Casino Revenue and Indian Health: The Link between Tribal Gaming and the Health Status and Behaviors of American Indians

Barbara Wolfe, University of Wisconsin at Madison
Jessica Jakubowski, University of Wisconsin at Madison
Robert Haveman, University of Wisconsin at Madison
Hannah Goble, University of Wisconsin at Madison
Marissa Courey, University of Wisconsin at Madison

The legalization of American Indian (AI) casino gaming and income flows to a historically disadvantaged population from it create an opportunity for a natural experiment that examines the causal relationship between income and health. Net revenue from gaming has been used to provide direct financial support to tribe members and to support tribal infrastructure. We compare tribes that have established casino-style gaming to tribes that have not, identifying the effects of increased revenues on AI health. We use data on tribal gaming, ecological health access data from the ARF and individual health and socioeconomic data from the BRFSS (1988-2003). We estimate a positive association between gaming and AI income. Gaming is directly and indirectly (through income) associated with decreased smoking, asthma, and disability, better mental health and access to health care. Our research is the first to evaluate the potential health effects of the largely exogenous introduction of gaming income.