Controlling Tuberculosis? Evidence from the Mother of All Community-Wide Health Experiments

68 Pages Posted: 21 Mar 2018

See all articles by Karen Clay

Karen Clay

Carnegie Mellon University - H. John Heinz III School of Public Policy and Management; National Bureau of Economic Research (NBER)

Peter Egedesø

University of Southern Denmark

Casper Worm Hansen

University of Copenhagen - Department of Economics; University of Copenhagen

Peter S. Jensen

University of Southern Denmark - Department of Business and Economics

Date Written: March 20, 2018

Abstract

This paper studies the immediate and long-run mortality effects of the first community-based health intervention in the world, which had a particular focus on controlling tuberculosis - the so-called Framingham Health and Tuberculosis Demonstration. Comparing death and TB-mortality rates between Framingham and seven (pre-selected) control towns during the Demonstration period between 1917 and 1923, the contemporary offcial evaluation committee concluded that the Demonstration was highly successful in controlling TB and reducing mortality. The Framingham Demonstration subsequently became a health example for the world. The findings in our paper question this very positive assessment. We collected and digitized causes-of-death data for towns/cities in Massachusetts and the United States for the period 1901-1934, allowing us to extend the number of control towns (or cities) and study whether the Demonstration reduced mortality in the long run. Compared to the official seven controls towns, we find that TB mortality in Framingham was on average lower between 1917 and 1923. In the extended control samples, these immediate TB mortality differences are smaller and often more than reversed by 1934. However, we do find robust evidence that the Demonstration reduced infant mortality, and these improvements persisted even after the Demonstration ended.

Keywords: Public Health; Health Demonstration; Tuberculosis Mortality; Infant Mortality

JEL Classification: I15; I18; N32

Suggested Citation

Clay, Karen B. and Egedesø, Peter and Hansen, Casper Worm and Jensen, Peter S., Controlling Tuberculosis? Evidence from the Mother of All Community-Wide Health Experiments (March 20, 2018). Available at SSRN: https://ssrn.com/abstract=3144355 or http://dx.doi.org/10.2139/ssrn.3144355

Karen B. Clay (Contact Author)

Carnegie Mellon University - H. John Heinz III School of Public Policy and Management ( email )

Pittsburgh, PA 15213-3890
United States

National Bureau of Economic Research (NBER) ( email )

1050 Massachusetts Avenue
Cambridge, MA 02138
United States

Peter Egedesø

University of Southern Denmark ( email )

Campusvej 55
DK-5230 Odense, 5000
Denmark

Casper Worm Hansen

University of Copenhagen - Department of Economics ( email )

Øster Farimagsgade 5
Copenhagen K, DK 1153
Denmark

University of Copenhagen ( email )

Nørregade 10
Copenhagen, København DK-1165
Denmark

Peter S. Jensen

University of Southern Denmark - Department of Business and Economics ( email )

Campusvej 55
DK-5230 Odense M, 5230
Denmark

HOME PAGE: http://www.sam.sdu.dk/staff/psj

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