Public health, poor relief and improving urban child mortality outcomes in the decade prior to the New Deal

This paper examines the effectiveness of the public health education and poverty relief programs prior to the New Deal. Prior researchers have speculated these programs contributed to the declining mortality rates during the 1920s, but have been unable to econometrically estimate their impact across a large set of cities. Data on municipal health education and social insurance expenditures is used to separately estimate how effective each of these programs were at reducing infant and child mortality. The effects are identified using the within variation for a panel of 68 cities over 10 years, with estimates suggesting that it was primarily spending on health education which led to lower infant and child mortality during the 1920s. Additionally, for both the infant and child age groups, the education programs required a two-year lag to generate an effect. Fixed effects estimates indicate that 1 dollar of per capita public health education spending in year t translated to about a 0.93 unit drop in the infant mortality rate in year t+2, and about a .02 unit drop in the crude death rate for children aged 1 to 4. In terms of actual municipal expenditures during this period, these estimates show that cities in the top quartile of public health education spending experienced an additional 2.4 unit average annual decline in their infant mortality rates than did cites in the bottom percentile. JEL codes I18, I38, and N32