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Some Unintended Fallout from Defense Policy: Measuring the Effect of Atmospheric Nuclear Testing on American Mortality Patterns

Keith Meyers∗

June 29, 2021

Abstract

To better understand the health and social costs associated with radioac-

tive and nuclear weapons development, this paper studies a historical

period of atmospheric nuclear testing in the 1950s. Using estimates of annual

county level fallout patterns for the continental U.S. and vital statistics records,

this paper finds that atmospheric nuclear testing performed in Nevada con-

tributed to substantial and prolonged increases in overall mortality and cancer

mortality. These increases in mortality occur over a broader geographic region

than previous medical research would suggest.

JEL Codes: I15, N32, Q53. Keywords: Nuclear Testing, Public Health, Ra-

dioactive Fallout, Defense Policy

∗Assistant Professor, University of Southern Denmark, [email protected]. This material is based in part upon work supported by the National Science Foundation under Grant Number SES 1658749 and additional financial support has been provided by the Economic History Association. Any opinions, findings, and conclusions or recommendations expressed in this material are those of the author(s) and do not necessarily reflect the views of the National Science Foundation. Thanks to Price Fishback, Derek Lemoine, Ashley Langer, Joseph Ferrie, and Cihan Artun¸cfor feedback, data and support. Additional thanks to Andre Bouville, Steven Simon, and the National Cancer Institute for their help providing fallout deposition records. 1 The development of nuclear weapons is one of the defining elements of the 20th Century. Advancement in this this technology involved destructive atmo- spheric nuclear tests. One consequence of this testing was the release of tremendous quantities of radioactive material into the environment. Like previous advancements and innovations in technology, such as the adoption of lead water piping or the adop- tion of fossil fuels (Troesken, 2008; Hanlon, 2016; Clay et al., 2016; Beach and Hanlon, 2016), the advancement of nuclear technologies created substantial unintended social consequences. The socioeconomic consequences of fallout from atmospheric nuclear testing are not fully understood, and studies on the health effects of testing focus primarily on populations surrounding nuclear test sites or the locations of nuclear dis- asters. This paper uses US vital statistics and fallout deposition estimates provided by the National Cancer Institute (NCI), to study whether atmospheric nuclear testing conducted in Nevada had discernible effects on US mortality patterns on a national scale. I find evidence that fallout from these nuclear tests contributed to substan- tial and prolonged increases in mortality across the continental United States, and that these increases occurred in places far beyond the region surrounding the testing location. Between 1945 and 1992 the United States conducted 1,054 nuclear tests and of these 216 were atmospheric nuclear tests (U.S. Department of Energy, 2000). The epicenter of US testing is located just northwest of Las Vegas, Nevada, at the (NTS). Here the US government conducted scores of atmospheric nuclear tests until 1963.1 Fallout from these tests landed across much of the continental United States in the days following these experiments, but the extent to which these tests affected public health remains uncertain. Medical and clinical researchers have carried out extensive research on the effects of the NTS tests on people living around the testing location (Stevens et al., 1990; Kerber et al., 1993; Gilbert et al., 1998, 2010). From these studies of these relatively small populations the National Cancer Institute (NCI) and others have extrapolated cancer risks to the general US population.

1The most active period of nuclear testing lasted from 1951 to 1958. A small number of low-yield, atmospheric tests were conducted in 1962.

2 Past economic research has shown that low levels of ionizing resulting from nuclear disasters and bomb testing can have broad effects on society and the economy. Lehmann and Wadsworth (2011) and Danzer and Danzer (2016) have shown that exposure to radiation adversely affects self-reported measures of health and economic well-being and that uncertainty surrounding personal radiation exposure imposes a substantial psychological burden. Elsner and Wozny (2018) show persons residing in more irradiated areas during the experience more rapid cognitive decline later in life. Ito and Kuriyama (2017) and Kawaguchi and Yukutake (2017) show that the Fukushima disaster affected consumer behaviors and land values. Using Nordic administrative records, Almond et al. (2009) and Black et al. (2019) find that prenatal exposure to low levels of from Chernobyl and nuclear testing decrease human capital, education, and earnings in adulthood. Within the context of the US, Meyers (2019) finds the NTS testing led to reductions in agricultural yields in more irradiated locations relative to less irradiated ones. The human capital effects observed in the economics literature is consistent with a body of scientific and medical research establishing that exposure to ionizing radiation can have substantial adverse effects on human health (National Research Council, 2006; Simon et al., 2006; Simon and Bouville, 2015). This literature finds that exposure to ionizing radiation is harmful to biological systems, can suppress the immune system, can increase the risk of developing cancers, and even lead to cardiovascular disease (National Research Council, 2006). Exposure to such radiation can damage tissue and DNA in ways that are difficult for the body to repair. Nevertheless, there is still much uncertainty surrounding the health effects of low dose exposure to ionizing radiation and it would take “extraordinarily large studies” to sufficiently ascertain these health risks (Brenner et al., 2003).

3 Historical Background

The U.S. ushered in the atomic age when it detonated its first nuclear bomb on July 16th, 1945 at the Alamogordo Bombing and Gunnery Range. Less than a month later, the U.S. detonated two additional bombs over the cities of Hiroshima and Nagasaki. The resulting destruction is estimated to have killed at least 150,000 Japanese civilians (The Manhatton Engineer District, 1946). After World War II, the United States conducted additional atmospheric nuclear tests at Bikini and Enewetak atolls in the Pacific Ocean. Over 2,000 nuclear weapons have been detonated. The United States is responsible for 1,054 of these nuclear tests. From 1945 to 1992, the United States conducted 210 atmospheric tests, 5 underwater tests, and 839 underground nuclear tests (U.S. Department of Energy, 2000; Fehner and Gosling, 2006). Figure 1 plots the number of U.S atomic tests from 1945 to 1992. From 1945 to 1958, the United States engaged in atmospheric nuclear testing. From 1958 to 1961 a testing moratorium between the U.S. and USSR led to a suspension of testing. This agreement ended and led to a small number of U.S. atmospheric tests in 1962. With the signing of the Partial Nuclear Test Ban Treaty in 1963 all atmospheric nuclear tests conducted by the U.S. ceased and testing went underground.

