Abstract

Fighting infectious disease in the past, much like today, focused on isolating the disease and thereby stopping its spread. New insights into the modes of transmission and the causal agents in the mid-nineteenth century, together with fear of new epidemic outbreaks, motivated public investments aimed at reducing mortality from infectious disease. Combining longitudinal individual-level data on 17,000 children in a rural/semi-urban region in southern Sweden with parish-level data on public health investment from local ledger registers, we explore the effects of public health initiatives, such as the establishment of isolation hospitals and improved midwifery, on infant and child mortality. Using a difference-in-differences approach, we find that the establishment of isolation hospitals in the mid-1890s had been efficient in reducing child mortality, while the reformation of the midwife system after 1900s led to the decline in infant mortality, both by a magnitude of more than 50 per cent.

Highlights

  • If we distinguish the treated child population by parish, we find that such effect was produced by two parishes, in Kågeröd for all children and in Kävlinge for older children

  • In the end of the period discussed in this study, in 1938, a nationwide travel report of journalist Lubbe Nordström - “Dirty Sweden” - drew the picture of rural Sweden as poor, dirty and backward (Nordström 1938)

  • We find that after the 1890s isolation hospitals and the employment of midwives qualified in disinfection routines suppressed both infant and child mortality

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Summary

Objectives

As this paper aims at exploring permanent effects of public health interventions on mortality, we consider pre- and post-treatment periods of 10 years each

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