Controlling Tuberculosis? Evidence from the First Community-Wide Health Experiment
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.
Avery Calkins and Karen Clay acknowledge research support from Carnegie Mellon University. Avery Calkins acknowledges research support from the Eunice Kennedy Shriver National Institute Of Child Health and Human Development of the National Institutes of Health under Award Number T32HD007339. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the National Bureau of Economic Research.
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. citation courtesy of