The Nevada Test Site

After the detonated its first successful nuclear bomb in 1949, U.S. policy makers sought to accelerate the development of its own nuclear capabilities. Initially hesitant towards testing within the continental U.S., security and logistical concerns after the breakout of the Korean War prompted the establishment of the NTS (Fehner and Gosling, 2000). The initial tests in 1945 were conducted in New Mexico. All other tests conducted prior to the opening of the NTS occurred in the Pacific. The Pacific tests proved logistically costly, slow to implement, and expensive. American leaders sought a convenient testing location and settled on the Nevada Test Site due

4 to its proximity to U.S. government labs, low levels of precipitation, and relatively secluded location (Center for Disease Control, 2006; National Cancer Institute, 1997). Located mostly in Nye County, Nevada, this military zone became the epicenter of the American nuclear weapons program and hosted 928 nuclear tests. Figure 2 describes the number, explosive magnitude (measured in kilotons of TNT), and estimated ra- dioactive release from these NTS nuclear tests by year. One estimate places the total atmospheric release of radioactive material from the NTS at over 12 billion Curies between 1951 and 1963. In comparison, Chernobyl released an estimated 81 million Curies of radioactive material (LeBaron, 1998). Figure 3 presents NCI estimates for cumulative deposition of radioactive - 131 for the continental United States. Notice there is substantial variation in cumu- lative deposition and there are areas far from the NTS that experienced relatively large quantities of radioactive fallout. The “Downwind” region located primarily in Arizona, Nevada, and Utah experienced tremendous quantities of radioactive fallout. California and the Pacific Northwest generally did not experience substantial fallout deposition. Many counties in the Great Plains and Midwest also experienced large amounts of deposition. In the Northeast, there is also a cluster of counties that were also substantially exposed to radioactive fallout from NTS testing. During the early 1950s, the public was largely unaware of the dangers that the NTS posed to public health. Often, the Public Health Service (PHS) and Atomic Energy Commission (AEC) sought to downplay concerns regarding the atomic testing. The initial official government statements made during the testing period asserted that all dangerous radioactive material remained within the confines of the NTS. These statements changed over the 1950s as fallout appeared in areas outside the confines of the NTS. Often, government agencies failed to adequately warn civilians living around the test site of the health risks associated with these atomic tests (Ball, 1986; Fradkin, 2004; LeBaron, 1998). Unlike more recent nuclear disasters where governments sought to limit and mitigate public exposure to potentially harmful ionizing radiation, there was no concerted national effort to inform the public on the potential risks NTS testing

5 posed. In some cases government officials sought to suppress or classify research suggest- ing radiation from these tests posed substantial health risks. For example, the Public Health Service and Centers for Disease Control studied clusters of leukemia and cancer appearing in Nevada and Utah in the 1960s, but the Federal government avoided link- ing leukemia to fallout from nuclear testing (Lyon, 1999). In the late 1970s, Congress opened a series of hearings regarding the consequences of radioactive fallout resulting from U.S. nuclear testing (United States House of Representatives, 1980). Subsequent Freedom of Information Act requests later revealed that the government knew that NTS activities posed a public health risk and that the AEC sought to suppress medical studies highlighting the health dangers (Fradkin, 2004).2 As a result of these Congressional hearings, Congress tasked the Department of Health and Human Services with estimating the amount of radiation the public was exposed to and ascertain the public health risks associated with fallout resulting from atmospheric nuclear testing (National Cancer Institute, 1997; Fehner and Gosling, 2000; Center for Disease Control, 2006).

Health effects of ionizing radiation

Ionizing radiation is an invisible environmental threat and is imperceptible with- out special equipment. Radioactivity generally refers to dangerous particles given off by of matter.3 With regard to nuclear testing, there are three ra- dioactive isotopes of concern to human health because of their relative radioactivity, prevalence, and how they are metabolized. These isotopes are iodine-131, - 90, and cesium-137. Other isotopes created during nuclear testing are less dangerous to human health because they do not remain in the body for extended periods or be-

2Knapp (1963) identifies the threat radioactive iodine-131 in dairy posed to the public and is an example of research the AEC sought to suppress. 3The weakest forms of ionizing radiation are alpha particles, and these particles generally cannot penetrate most thin physical barriers. Beta radiation is more dangerous and can penetrate deep into flesh and cause damage. Gamma radiation is the most dangerous form of radioactivity and consists of highly energetic photons. Gamma radiation can travel easily through the body and causes immense damage to biological tissues.

6 cause they are created in minuscule quantities. Many other radioactive isotopes pass through the body and are secreted following ingestion.4 When nuclear tests occurred in the Nevada desert many times the testing would vaporize and induce radioactivity in the surrounding soil.5 As the carries irradiated debris up into the atmosphere, winds would carry harmful radioactive material. Low altitude winds would carry radioactive debris with dust storms into the “Downwind” region imme- diately surrounding the NTS. Higher altitude winds carried much of this irradiated matter vast distances where it would precipitate down with rainfall.

The medical and scientific knowledge regarding the effects of human exposure to - izing radiation comes from many sources. Studies of Japanese atomic bomb survivors and persons living downwind of nuclear test sites provide much of this knowledge. In human population studies of radiation exposure, researchers have measured a va- riety of negative health and developmental consequences from exposure to ionizing radiation. Studies of atomic bomb survivors and persons exposed during demonstrate increased cancer risks, and negative developmental and cognitive effects due to radiation exposure (Otake et al., 1993; Otake, 1996; Schull, 1997; Lee, 1999). Researchers studying Chernobyl have found greater incidences of cancers, and lesions indicative of iodine-131 poisoning in exposed populations (Shibata et al., 2001; Williams, 2002). Researchers studying downwind American populations have also found evidence of increased and leukemia risks in downwind cohorts (Kerber et al., 1993; Stevens et al., 1990; Gilbert et al., 2010). Together, the medical and scientific literature suggest that exposure to ionizing radiation increases the risks of various types of cancer and can have detrimental effects upon human growth and development.

