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Controlling Tuberculosis? Evidence from the First Community-Wide Health Experiment

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  • Karen Clay
  • Peter Juul Egedesø
  • Casper Worm Hansen
  • Peter Sandholt Jensen
  • Avery Calkins

Abstract

This paper studies the immediate and long-run mortality effects of the first community-based health intervention in the world – the Framingham Health and Tuberculosis Demonstration, 1917-1923. The official evaluation committee and the historical narrative suggest that the demonstration was highly successful in controlling tuberculosis and reducing mortality. Using newly digitized annual cause-of-death data for municipalities in Massachusetts, 1901-1934, and different empirical strategies, we find little evidence to support this positive assessment. In fact, we find that the demonstration did not reduce tuberculosis mortality, all-age mortality, nor infant mortality. These findings contribute to the ongoing debate on whether public-health interventions mattered for the decline in (tuberculosis) mortality prior to modern medicine. At a more fundamental level, our study questions this particular type of community-based setup with non-random treatment assignment as a method of evaluating policy interventions.

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  • Karen Clay & Peter Juul Egedesø & Casper Worm Hansen & Peter Sandholt Jensen & Avery Calkins, 2019. "Controlling Tuberculosis? Evidence from the First Community-Wide Health Experiment," NBER Working Papers 25884, National Bureau of Economic Research, Inc.
  • Handle: RePEc:nbr:nberwo:25884
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    Cited by:

    1. Alex Hollingsworth & Krzysztof Karbownik & Melissa A. Thomasson & Anthony Wray, 2022. "The Gift of a Lifetime: The Hospital, Modern Medicine, and Mortality," NBER Working Papers 30663, National Bureau of Economic Research, Inc.
    2. Marein, Brian, 2023. "Public health departments and the mortality transition in Latin America: Evidence from Puerto Rico," Journal of Development Economics, Elsevier, vol. 160(C).
    3. Philipp Ager & Casper Worm Hansen & Peter Z. Lin, 2023. "Medical Technology and Life Expectancy: Evidence from the Antitoxin Treatment of Diphtheria," Working Papers 0241, European Historical Economics Society (EHES).
    4. He, Ke & Wang, Yujie & Zhang, Junbiao & Wang, Qingbin, 2022. "Out of the shadows: Impact of SARS experience on Chinese netizens' willingness to donate for COVID-19 pandemic prevention and control," China Economic Review, Elsevier, vol. 73(C).
    5. Volha Lazuka & Peter Sandholt Jensen, 2024. "Multigenerational Effects of Smallpox Vaccination," Working Papers 0251, European Historical Economics Society (EHES).

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    More about this item

    JEL classification:

    • I15 - Health, Education, and Welfare - - Health - - - Health and Economic Development
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • N32 - Economic History - - Labor and Consumers, Demography, Education, Health, Welfare, Income, Wealth, Religion, and Philanthropy - - - U.S.; Canada: 1913-

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