Explaining declines in US rural mortality, 1910–1933: The role of county health departments

Abstract

This study assesses the mortality decline associated with one of the first and most extensive rural public health efforts in the United States. Between 1908 and 1933, county governments enacted county health departments (CHDs) that provided sanitation and child-oriented health services. Using an event study design, I exploit variation in the location and timing of CHD arrival to measure the health effects. I find that CHD entry led to a decline in infant mortality, but provided little advantage to overall population health. For infants, CHDs prevented two deaths per 1000 births, which accounts for 8–10% of the period-specific mortality decline. The effect is most substantial in rural-only counties where infant mortality declines by roughly three deaths per 1000 births.