4In particular, iodine-131 is a potent radioactive poison. It possesses an eight-day half-life, concen- trates in the thyroid gland, and emits highly active forms of beta and gamma radiation as it decays (LeBaron, 1998). These traits of iodine-131 cause acute and rapid damage to tissue surrounding the thyroid. Strontium 90 also appears in plant products in limited quantities. This isotope collects in bones and teeth. Strontium-90 possesses a 25 year half-life, diffuses across the body uniformly and emits beta radiation (LeBaron, 1998). Cesium-137, which was released in large quantities during the recent Fukushima Daiichi disaster, collects in fleshy tissue and does not concentrate in any particular organ. It has a half-life of 33 years and emits both alpha and beta radiation (LeBaron, 1998). 5The technical term for this process is called . 7 Radioactive iodine and milk

Exposure to harmful radioactive fallout can occur either through direct channels such as landing on the skin or inhalation of irradiated dust, or through indirect channels such as the consumption of irradiated food products. Research by the National Cancer Institute (1997) and Center for Disease Control (2006) establishes that the food supply served as the main vector of exposure for most Americans during the atomic testing period. Scientific evidence contemporaneous with the testing period also substantiates that radioactive materials resulting from nuclear fission appeared in crops, people, and animals (Van Middlesworth, 1956; Kulp et al., 1958; Olson, 1962; Beierwaltes et al., 1960; Garner, 1963; Wolff, 1957). Radioactive iodine-131 has unique characteristics that results in it concentrating in fresh dairy. Dairy cows would inadvertently consume freshly irradiated grasses before the iodine decays. Since iodine is an essential nutrient that collects in the thyroid, the body metabolizes it and cows secrete excess iodine in milk. The structure of the dairy industry during the 1950s involved local production and often daily deliveries of milk to households. In this way irradiated dairy tended to be produced and consumed locally (Dreicer et al., 1990; National Cancer Institute, 1997; Manchester and Blayney, 1997).6 In the days following fallout precipitating down in a region, the public would inad- vertently consume irradiated fresh milk and this irradiated material would concentrate around the thyroid causing tissue damage and harm.7 The ingestion of irradiated ma- terial directly exposes organs and tissue to greater harm than just the environmental presence of ionizing radiation. Most atmospheric testing conducted at the NTS oc- curred between March and August of the calendar year. This timing coincides with the time of year many cows would be out to pasture. Through this dairy channel, local deposition of fallout is connected with human exposure to fallout. The NCI es- timates the majority of the 160 million US residents alive during the period of testing

6In the late 1950s refrigerated truck adoption increased and deliveries switched to every few days (Dreicer et al., 1990). 7The Chernobyl accident also resulted in the release of radioactive iodine and during the crisis the consumption of irradiated dairy posed a similar public health hazard (Dreicer et al., 1996). 8 experienced some level of exposure to fallout resulting from NTS activities.

Data and Descriptive Analysis

Radiation Exposure Data

The radiation deposition and exposure data used in this research is provided by the National Cancer Institute (NCI). These records are the most complete estimates of radioactive fallout resulting from nuclear testing conducted in Nevada from 1951 to 1958. The NCI derived estimates from raw gummed film radiation monitors for total radiation, the position of radiation clouds in the days following tests, and meteoro- logical data. Estimates for radioactive iodine-131 is derived from estimates for total fallout deposition.8 In 1983, Congress authorized the Secretary of Health and Human Services to in- vestigate and measure thyroid cancers resulting from radioactive iodine created by nuclear testing. This came as a result of Congressional investigations into the health effects of the U.S.’s nuclear testing program. The NCI undertook the task of gathering and reconstructing records monitoring radioactive fallout deposition across the United States. With these records and a much denser meteorological station data, the NCI created radioactive fallout deposition estimates for almost all atmospheric nuclear tests conducted between 1951 and 1958.9 The primary measurement for radiation exposure by county used in this analysis is cumulative annual average iodine-131 deposition per m2.10 The NCI estimated fallout deposition through an interpolation process called krig-

8Specific details on how the NCI constructed the data is available in the appendix. The iodine-131 estimates are proportional to total fallout deposition due since heavier and lighter fallout would not have separated much during the few days following the tests. 9In 1962 some atmospheric nuclear testing occurred when a nuclear testing moratorium between the US and USSR broke down. These tests had a cumulative yield of less than two kilotons of TNT. The resulting atmospheric release from the 1962 tests were negligible outside of the NTS region. 10This radioactive fallout deposition occurred prior to the foundation of the Environmental Protec- tion Agency. Unlike other , fallout from atmospheric nuclear testing is not the result of local economic activities such as electricity generation. Furthermore, unlike other potential sources of ra- diation exposure such as radon (inhalation hazard) or water soluble in soil (non-metabolized ingestion hazard), fallout from nuclear tests is time varying and contained radioactive materials that can be readily metabolized. 9 ing. Kriging is a common statistical technique that models conditions between moni- toring stations. It is commonly used to estimate meteorological conditions between ar- eas without weather stations. The regions surrounding the NTS had a dense radiation monitoring station network and the continental United States had a separate national radiation monitoring station network.11 With these monitoring station records, the NCI is able to identify the position of radioactive fallout clouds and the rate at which fallout deposits under varying meteorological conditions. In the regions surrounding the NTS, low altitude winds carried radioactive dust. In these “Downwind” areas visible dust storms carried radioactive matter across the landscape. In these areas, precipitation was not necessary for radioactive pollution to be delivered at the ground level. Most of the irradiated material generated by nuclear testing was carried kilometers up into the atmosphere with the mushroom cloud. High altitude winds would carry this irradiated material across the continent in the days following the test. In areas outside of the “Downwind” region, high altitude winds carried radioactive material and would be scavenged by precipitation. Many areas of the US experienced fallout if it rainfall happened to coincide with the travel path of the fallout cloud.

Aggregate public health and mortality data

Annual overall mortality, commonly referred to as crude deaths, are provided by Bailey et al. (2016).12 Since radiation poisoning not only increases cancer risks but can also adversely affect the immune system, this measure proxies for the adverse health effects of atmospheric nuclear testing. Furthermore, cancer might not be attributed as a cause of death on death certificates if it is only a contributing cause.

