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The Rise and Fall of Pellagra in the American South

Karen Clay, Ethan Schmick, Werner Troesken

NBER Working Paper No. 23730
Issued in August 2017, Revised in May 2018
NBER Program(s):Development of the American Economy, Health Care

We explore the rise and fall of pellagra, a disease caused by inadequate niacin consumption, in the American South, focusing on the first half of the twentieth century. We first consider the hypothesis that the South’s monoculture in cotton undermined nutrition by displacing local food production. Consistent with this hypothesis, a difference-in-differences estimation shows that after the arrival of the boll weevil, food production in affected counties rose while cotton production and pellagra rates fell. The results also suggest that after 1937 improved medical understanding and state fortification laws helped eliminate pellagra.

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Document Object Identifier (DOI): 10.3386/w23730

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