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

这一博士论文改进奖允许学生研究20世纪初城市和农村地区儿童和婴儿死亡率与公共卫生和福利支出之间的关系。20世纪初，美国各地的婴儿死亡率和儿童死亡率大幅下降，尽管不同县的下降程度存在很大差异。该项目使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，并审查联邦、州和地方政府在做出投资选择时的政治经济学。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功于教育努力，这些努力教会了家庭洗手、牛奶巴氏杀菌和更好的营养等简单的事情。虽然这些政策的教育性质在历史上使其影响难以衡量，但关于县公共卫生组织的资金和活动的丰富信息来源已经被发现。这使得博士生能够更有效地衡量1912年至1932年期间美国700多个县每年的这些努力。此外，该学生计划将1910年至1940年人口普查局城市财政报告中报告的公共卫生教育支出、各种形式的卫生设施和市政地区福利支出的广泛信息进行计算机化和分析。在州一级，他计划审查1921年《谢泼德-汤纳法案》下的资金的作用，该法案在20世纪20年代分配了大量公共卫生资金。在这个过程中，学生还考察了技术变化、给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的影响。智力价值：就智力价值而言，拟议的活动有助于了解各种类型的公共卫生政策投资的有效性。此外，还收集了目前无法以电子格式提供的数据，并将其装入易于使用和访问的数据库文件。这包括但不限于详细的农村卫生支出统计数据、1910年至1932年的城市金融统计数据，以及同一时期按城市和行业分列的城市纳税申报单和制造业统计数据。更广泛的影响：该项目具有更广泛的影响，因为它让公共政策了解公共卫生和福利支出的相对有效性。在1910年代和1920年代的公共卫生运动之前，美国的农村卫生状况与发展中国家目前的状况非常相似。婴儿死亡率极高，卫生条件差，疾病盛行。了解美国的公共卫生干预措施如何减轻此类问题的严重性，并在某些情况下完全消除此类问题，将使政策制定者了解，在当今面临类似问题的贫穷国家，哪些卫生和福利选择将是最有效的。在许多情况下，教育方案的实施成本比大规模的卫生和水处理工程更低。审查这类政策的有效性有助于更好地了解这类低成本政策在降低当前时期儿童和婴儿死亡率方面可能发挥的作用。

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.