11For additional details on how the NCI constructed these fallout measures, see chapter 3 of (Na- tional Cancer Institute, 1997). The number and location of stations fluctuated year to year in the national monitoring station network. The number of stations never exceeded one hundred stations. The NCI also used records from airborne monitors to track the location, altitude, and size radioac- tive dust clouds when available. The raw radiation monitoring data used in the NCI’s kriging is unavailable, and the location of all monitors is not provided by the NCI. The NCI did perform vali- dation exercises comparing the performance of the interpolation techniques against a dense radiation monitoring network surrounding the NTS. 12Deaths by age and thus age adjusted mortality is not available at the county level until 1959. This is when individual level death certificates containing age information become available. 10 In addition to this overall death measure, I also collect and use information on annual cancer and automotive deaths by county. Cancer has historically been the outcome focus of radiation health studies. Automotive deaths should be unrelated with nuclear testing and are used for falsification tests. For 1946 to 1958, these records were constructed from cause of death tables in the Vital Statistics of the United States (National Center for Health Statistics, 1958). Cancer and automotive deaths from 1959 to 1967 were aggregated from the National Center for Health Statistics’ Multiple Cause of Death Files (National Center for Health Statistics, 1967).13 Cancer and automotive deaths from 1968 to 1988 were compiled at the county year level from the National Center for Health Statistics’ Compressed Mortality File (National Center for Health Statistics, 1988). Figures 4 and 5 plot out the annual average mortality rate by total fallout de- position from 1951 to 1958 for crude deaths and cancer deaths. These averages are weighted by county population. Crude deaths for both groups of counties move to- gether prior to the period of testing, diverge in the 1950s and converge again in the 1960s. With higher deposition counties experiencing greater mortality on average. Prior to testing cancer mortality in above median and below median deposition coun- ties follow a similar trajectory. Cancer mortality in above median deposition counties increases more than in low deposition counties during the period of testing but the averages converge by 1970.

Demographic and weather data

Demographic characteristics of an area can proxy for relevant factors that affect mortal- ity (Chay et al., 2003). Therefore, I include additional demographic information such as race, education, income, and population from decennial censuses come from (Haines, 2010). Since weather events such as temperature can affect mortality (Barreca et al., 2016), estimated fallout from nuclear testing is in part derived from meteorological records: some specifications include monthly temperature averages and precipitation

13I thank Michael Haines for the support he provided in geocoding these records.

11 controls derived from the National Oceanic and Atmospheric Administration’s Global Historic Climatology Network (Lawrimore et al., 2011).

Fallout’s effect on mortality patterns

The primary hypothesis of this paper is that more irradiated counties experienced greater increases in mortality in the years following fallout deposition than counties that received less fallout deposition. To study how fallout affects mortality patterns in the short-run, I perform an event study analysis on how an initial fallout deposition event affects crude deaths, cancer deaths, and motor vehicle deaths pre and post the deposition event. A subsequent two-way fixed effects panel regression studies how average fallout deposition one to five, six to ten, eleven to fifteen, and sixteen to twenty years prior affects mortality. The sample used in the analysis includes 3,016 county equivalent units from 1946 to 1988. Counties with border changes are merged into time consistent geographic units using Horan-Hargis identifiers included in Bailey et al. (2016). Table 1 provides the summary statistics.14 Crude deaths are on approximately 10 per 1,000 residents, cancer deaths are 1.6 per 1,000 residents, and motor vehicle deaths are 0.323 deaths per resident.

Fallout threshold event study

Fallout occurred over multiple years during the 1950s and the NCI estimates that most counties in the US experienced non-negligible levels of iodine-131 deposition. Some locations, primarily west of the NTS, received little deposition while many areas east of the NTS experienced multiple deposition events. In this section I define a threshold event for fallout deposition as the first time a county in the sample experiences NTS fallout exceeding the median deposition amount across all testing years. Most counties

14Following the example of Hornbeck (2012), regressions on the relationship between decennial Census observables and total fallout deposition are in the appendix. The only notable difference is that areas with greater fallout had higher rates of high school degree completion before, during, and after the period of testing than areas that had less fallout.

12 in the sample eventually exceed this threshold.15 The threshold in the sample is the first time a county exceeds more that 309 nanoCuries of iodine-131 per m2.

10 yit = Σr=−5φr ∗ DEir + Xitβ + Witω + αi + γt + it (1)

Equation 1 describes the full specification of the event study regression. yit denotes mortality per 1,000 people in a given county i and year t. DEir denotes a set of indicator variables that take the value one if year t is r years relative to the threshold fallout deposition event. There are five indicator variables for the years leading up to the event and eleven indicator variables for years after fallout has exceeded the threshold event. Identification of the φ coefficients comes from differences in the timing of initial fallout exposure between counties that have and have not yet exceeded the threshold. Some counties experience threshold exceeding fallout events earlier that others. Xit is a vector of interpolated demographic and economic controls. These include the share of county population that is white, share of the population with high school degrees or higher, and the log of the median household income.16 A vector of twelve monthly precipitation total and twelve average monthly temperatures controls represented by Wit control for mortality affecting weather factors that could be correlated with fallout deposition. The variables αi and γt denote county and year fixed effects. These county fixed effects control for time invariant county characteristics.17 The year fixed effects account for unobserved annual shocks shared across counties.

The variable it denotes the heteroskedastic error term and is clustered at the county level. The regression specification is weighted by county population. Figures 6, 7, and 8 present coefficients from the threshold event study and a 95% confidence interval. The coefficients report the associated effect of fallout exceeding the median level of deposition experienced during all atmospheric testing years from

15In total 2,811 counties in the sample exceed the threshold. Only 205 counties, mostly in states on the west and gulf coasts, do not exceed the deposition event threshold. 16Household income is first reported in 1950. Values for 1946-1949 are extrapolated from the 1950 to 1960 trend 17County fixed effects control for time invariant sources of radiation exposure such as naturally occurring uranium deposits or average radon seepage into basements.

13 1951 to 1958. Figure 6 shows that overall mortality begins to increase in the year the deposition event, and peaks three to four years after the event. In the five years prior to the threshold deposition event, there is no difference in the crude death rate relative to years outside the 16-year window examined. The value of the statistically significant coefficients ranges between 0.115 and 0.229 additional crude deaths per 1,000 residents. Deaths from cancer in figure 7 follow a similar pattern to crude deaths, though the event study suggests that cancer mortality is more sensitive to exceeding the fallout deposition threshold. Statistically significant differences in cancer mortality appear in the year of initial deposition, peaks three to four years after the initial deposition event and begins to decline in subsequent years. The value of the statistically signif- icant coefficients ranges between 0.021 and 0.066 additional cancer deaths per 1,000 residents. Deaths from motor vehicle accidents should plausibly be unrelated to fallout deposition and exceeding the threshold used in the event study. Figure 8 presents the coefficients for the event study using deaths from motor vehicle accidents as an out- come. In this falsification exercise there is no discernible relationship between crossing the fallout deposition threshold and motor vehicle deaths. This is both true before and after the threshold is exceeded.

