Doctoral Dissertation Research in Economics: Public Health Movements, Local Poor Relief, and Child Mortality in the United States: 1910-1932

该博士论文进修奖允许学生研究儿童和婴儿死亡率与公共卫生和福利支出之间的关系，在20世纪初的城市和农村地区。20世纪初，美国各地的婴儿死亡率和儿童死亡率急剧下降，尽管各县下降的程度有很大差异。本项目利用不同时间和地点的差异来确定导致这些下降的公共卫生投资类型，并检查联邦、州和地方政府在进行投资时所作选择的政治经济学。许多公共卫生学者认为，儿童和婴儿死亡率的下降在很大程度上可以归因于教育的努力，这些教育教会了家庭一些简单的事情，比如洗手、牛奶巴氏消毒和更好的营养。虽然这些政策的教育性质历来使其效果难以衡量，但已经发现了关于县公共卫生组织的供资和活动的丰富信息来源。这使得博士论文的学生可以更有效地衡量1912年至1932年间美国700多个县每年的这些努力。此外，学生计划计算机化和分析广泛的信息，包括1910年至1940年人口普查局关于城市财政的报告中关于公共卫生教育、各种形式的卫生和市政福利支出的报告。在州一级，他计划根据1921年的谢泼德-汤纳法案（Sheppard-Towner Act）审查资金的作用，该法案在20世纪20年代分配了大量的公共卫生资金。在这个过程中，学生还会考察技术变革、供水和下水道公共工程项目、收入和经济活动的变化以及工业污染的变化所带来的影响。智力价值：就智力价值而言，拟议的活动有助于形成关于各类公共卫生政策投资有效性的知识体系。此外，收集目前无法以电子格式获得的数据，并将其载入易于使用和存取的数据库文件。这包括但不限于详细的农村卫生支出统计、1910年至1932年间的城市财政统计，以及同一时期城市纳税申报和城市和工业制造业统计。更广泛的影响：该项目具有更广泛的影响，因为它向公共政策通报了公共卫生和福利支出的相对有效性。在20世纪10年代和20年代的公共卫生运动之前，美国农村的卫生状况与目前发展中国家的状况非常相似。婴儿死亡率极高，卫生条件差，疾病流行。了解美国的公共卫生干预措施如何减轻了这些问题的严重性，在某些情况下完全消除了这些问题，将教育决策者，哪些健康和福利选择在今天面临类似问题的贫穷国家是最有效的。在许多情况下，教育项目的实施成本比大规模的卫生设施和水处理厂要低。审查这些政策的有效性可以更好地了解这些低成本政策如何在当前时期降低儿童和婴儿死亡率。

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.