This doctoral dissertation improvement award permits the student to examine the relationship between child and infant mortality and public health and welfare spending in both urban and rural areas during the early 20th century. Infant mortality and child mortality rates dropped sharply across the United States during the early 1900s, although there was substantial variation in the degree of decline across counties. This project uses the variation across time and place to identify the types of public health investments that contributed to these declines and examines the political economy of the choices made by Federal, state and local governments in making the investments. Many public health scholars suggest that a great deal of the decline in child and infant mortality can be attributed to education efforts that taught families simple things like hand washing, milk pasteurization and about better nutrition. While the educational nature of these policies has historically made their effects hard to measure, a rich source of information on the funding and activities of county public health organizations has been discovered. This allows the doctoral dissertation student to more effectively measure these efforts in every year between 1912 and 1932 for over 700 counties in the United States. In addition, the student plans to computerize and analyze extensive information about spending on public health education, various forms of sanitation, and welfare spending in municipal areas reported from 1910 through 1940 in the Census Bureau reports on city finances. At the state level he plans to examine the role of funding under the Sheppard-Towner Act of 1921, which distributed large amounts of public health funding during the 1920s. In the process the student also examines the influences of technological change, water and sewer public works projects, changes in income and economic activity, and changes in industrial pollution.
Intellectual Merit: In terms of intellectual merit, the proposed activity contributes to the body of knowledge about the effectiveness of investments in various types of public health policies. In addition, data currently unavailable in electronic format is collected and loaded into easily usable and accessible database files. This includes, but is not limited to, detailed rural health spending statistics, city financial statistics between 1910 and 1932, as well as statistics on city tax returns and manufacturing statistics by city and industry during this same time period.
Broader Impact: The project has a broader impact because it informs public policy about the relative effectiveness of public health and welfare spending. Prior to the public health campaigns in the 1910s and 1920s, rural health conditions in the United States closely resembled current conditions in developing countries. Infant mortality rates were extremely high, sanitary conditions were poor and disease prevalent. Knowledge about how public health interventions in the United States reduced the severity of, and in some cases entirely eliminated these types of issues will educate policy makers about which health and welfare options would be most effective in poor countries facing similar issues today. In many cases the educational programs were more cheaply implemented than large-scale sanitation and water-treatment works. Examining the effectiveness of such policies allows better understanding about how such low-cost policies might work in reducing child and infant mortality during the current period.