Fallout and mortality over the long-run

The purpose of the event study is to test if areas that experienced substantial de- viations in fallout experienced statistically significant deviations in mortality. The deposition threshold event does not necessarily account for the health effects of previ- ous deposition events below the threshold. To account for the marginal effect of fallout deposition across time, I use pooled averages of historical deposition in a difference in differences framework with a continuous treatment. This allows me to first measure if fallout events below the threshold are associated with changes in mortality. Second, this model lets me measure the temporal persistence of these changes in mortality.18

18I pool the lagged deposition measures to limit the profusion of coefficients in the regression model and address potential serial correlation in fallout deposition events in counties. 14 4 yit = Σj=0θjAvg Eit,j + Xitφ + Witω + αi + γt + it (2)

Equation (2) describes the distributed lag specification for the long-run panel re- gressions. This model uses the same variables that are in Equation 1, but the measure of interest consists of lagged five year averages of the iodine-131 deposition measure.19

The variable Avg Eit,j denotes the average deposition term with j lags. This dis- tributed lag structure measures the dynamic mortality response to county level radi- ation deposition over a longer time horizon. Using lagged five year averages measures the temporal extent to which fallout affects mortality. This model uses variation in average fallout deposition one to five years prior, six to ten years prior, eleven to fifteen years prior, and sixteen to twenty years prior prior to identify the temporal extent to which fallout affected mortality patterns. Identification comes from comparisons in annual mortality between counties more exposed to fallout relative to counties less exposed to fallout. The hypothesis being that areas with greater amounts of fallout during a five year lag would experience greater deviations in mortality than areas that experienced less fallout deposition. The regression specification is weighted by county population.20 The results for crude death rates and cancer death rates are presented in tables 2 and 3. Both the crude death rate and cancer death rate increase in counties with more deposition relative to those with less deposition and that these increases in mortality may persist up to fifteen years after the fallout occurs. Table 4 presents results showing

19 yit mortality per 1,000 people in a given county i and year t. Xit is a vector of interpolated demographic and economic controls measuring the share of county population in share of the pop- ulation that is white, share of the population with high school degrees or higher, and the log of the median household income. A vector of twelve monthly precipitation total and twelve average monthly temperatures controls represented by Wit. The variables αi and γt denote county and year fixed effects.The variable it denotes the heteroskedastic error term and is clustered at the county level. The regression specification is weighted by county population. 20One caveat, measuring the effect of fallout across time on aggregate mortality rates implicitly assumes that most people who were exposed to radioactive fallout eventually die in the county where they were exposed. There is no strong a priori reason to believe that fallout deposition is system- atically correlated with underlying migration patterns in such a way that it would affect underlying patterns in county mortality. In a subsequent section I test whether or not migration prior to nu- clear testing or measures of population are correlated with fallout deposition and find little evidence suggesting that fallout is correlated with underlying trends in population or migration.

15 there is no discernible statistically significant relationship between deaths from motor vehicle accidents and pooled five-year averages of fallout deposition. According to specification (3) in table 2, fallout deposition is associated with sta- tistically significant increases in crude deaths one to five, six to ten years, and eleven to fifteen following deposition. The coefficient of 0.260 suggest a one standard devia- tion increase in the five year average of deposition, 163 nCi per m2, results in 0.042 additional deaths per 1,000 residents one to five years after deposition. The coeffi- cient of 0.170 suggests a one standard deviation increase in fallout results in 0.028 deaths per 1,000 residents six to ten years after deposition. The coefficient of 0.118 suggests a one standard deviation increase in fallout results in 0.019 additional deaths per 1,000 residents eleven to fifteen years after deposition. According to specification (3) in table 3, fallout deposition is associated with statistically significant increases in cancer deaths one to five, six to ten, and eleven to fifteen years after the fallout deposition event. The coefficient of 0.089 suggest a one standard deviation increase in the five year average of deposition, 163 nCi per m2, results in 0.015 additional cancer deaths per 1,000 residents one to five years after deposition. The coefficient of 0.070 suggests a one standard deviation increase in fallout results in 0.011 cancer deaths per 1,000 residents six to ten years after deposition. The coefficient of 0.042 suggests a one standard deviation increase in fallout results in 0.007 additional cancer deaths per 1,000 residents eleven to fifteen years after deposition.

Implications of atmospheric nuclear testing

America’s nuclear weapons program was (and still is) a costly national defense pol- icy. From 1940 to 1996 the estimated cost of America’s nuclear weapons program was approximately $9.37 Trillion in 2018$ (Schwartz, 2011). These monetary costs, how- ever, do not fully capture the full social cost of America’s nuclear weapons program. Since the the Federal Government has paid some compensation to victims of America’s domestic nuclear weapons program through the Radiation Exposure Com- pensation Act (RECA). This compensation has focused on workers involved in the

16 nuclear weapons program and those who lived downwind of the NTS during the 1950s.

As of 2015 the U.S. Department of Justice has paid out over $2 billion in compensation to victims. According to RECA, only persons living in twenty-two counties during the periods of testing can be considered living “Downwind” of the NTS.21 The results from the long-run panel regressions suggest that fallout resulting from atmospheric tests conducted in Nevada from 1951 to 1958 led to statistically significant increases in both overall mortality and cancer mortality. These increases in mortality persist up to fifteen years after fallout landed in a region. Since small amounts of fallout were broadly distributed in the United States during the period of testing, the empirical results suggest that the public health effects of atmospheric nuclear testing are broader than that suggested by researchers focusing on populations surrounding the testing locations. Using coefficients from regression specification (3) the model suggests that atmo- spheric nuclear testing in the US contributed towards approximately 186,500 crude deaths and 63,500 cancer deaths over a fifteen year period.22 In the sample used there were 61,989,820 total deaths in the counties and 11,317,503 deaths from cancer for the years 1951 to 1988. Relatively speaking, the regression coefficients in this paper sug- gest atmospheric nuclear testing at the NTS contributed to 0.3 percent of all deaths over this period and 0.6 percent of cancer deaths over this period. In comparison, estimates from Simon and Bouville (2015) suggest that nuclear testing at the NTS resulted in approximately 49,000 additional cases of thyroid cancer and up to 12,000 deaths from other cancers in the US. They, however, stress there are large uncertainties with these estimates. While fallout attributable deaths are substantial in magnitude, deaths attributable to outdoor (e.g. PM2.5 and ) far exceed that which can be attributed to NTS fallout. Recent estimates on the mortality burden of outdoor air pollution in the US by Dedoussi et al. (2020) suggest that air pollution contributes to tens of

21See https://www.justice.gov/civil/common/reca for more details on RECA. 22This calculation uses coefficients specification (3) in tables 2 and 3. I multiplied statistically significant coefficients by iodine-131 deposition values and population.

