Explaining declines in US rural mortality, 1910-1933

Abstract

This study estimates the impact of an American rural public health program on child mortality over 1908 to 1933. Due to the absence of sanitation and child-oriented health services outside of urban areas, public and private agencies sponsored county-level health departments (CHDs) throughout the US. Variation in the location and timing of the CHDs identifies improvements in population health, which are captured entirely by children. Mortality declines emerge in infancy and gradually decay through childhood. Adversely affected areas with either an ample population of nonwhites or greater levels of preexisting infectious disease undergo larger reductions in mortality.