IFREE-Sponsored Lecture Series at ESI

Melissa Thomasson, Ph.D.
Nov. 4th, 2011

Saving Babies: The Contribution of Sheppard-Towner to the Decline in Infant Mortality in the 1920s

"A fundamental question that economists examine is public vs. private provision of goods and services. In the early 20th century, the role of government in providing public health education came into sharp focus with the enactment of the Sheppard-Towner Act in 1922. Under this program, the federal government provided matching grants to states to assist them in providing maternal and infant care education. The Act was highly controversial and state participation in the program varied widely; three states even refused to participate on the grounds that the program violated states’ rights. Ultimately, Congress repealed the Sheppard-Towner Act and it ended in 1929. When the program ended, the U.S. Children’s Bureau concluded that the program helped to decrease maternal and infant death rates in the 1920s, but the American Medical Association argued that the public health spending had no impact.

We measure the contribution of Sheppard-Towner to declining infant mortality rates by using a panel of data on state-level mortality rates and information on Sheppard-Towner expenditures. In addition, this paper leverages the variation in the types of activities conducted by states to examine whether different activities had differential effects on mortality. Results suggest that Sheppard-Towner activities accounted for 11-12 percent of the decline in infant mortality over the period. Moreover, we find that not all educational activities had equal impact. Interventions that allowed personal one-on-one contact seemed more beneficial than classes and demonstrations. Constructing public health centers and sending public health nurses to visit homes both lowered infant mortality, while conducting health conferences and enrolling midwives in classes did not. "

Bio:
Thomasson earned her Ph.D. in economics from the University of Arizona in 1998 and has been on the faculty at Miami since 1998. She works in the areas of health economics and economic history. Her work has been published in top journals in economics, and she is the recipient of several grants and awards, including a grant from the National Science Foundation. Thomasson’s work has been cited in the New England Journal of Medicine, the Yale Law Journal, reports prepared for the U.S. Senate and the United Nations, and on the floor of the U.S. Senate during the debate over health insurance reform. Recently, her work on the economic history of health insurance was the subject of a feature on “This American Life,” produced by Chicago Public Radio, and on “All Things Considered” on National Public Radio.

Abstract:
Enacted in 1922, the Sheppard-Towner Act provided matching grants to states to assist them in providing maternal and infant care education. Although the program was repealed in 1929, the U.S. Children’s Bureau concluded that the program helped to decrease maternal and infant death rates in the 1920s. This paper measures the contribution of Sheppard-Towner to declining infant mortality rates by using a panel of data on state-level mortality rates and information on Sheppard-Towner expenditures. In addition, this paper leverages the variation in the types of activities conducted by states to examine whether different activities had differential effects on mortality. Results suggest that Sheppard-Towner activities accounted for 11-12 percent of the decline in infant mortality over the period. Moreover, we find that not all educational activities had equal impact. Interventions that allowed personal one-on-one contact seemed more beneficial than classes and demonstrations. Constructing public health centers and sending public health nurses to visit homes both lowered infant mortality, while conducting health conferences and enrolling midwives in classes did not.

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