17 thousands of deaths a year in the US. The authors find that outdoor air pollution contributed towards 96,600 deaths in 2005, 83,000 in 2011, and 66,100 in 2018. Other estimates on the annual number of deaths attributable to air pollution in the US range between 90,000 to 360,000 per year. Policy makers often assign accounting values to human lives when evaluating policy decisions. Viscusi (1993) and Viscusi and Aldy (2003) survey these valuations placed on human life. From 1988 to 2000, valuations of human life by U.S. Federal Gov- ernment agencies ranged between $1.6 million and $9.2 million in 2018$. Using their values, I estimate the value of total life lost from ground deposition between $298 bil- lion and $1.7 trillion. For cancer specific deaths, the values range from $110 billion to $631 billion. Costa and Kahn (2004) use hedonic wage regressions on industrial sector mortality risks to estimate plausible market values for human life for each decade from 1940 to 1980. Using their decennial estimate the implied social cost of nuclear testing is $458 billion for crude deaths and $169 billion for cancer deaths. These estimates of social cost using statistical values of lives greatly exceed the $2 billion in compensation paid through RECA and could be valued as high as 18% of the total cost of the US’s nuclear weapons program as outlined in Schwartz (2011).

Robustness and alternative specifications

Migration and population change

Selective migration over a long period could introduce bias if systemically correlated with the variable of interest. If migration is not correlated with fallout deposition, then the migration of individuals exposed to fallout different from their place of death would introduce measurement error in the treatment variable and bias coefficients towards zero. Demographers and historians tend to use net migration measures, defined as the change of population between Censuses plus deaths and minus births, to study migration for the relevant period. This measure of migration is unsuitable since is it constructed from one of the outcome variables used in the mortality analysis. To the

18 author’s knowledge, there is no consistent measures of county to county migration in the US for the periods prior, during, or immediately after nuclear testing that could be used to weight the fallout measures.23 The 1940 complete count US Census has measures of migration by county. Using the complete count 1940 IPUMS sample (Ruggles et al., 2017), I construct shares of the population that do not migrate, move state to state, move within state, and move from abroad within the past five years. I then regress these values against cumulative fallout deposition estimates in US counties from 1951 to 1958 while controlling for state fixed effects. The results are presented in table 5 and show no relationship between cumulative fallout deposition and migration prior to nuclear testing. Since changes in population are in part caused by migration and since population is the denominator of the mortality rates of empirical interest, I regress decennial population from 1940 to 1980 against cumulative deposition and find no statistically significant relationship between population and deposition. These two results suggest that migration prior to nuclear testing and underlying changes in population before and after testing are uncorrelated with the fallout.

Alternative specifications

Tables 6, 7, and 8 present alternative specifications for crude deaths, cancer deaths, and motor vehicle deaths. Specification (1) is the baseline regression result from specifica- tion (3) in the main text and includes all controls. Specification (2) is the unweighted specification. Since the outcomes studied are mortality rates, the preferred model spec- ification weights the outcomes by the denominator of population. Failing to weight for differences in population increases the magnitude of the deposition coefficients of interest. Specification (3) addresses concerns about spatial correlation in standard errors by clustering at a higher level. The agriculture and climate change literature commonly uses state clustering to account for spatial correlation in weather data and the results are generally equivalent to standard error adjustments done according to

23The IRS provides county to county migration estimates from US tax filings starting in 1978, form more details see ICPSR record 2937 https://doi.org/10.3886/ICPSR02937.v1. 19 Conley (1999) (Deschˆenes and Greenstone, 2007).24 Specification (4) excludes counties covered under the Radiation Exposure Compensation Act (RECA). These regions are the most irradiated regions surrounding the Nevada Test Site. The empirical results hold with the exclusion of these highly irradiated counties. Specification (5) includes state specific time trends. Specification (6) includes controls for denoting the share of the population in the following age groups: 0-4, 5-14, 15-24, 25-34, 35-44, 45-54, 55-64, 65-74, and 75+. Since age adjusted mortality by county is not available until 1959, this alternative specification attempts to control for the underlying age structure of the population in a manner used in Barreca et al. (2016).

Conclusion

In many settings, the government attempts to address the external costs associated with polluting activities, but there are cases where government policy is the direct cause of harmful pollution. During the Cold War the United States detonated hundreds of nuclear weapons. Prior to 1963 many of these tests were conducted above ground and released tremendous quantities of radioactive material into the atmosphere. One location situated in the Mojave Desert, the Nevada Test Site, served as the center of the United State’s testing program. This paper finds that fallout resulting from atmospheric nuclear testing conducted in Nevada is associated with substantial and persistent increases in both cancer and overall mortality in regions far from the NTS. This finding suggests that the US’s nuclear testing program had broader effects on public health than previously thought, and that fallout deposition from these tests affects human capital in the extreme. These results are consistent with the fetal origins literature showing that prenatal exposure to ionizing radiation affects educational, income, and labor force outcomes later in adulthood. Approximately 160 million Americans lived through the period of atmospheric nuclear testing and were exposed to nontrivial quantities of radioactive pollutants

24Common implementation of Conley standard errors in STATA using a package written by Solomon Hsiang does not allow for the implementation of weights in the regressions. http: //www.fight-entropy.com/2010/06/standard-error-adjustment-ols-for.html 20 (Simon and Bouville, 2015). The social cost of this inadvertent exposure to fallout is still not fully known. The extent to which Nevada Test Site fallout affected economic development, education, and other measures of economic welfare in the United States has not been quantified. Large stockpiles of nuclear weapons, , and aging nuclear power infrastructure are potential sources of radioactive pollution. Management of these risks, and other existential risks such as climate change, requires competent and responsible governance.

