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Public Health Investments and the Infant Mortality Gap: Evidence from Federal Sanitation Interventions on U.S. Indian Reservations




To what extent do differential levels of investment in public health inputs explain observed differences in health outcomes across socioeconomic and racial groups? This study investigates the impact of 3,700 projects that were part of a widespread Federal initiative to improve sanitation infrastructure on U.S. Indian reservations starting in 1960. Sanitation investment substantially reduced the cost of clean water for households, leading to sharp reductions in both waterborne gastrointestinal disease and infectious respiratory disease among Native American infants. The sanitation program was quite cost-effective, in part because improvements in the overall disease environment also reduced infectious respiratory disease among nearby white infants. Despite the health externalities, Federal sanitation interventions explain almost forty percent of the convergence in Native American and white infant mortality rates in reservation counties since 1970.

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  • Tara Watson, 2005. "Public Health Investments and the Infant Mortality Gap: Evidence from Federal Sanitation Interventions on U.S. Indian Reservations," Department of Economics Working Papers 2005-02, Department of Economics, Williams College.
  • Handle: RePEc:wil:wileco:2005-02

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    1. Viscusi, W Kip, 1993. "The Value of Risks to Life and Health," Journal of Economic Literature, American Economic Association, vol. 31(4), pages 1912-1946, December.
    2. David M. Cutler & Ellen Meara, 1998. "The Medical Costs of the Young and Old: A Forty-Year Perspective," NBER Chapters,in: Frontiers in the Economics of Aging, pages 215-246 National Bureau of Economic Research, Inc.
    3. David M. Cutler & Edward L. Glaeser & Jacob L. Vigdor, 1999. "The Rise and Decline of the American Ghetto," Journal of Political Economy, University of Chicago Press, vol. 107(3), pages 455-506, June.
    4. Troesken, Werner, 2001. "Race, Disease, And The Provision Of Water In American Cities, 1889 1921," The Journal of Economic History, Cambridge University Press, vol. 61(03), pages 750-776, September.
    5. William N. Evans & Julie H. Topoleski, 2002. "The Social and Economic Impact of Native American Casinos," NBER Working Papers 9198, National Bureau of Economic Research, Inc.
    6. Marianne Bertrand & Esther Duflo & Sendhil Mullainathan, 2004. "How Much Should We Trust Differences-In-Differences Estimates?," The Quarterly Journal of Economics, Oxford University Press, vol. 119(1), pages 249-275.
    7. David M. Cutler & Ellen Meara, 2000. "The Technology of Birth: Is It Worth It?," NBER Chapters,in: Frontiers in Health Policy Research, Volume 3, pages 33-68 National Bureau of Economic Research, Inc.
    8. Sebastian Galiani & Paul Gertler & Ernesto Schargrodsky, 2005. "Water for Life: The Impact of the Privatization of Water Services on Child Mortality," Journal of Political Economy, University of Chicago Press, vol. 113(1), pages 83-120, February.
    9. William J. Collins & Melissa A. Thomasson, 2002. "Exploring the Racial Gap in Infant Mortality Rates, 1920-1970," Vanderbilt University Department of Economics Working Papers 0201, Vanderbilt University Department of Economics.
    10. Currie, Janet & Gruber, Jonathan, 1996. "Saving Babies: The Efficacy and Cost of Recent Changes in the Medicaid Eligibility of Pregnant Women," Journal of Political Economy, University of Chicago Press, vol. 104(6), pages 1263-1296, December.
    11. Orley Ashenfelter & Michael Greenstone, 2004. "Using Mandated Speed Limits to Measure the Value of a Statistical Life," Journal of Political Economy, University of Chicago Press, vol. 112(S1), pages 226-267, February.
    12. Edward Miguel & Michael Kremer, 2004. "Worms: Identifying Impacts on Education and Health in the Presence of Treatment Externalities," Econometrica, Econometric Society, vol. 72(1), pages 159-217, January.
    13. Kenneth Y. Chay & Michael Greenstone, 2003. "Air Quality, Infant Mortality, and the Clean Air Act of 1970," Working Papers 0406, Massachusetts Institute of Technology, Center for Energy and Environmental Policy Research.
    14. Hoyt Bleakley, 2007. "Disease and Development: Evidence from Hookworm Eradication in the American South," The Quarterly Journal of Economics, Oxford University Press, vol. 122(1), pages 73-117.
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    1. Watson, Tara, 2006. "Public health investments and the infant mortality gap: Evidence from federal sanitation interventions on U.S. Indian reservations," Journal of Public Economics, Elsevier, vol. 90(8-9), pages 1537-1560, September.

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