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

Karen Clay, Peter Juul Egedesø, Casper Hansen, Peter Jensen and Avery Calkins

No 25884, NBER Working Papers from National Bureau of Economic Research, Inc

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.

JEL-codes: I15 I18 N32 (search for similar items in EconPapers)
Date: 2019-05
New Economics Papers: this item is included in nep-exp, nep-hea and nep-his
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Published as Karen Clay & Peter Juul Egedesø & Casper Worm Hansen & Peter Sandholt Jensen & Avery Calkins, 2020. "Controlling tuberculosis? Evidence from the first community-wide health experiment," Journal of Development Economics, vol 146.

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