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

Karen Clay, Peter Juul Egedesø, Casper Worm Hansen, Peter Sandholt Jensen, Avery Calkins

NBER Working Paper No. 25884
Issued in May 2019
NBER Program(s):Development of the American Economy, Development Economics, Health Care

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.

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Document Object Identifier (DOI): 10.3386/w25884

 
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