Controlling tuberculosis? Evidence from the first community-wide health experiment

This paper studies the immediate and long-run health effects of the first community-based health intervention in the world – the Framingham Health and Tuberculosis Demonstration, 1917–1923. 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. Although we find that the Demonstration increased the identification of new TB case, this did not translate into reductions in tuberculosis mortality, total mortality, or infant mortality. This evidence contributes to an ongoing debate on whether public health interventions mattered for the historical decline in (tuberculosis) mortality prior to modern medicine and may help us to understand how to lower the burden of tuberculosis in the developing world today.