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.

这项研究评估了与美国最早，最广泛的农村公共卫生工作之一相关的死亡率下降。在1908年至1933年之间，县政府制定了县卫生部门（CHD），提供卫生设施和面向儿童的卫生服务。使用事件研究设计，我利用CHD到达的位置和时间的变化来衡量健康影响。我发现，冠心病的进入导致婴儿死亡率的下降，但对总体人口健康却无济于事。对于婴儿而言，冠心病预防了每千名婴儿中的两例死亡，占特定时期死亡率下降的8-10％。这种影响在仅农村地区的县中最为明显，在这些县中，婴儿死亡率每1000胎下降约3例死亡。