The White Death, Public Policy and Development (Research project funded by DFF)
About a century ago Tuberculosis (TB) was present in every part of the world, killing children and prime-age adults on a large scale. Nowadays, TB is only a major killer in developing countries, where it ranks alongside HIV as a leading cause of death. Consequently, eradicating TB has become part of the UN’s third sustainable development goal. TB became treatable with antibiotics in the late 1940s, though drug resistant strains have started to emerge. However, many European countries and the US were able to significantly reduce the number of TB deaths prior to the advent of antibiotics.
For example, in Denmark, the number of TB deaths per 100,000 people decreased from 300 in 1885 to less than 50 in 1940. But why did TB mortality start to decrease long before it became treatable with medicine and what were the socioeconomic implications of this decline?
In the project, we provide new evidence on these questions by studying how different pre-antibiotic public-health policies affected TB mortality and socioeconomic outcomes, such as income and income inequality. In particular, we study the effect of the establishment of TB dispensaries, TB sanatoria, bans of spitting in public and pasteurization of milk using data for US, Denmark and other European countries.
A Gift of Health: The Duke Endowment’s Impact on Health Care in the Carolinas, 1925-1962
In this project we evaluate the effects of health investments in the form of increased access to hospital care during infancy and early childhood on longevity and other aging-related health outcomes such as disability receipts and cause-specific mortality. The study utilizes quasi-exogenous variation in access to hospital care through funding from the Duke Endowment between 1925 and 1962 in North and South Carolina. We measure exposure to Duke funding using data on supported hospitals, their capacity, and expenditures.
The Duke Endowment was founded in 1924 to not only establish Duke University and its School of Medicine, but also build and operate hospitals in North and South Carolina as the only southern philanthropic organization that provided substantial aid for African American health at the time. By 1940, the Endowment gave over $1 million annually to 130 hospitals in the Carolinas and about one-third of the patients at these facilities received free care. Furthermore, it supported the construction of new mixed-race hospitals, investment in hospital equipment, and increases in the staffing of adequately trained physicians.
We use a difference-in-differences strategy to evaluate the impact of hospital funding on aging. Specifically, we compare the differential timing of obtaining the first dollar of financial aid or the first capital contribution for the construction of a new hospital across counties in the Carolinas. We also explore potential mechanisms such as the supply of physicians and nurses, equipment upgrades, and physical capital investments.
Joint work of Alex Hollingsworth, Krzystof Karbownik, Melissa Thomasson, Anthony Wray.
The effect of domestic violence on child mortality
India accounts for 1.7 million child deaths, a quarter of global child mortality. The current literature has succeeded in establishing an association between domestic violence and child mortality but has yet to present evidence of a causal relationship. I use an instrumental variable approach to analyze the causal impact of domestic violence against the mother on child mortality in the Indian context. Domestic violence is instrumented with the real price of gold at the month of marriage of the mother. Results lend evidence to a significant positive relationship between domestic violence against the mother and child mortality. A one standard deviation increase in domestic violence translates to a 17.6 and 16.9 percentage point increase in both neonatal and infant mortality respectively.