Controlling Tuberculosis? Evidence from the First Community-Wide Health Experiment

This paper studies the immediate and long-run mortality effects of the first community-based health intervention in the world -the Framingham Health and Tuberculosis Demonstration, 1917Demonstration, -1923.The official evaluation committee and the historical narrative suggest that the demonstration was highly successful in controlling tuberculosis and reducing mortality.Using newly digitized annual cause-of-death data for municipalities in Massachusetts, 1901-1934, and different empirical strategies, we find little evidence to support this positive assessment.In fact, we find that the demonstration did not reduce tuberculosis mortality, all-age mortality, nor infant mortality.These findings contribute to the ongoing debate on whether public-health interventions mattered for the decline in (tuberculosis) mortality prior to modern medicine.At a more fundamental level, our study questions this particular type of community-based setup with nonrandom treatment assignment as a method of evaluating policy interventions.