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27 Figure 1: Number of U.S. Nuclear Tests 1945-1993. Source: Created from U.S. De- partment of Energy 2000 records.

Figure 2: Annual Cumulative Atmospheric Yields, Atmospheric iodine-131 Releases, and Number of Tests for the NTS, 1951-1958. Source: Created from National Cancer Institute (1997) records.

28 Figure 3: Cumulative Radioactive iodine-131 Deposition per m2 for NTS Atmospheric Tests conducted from 1951-1958. Source: Created from National Cancer Institute (1997) records.

Figure 4: Mean crude deaths per 1,000 by cumulative iodine 131 deposition, averages weighted by county population

29 Figure 5: Mean cancer deaths per 1,000 by cumulative iodine 131 deposition, averages weighted by county population

Figure 6: Fallout threshold coefficients and 95%CI , crude death rate per 1,000. Source: Author’s calculation.

30 Figure 7: Fallout threshold coefficients and 95%CI , cancer death rate per 1,000. Source: Author’s calculation.

Figure 8: Fallout threshold coefficients and 95%CI, motor vehicle death rate per 1,000. Source: Author’s calculation.

31 Table 1: Summary Statistics

Variable Mean Std. Dev. Min. Max. N deaths per 1,000 9.999 2.521 0 56.487 129688 cancer deaths per 1,000 1.599 0.648 0 16.821 129688 motor vehicle deaths per 1k 0.323 0.243 0 13.369 129688 population 57743.640 203500.358 73 8586032 129688 deposition, 1000s nCi per m2 0.054 0.298 0 43.916 129688 avg. five year dep., 1000s nCi per m2 0.054 0.163 0 10.583 129688 share of pop. white 0.684 0.311 0.002 1 129688 share of pop. with high school degree 43.59 17.589 3.7 95.460 129688 ln(median household income) 8.744 (0.867) 3.109 10.925 128902

32 Table 2: Long-run relationship between crude deaths and iodine-131 deposition, 1946- 1988

(1) (2) (3) deaths per 1,000 deaths per 1,000 deaths per 1,000 avg. dep.1-5 yrs ago 0.302∗∗∗ 0.286∗∗∗ 0.260∗∗ (0.103) (0.100) (0.109)

avg. dep.6-10 yrs ago 0.190∗∗ 0.212∗∗ 0.170∗∗ (0.085) (0.085) (0.079)

avg. dep.11-15 yrs ago 0.165∗∗ 0.123 0.118∗ (0.080) (0.078) (0.071)

avg. dep.16-20 yrs ago -0.013 -0.009 0.031 (0.072) (0.073) (0.074) year FE Yes Yes Yes county FE Yes Yes Yes weather controls No Yes Yes US Census controls No No Yes N 129688 129688 128902 adjusted r2 0.790 0.793 0.804 Standard errors in parentheses clustered by county or county equivalent unit in cases of border changes. All regressions are weighted by population. Sample is fully balanced with 3,016 counties per year from 1946 to 1988. Weather controls include monthly precipitation totals and temperature averages for each county and year. US census controls include linearly interpolated measures from decennial censuses. These include share of population white, share of population with high school degree, and median household income. Median household income for 1946 to 1949 is extrapolated from the 1950 to 1960 trend since the 1940 census only reports wage income. ∗ p < 0.10, ∗∗ p < 0.05, ∗∗∗ p < 0.01

33 Table 3: Long-run relationship between cancer deaths and iodine-131 deposition, 1946- 1988

(1) (2) (3) deaths per 1,000 deaths per 1,000 deaths per 1,000 avg. dep.1-5 yrs ago 0.095∗∗∗ 0.091∗∗∗ 0.089∗∗∗ (0.031) (0.030) (0.025)

avg. dep.6-10 yrs ago 0.065∗∗∗ 0.074∗∗∗ 0.070∗∗∗ (0.021) (0.020) (0.018)

avg. dep.11-15 yrs ago 0.043∗∗ 0.035∗ 0.042∗∗ (0.018) (0.018) (0.017)

avg. dep.16-20 yrs ago -0.014 -0.016 0.001 (0.013) (0.013) (0.018) year FE Yes Yes Yes county FE Yes Yes Yes weather controls No Yes Yes US Census controls No No Yes N 129648 129648 128902 adjusted r2 0.749 0.752 0.763 Standard errors in parentheses clustered by county or county equivalent unit in cases of border changes. All regressions are weighted by population. Sample is fully balanced with 3,016 counties per year from 1946 to 1988. Weather controls include monthly precipitation totals and temperature averages for each county and year. US census controls include linearly interpolated measures from decennial censuses. These include share of population white, share of population with high school degree, and median household income. Median household income for 1946 to 1949 is extrapolated from the 1950 to 1960 trend since the 1940 census only reports wage income. ∗ p < 0.10, ∗∗ p < 0.05, ∗∗∗ p < 0.01

34 Table 4: Long-run relationship between motor vehicle deaths and iodine-131 deposi- tion, 1946-1988

(1) (2) (3) deaths per 1,000 deaths per 1,000 deaths per 1,000 avg. dep.1-5 yrs ago -0.001 0.001 -0.001 (0.004) (0.004) (0.004)

avg. dep.6-10 yrs ago 0.006 0.006∗ 0.004 (0.004) (0.004) (0.004)

avg. dep.11-15 yrs ago 0.005 0.005 0.004 (0.006) (0.006) (0.006)

avg. dep.16-20 yrs ago 0.004 0.006 0.005 (0.007) (0.007) (0.007) year FE Yes Yes Yes county FE Yes Yes Yes weather controls No Yes Yes US Census controls No No Yes N 129648 129648 128902 adjusted r2 0.446 0.447 0.456 Standard errors in parentheses clustered by county or county equivalent unit in cases of border changes. All regressions are weighted by population. Sample is fully balanced with 3,016 counties per year from 1946 to 1988. Weather controls include monthly precipitation totals and temperature averages for each county and year. US census controls include linearly interpolated measures from decennial censuses. These include share of population white, share of population with high school degree, and median household income. Median household income for 1946 to 1949 is extrapolated from the 1950 to 1960 trend since the 1940 census only reports wage income. ∗ p < 0.10, ∗∗ p < 0.05, ∗∗∗ p < 0.01

35 Table 5: Relationship between migration status five years prior in 1940 Census and iodine-131 deposition

(1) (2) (3) (4) Share non-movers Share within state movers Share cross state movers Share abroad movers cum. dep. 0.073 0.040 -0.022 -0.003

