Casino Gaming on American Indians

  • Barbara Wolfe
  • Jessica JakubowskiEmail author
  • Robert Haveman
  • Marissa Courey


The legalization of American Indian casino gaming in the late 1980s allows examination of the relationship between income and health in a quasi-experimental way. Revenue from gaming accrues to individual tribes and has been used both to supplement tribe members’ income and to finance tribal infrastructure. We assembled annual data from 1988–2003 on tribal gaming, health care access (from the Area Resource File), and individual health and socioeconomic characteristics data (from the Behavioral Risk Factors Surveillance System). We use this information within a structural, difference-in-differences framework to study the effect of casino gaming on tribal members’ income, health status, access to health care, and health-related behaviors. Our difference-in-differences framework relies on before-after comparisons among American Indians whose tribe has at some time operated a casino and with-without comparisons between American Indians whose tribe has and those whose tribe has not initiated gaming. Our results provide identified estimates of the positive effect of gaming on American Indian income and on several indicators of American Indian health, health-related behaviors, and access to health care.


Income gradient Health American Indian health Social determinants 



The authors wish to thank the Robert Wood Johnson Foundation for their support for this project and the Guggenheim Foundation for their support for Barbara Wolfe. The authors also thank the following persons for helpful comments: two referees for this journal, attendees at the 2009 summer research workshop on health economics in Sydney (AU) including in particular Michael Grossman, colleagues at the Research School for the Social Sciences (now the Research School of Economics) at the Australian National University, those in the economics department of Queensland University of Technology, and Ari Kapteyn. We also wish to thank Gary Sandefur for his insights, William Evans for sharing the Evans-Topolesky data, and Hannah Goble for her work with the county data. All responsibility for errors remains with the authors.

Supplementary material

13524_2012_98_MOESM1_ESM.pdf (58 kb)
ESM 1 (PDF 57 kb)
13524_2012_98_MOESM2_ESM.pdf (69 kb)
ESM 2 (PDF 69 kb)
13524_2012_98_MOESM3_ESM.pdf (72 kb)
ESM 3 (PDF 71 kb)


