Public health departments and the mortality transition in Latin America: Evidence from Puerto Rico

This paper examines the role of public health in reducing mortality prior to modern medicine by studying Puerto Rico in the early 20th century. From 1930 to 1960, Puerto Rico experienced one of the fastest increases in life expectancy in history and completed the first mortality transition outside of Europe and Western offshoots. Using municipal-level data in an event study framework, I show that public health units (county health departments) caused around half of the reduction in infant and tuberculosis mortality from 1923 to 1945, without significantly increasing public expenditures. Public health units also reduced maternal mortality and stillbirths. I present descriptive evidence that more assistant midwives per capita correspond to larger declines in maternal mortality, suggesting the importance of the training of midwives by health units. This investigation provides a window into Latin America more broadly, since most countries in Latin America subsequently adopted public health units.