(0.106) (0.079) (0.067) (0.003) N 3059 3059 3059 3059 adjusted r2 0.426 0.362 0.511 0.302 Robust standard errors in parentheses and include state fixed effects. ∗ p < 0.10, ∗∗ p < 0.05, ∗∗∗ p < 0.01 36 Table 6: Alternative specifications, crude deaths, 1946-1988

(1) (2) (3) (4) (5) (6) baseline unweighted state cluster SE excl. Downwind state trends age controls avg. deposition 1-5 yrs ago 0.260∗∗ 0.352∗∗∗ 0.260∗ 0.272∗∗ 0.320∗∗∗ 0.319∗∗∗ (0.109) (0.094) (0.143) (0.121) (0.087) (0.065)

avg. deposition 6-10 yrs ago 0.170∗∗ 0.258∗∗∗ 0.170∗ 0.178∗∗ 0.153∗ 0.140∗∗ (0.079) (0.085) (0.088) (0.089) (0.083) (0.055)

avg. deposition 11-15 yrs ago 0.118∗ 0.157∗∗ 0.118 0.133∗ 0.099 0.061 (0.071) (0.071) (0.109) (0.080) (0.073) (0.054)

37 avg. deposition 16-20 yrs ago 0.031 0.056 0.031 0.037 -0.061 -0.055 (0.074) (0.064) (0.126) (0.085) (0.061) (0.052) year FE Yes Yes Yes Yes Yes Yes county FE Yes Yes Yes Yes Yes Yes weather controls Yes Yes Yes Yes Yes Yes US Census controls Yes Yes Yes Yes Yes Yes N 128902 128902 128902 127830 128902 128902 adjusted r2 0.804 0.661 0.804 0.804 0.831 0.827 Standard errors in parentheses clustered by county or county equivalent unit in cases of border changes in all speci- fications but (3). Sample is fully balanced with 3,016 counties per year from 1946 to 1988. Weather controls include monthly precipitation totals and temperature averages for each county and year. US census controls include linearly interpolated measures from decennial censuses. These include share of population white, share of population with high school degree, and median household income. Median household income for 1946 to 1949 is extrapolated from the 1950 to 1960 trend since the 1940 census only reports wage income. ∗ p < 0.10, ∗∗ p < 0.05, ∗∗∗ p < 0.01 Table 7: Alternative specifications, cancer deaths, 1946-1988

(1) (2) (3) (4) (5) (6) baseline unweighted state cluster SE excl. Downwind state trends age controls avg. deposition 1-5 yrs ago 0.089∗∗∗ 0.105∗∗∗ 0.089∗∗ 0.096∗∗∗ 0.044∗∗∗ 0.107∗∗∗ (0.025) (0.029) (0.037) (0.027) (0.016) (0.016)

avg. deposition 6-10 yrs ago 0.070∗∗∗ 0.086∗∗∗ 0.070∗∗∗ 0.074∗∗∗ 0.029∗∗ 0.068∗∗∗ (0.018) (0.022) (0.025) (0.020) (0.013) (0.014)

avg. deposition 11-15 yrs ago 0.042∗∗ 0.058∗∗∗ 0.042 0.045∗∗ 0.015 0.030∗∗ (0.017) (0.016) (0.033) (0.019) (0.012) (0.015)

38 avg. deposition 16-20 yrs ago 0.001 0.007 0.001 0.006 -0.025∗ -0.017 (0.018) (0.014) (0.030) (0.020) (0.013) (0.015) year FE Yes Yes Yes Yes Yes Yes county FE Yes Yes Yes Yes Yes Yes weather controls Yes Yes Yes Yes Yes Yes US Census controls Yes Yes Yes Yes Yes Yes N 128902 128902 128902 127830 128902 128902 adjusted r2 0.763 0.555 0.763 0.763 0.788 0.781 Standard errors in parentheses clustered by county or county equivalent unit in cases of border changes in all speci- fications but (3). Sample is fully balanced with 3,016 counties per year from 1946 to 1988. Weather controls include monthly precipitation totals and temperature averages for each county and year. US census controls include linearly interpolated measures from decennial censuses. These include share of population white, share of population with high school degree, and median household income. Median household income for 1946 to 1949 is extrapolated from the 1950 to 1960 trend since the 1940 census only reports wage income. ∗ p < 0.10, ∗∗ p < 0.05, ∗∗∗ p < 0.01 Table 8: Alternative specifications, motor vehicle deaths, 1946-1988

(1) (2) (3) (4) (5) (6) baseline unweighted state cluster SE excl. Downwind state trends age controls avg. deposition 1-5 yrs ago -0.001 0.016∗∗ -0.001 -0.004 0.013∗∗ -0.004 (0.004) (0.007) (0.006) (0.004) (0.006) (0.004)

avg. deposition 6-10 yrs ago 0.004 0.017∗ 0.004 0.003 0.011∗∗ -0.003 (0.004) (0.009) (0.006) (0.005) (0.005) (0.004)

avg. deposition 11-15 yrs ago 0.004 0.004 0.004 0.003 0.009 -0.004 (0.006) (0.010) (0.009) (0.006) (0.006) (0.004)

39 avg. deposition 16-20 yrs ago 0.005 0.009 0.005 0.001 0.004 -0.002 (0.007) (0.008) (0.013) (0.007) (0.006) (0.005) year FE Yes Yes Yes Yes Yes Yes county FE Yes Yes Yes Yes Yes Yes weather controls Yes Yes Yes Yes Yes Yes US Census controls Yes Yes Yes Yes Yes Yes N 128902 128902 128902 127830 128902 128902 adjusted r2 0.456 0.170 0.456 0.452 0.468 0.464 Standard errors in parentheses clustered by county or county equivalent unit in cases of border changes in all speci- fications but (3). Sample is fully balanced with 3,016 counties per year from 1946 to 1988. Weather controls include monthly precipitation totals and temperature averages for each county and year. US census controls include linearly interpolated measures from decennial censuses. These include share of population white, share of population with high school degree, and median household income. Median household income for 1946 to 1949 is extrapolated from the 1950 to 1960 trend since the 1940 census only reports wage income. ∗ p < 0.10, ∗∗ p < 0.05, ∗∗∗ p < 0.01