  1. Akee, R., Copeland, W., Costello, E. J., Angold, A., & Keeler, G. (2008). Educational attainment, drug use and casino payments: Young adult outcomes from a quasi-experiment in Indian country (Working paper). Retrieved from
  2. American Indian Policy Center (AIPC). (2005). Tribal governments in 2010—Tribal gaming. St. Paul, MN: AIPC. Retrieved from
  3. Area Resource File (ARF). (2008). Rockville, MD: U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Professions.Google Scholar
  4. Case, A. (2004). Does money protect health status? Evidence from South African pensions. In D. Wise (Ed.), Perspectives on the economics of aging (pp. 287–305). Chicago, IL: University of Chicago Press.Google Scholar
  5. Case, A., Lubotsky, D., & Paxson, C. (2002). Economic status and health in childhood: The origins of gradient. American Economic Review, 92, 1308–1334.CrossRefGoogle Scholar
  6. Centers for Disease Control and Prevention (CDC). (1988–2003). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention.Google Scholar
  7. Condliffe, S., & Link, C. R. (2008). The relationship between economic status and child health: Evidence from the United States. American Economic Review, 98, 1605–1618.CrossRefGoogle Scholar
  8. Costello, E. J., Compton, S. N., Keeler, G., & Angold, A. (2003). Relationship between poverty and psychopathology: A natural experiment. Journal of the American Medical Association, 290, 2023–2029.CrossRefGoogle Scholar
  9. Costello, E. J., Erkanli, A., Copeland, W., & Angold, A. (2010). Association of family income supplements in adolescence with development of psychiatric and substance use disorders in adulthood among an American Indian population. Journal of the American Medical Association, 303, 1954–1960.CrossRefGoogle Scholar
  10. Currie, J., & Lin, W. (2007). Chipping away at health: More on the relationship between income and child health. Health Affairs, 26, 331–344.CrossRefGoogle Scholar
  11. Currie, J., & Stabile, M. (2003). Socioeconomic status and child health: Why is the relationship stronger for older children? American Economic Review, 93, 1813–1823.CrossRefGoogle Scholar
  12. Evans, W. N., & Topoleski, J. H. (2002). The social and economic impact of Native American casinos (NBER Working Paper No. 9198). Cambridge, MA: National Bureau of Economic Research. Retrieved from
  13. Fernand, L. C. H., Gertler, P. J., & Neufeld, L. M. (2008). Role of cash in conditional cash transfer programmes for child health, growth, and development: An analysis of Mexico’s Opportunidades. Lancet, 371, 828–837.CrossRefGoogle Scholar
  14. Frijters, P., Haisken-DeNew, J. P., & Shields, M. A. (2005). The causal effect of income on health: Evidence from German reunification. Journal of Health Economics, 24, 997–1017.CrossRefGoogle Scholar
  15. Gonzales, A. A. (2003). Gaming and displacement: Winners and losers in American Indian Casino development. International Social Science Journal, 55, 123–133.CrossRefGoogle Scholar
  16. House, J. (2002). Understanding social factors and inequalities in health: 20th century progress and 21st century prospects. Journal of Health & Social Behavior, 43, 125–142.CrossRefGoogle Scholar
  17. Khanama, R., Nghiemb, H. S., & Connelly, L. B. (2009). Child health and the income gradient: Evidence from Australia. Journal of Health Economics, 28, 805–817.CrossRefGoogle Scholar
  18. Lillie-Blanton, M., & Roubideaux, Y. (2005). Understanding and addressing the health care needs of American Indians and Alaska natives. American Journal of Public Health, 95, 759–761.CrossRefGoogle Scholar
  19. Link, B. G., & Phelan, J. C. (1996). Understanding sociodemographic differences in health—The role of fundamental social causes. American Journal of Public Health, 86, 471–472.CrossRefGoogle Scholar
  20. Menchik, P. L. (1993). Economic status as a determinant of mortality among black and white older men: Does poverty kill? Population Studies, 47, 427–436.CrossRefGoogle Scholar
  21. Murasko, J. E. (2008). An evaluation of the age-profile in the relationship between household income and the health of children in the United States. Journal of Health Economics, 27, 1489–1502.CrossRefGoogle Scholar
  22. National Indian Gaming Association (NIGA). (2008). National Indian Gaming Association 2008 economic impact report. Retrieved from
  23. Redelmeier, D. A., & Singh, S. M. (2001). Survival in Academy Award–winning actors and actresses. Annals of Internal Medicine, 134, 955–962.Google Scholar
  24. Ruhm, C. J. (2005). Healthy living in hard times. Journal of Health Economics, 24, 341–363.CrossRefGoogle Scholar
  25. Rutter, M. (2007). Proceeding from observed correlation to causal inference: The use of natural experiments. Perspectives on Psychological Science, 2, 377–395.CrossRefGoogle Scholar
  26. Smith, J. P., & Kington, R. (1997). Demographic and economic correlates of health in old age. Demography, 34, 159–170.CrossRefGoogle Scholar
  27. Taylor, J., & Kalt, J. (2005). American Indians on reservations: A databook of socioeconomic change between the 1990 and 2000 censuses. Cambridge, MA: The Harvard Project on American Indian Economic Development.Google Scholar
  28. U.S. Census Bureau. (1990). General population characteristics: American Indians and Alaska native areas (Census Report CP-1-1A). Washington, DC: U.S. Census Bureau. Retrieved from
  29. U.S. Census Bureau. (1994). Phoneless in America (Statistical Brief SB/94-16). Washington, DC: U.S. Census Bureau.Google Scholar
  30. U.S. Census Bureau. (2007). The American community—American Indians and Alaska Natives: 2004 (American Community Survey Report ACS-07). Washington, DC: U.S. Census Bureau.Google Scholar
  31. U.S. National Center for Health Statistics (NCHS). (2007). Health, United States, 2007 with chartbook on trends in the health of Americans. Hyattsville, MD: NCHS. Retrieved from
  32. Wilkinson, R. G. (1990). Income distribution and mortality: A natural experiment. Sociology of Health and Illness, 12, 391–412.CrossRefGoogle Scholar
  33. Williams, D. R., & Collins, C. (1995). U.S. socioeconomic and racial differences in health: Patterns and explanations. Annual Review of Sociology, 21, 349–386.CrossRefGoogle Scholar

Copyright information

© Population Association of America 2012

Authors and Affiliations

  • Barbara Wolfe
    • 1
  • Jessica Jakubowski
    • 1
    • 2
    Email author
  • Robert Haveman
    • 1
  • Marissa Courey
    • 1
  1. 1.Institute for Research on PovertyUniversity of Wisconsin–MadisonMadisonUSA
  2. 2.Department of SociologyUniversity of Wisconsin–MadisonMadisonUSA

Personalised recommendations