City health departments, public health expenditures, and urban mortality over 1910–1940

Over the early twentieth century, urban centers adopted full‐time public health departments. We show that opening full‐time administration had little observable impact on mortality. We then attempt to determine why health departments were ineffective. Our results suggest that achievements in public health occurred regardless of health department status. Further, we find that cities with and without a full‐time health department allocated similar per capita expenditures towards health administration. This health department funding also better predicts infant mortality declines. Our conclusions indicate that specific campaigns, public health systems, and funding may have been more meaningful for local health over this era.