Health Economics and Health Policy - Health and Health Policies in Low Income Countries

Health Economics and Health Policy

Part III: Health and Health Policies in Low Income Countries

Prof. Dr. Michael Grimm

This paper by Hoyt Bleakley titled “Disease and Development: Evidence from Hookworm Eradication in the American South” published in the Quarterly Journal of Economics in February 2007 is a historical confirmation of what has already been a broadly consistent contemporary evidence of a RCT finding (with claimed robustness) in Kenya of de-worming as measured in the classic paper by Edward Miguel and Michael Kremer (2004) and its effects of one-quarter reduced absenteeism (although it didn’t improve test scores). Similarly, Bobonis, Miguel and Sharma (2006) gets similar impact of a combination of de-worming and iron supplementation on school attendance in North India.

This write-up on this paper by Hoyt Bleakley is divided in the following parts: short summary, literature review around this topic and broader theme of disease and economic growth/development, critical assessment of the paper and the last section consists of conclusion and policy implications/recommendation.

1. Summary of the paper

The paper focuses on analyzing the specific intervention toward hookworm eradication in the American South which started in 1910 with the help of natural data. The successful eradication of the program in itself should not be thought of as endogenous as there was critical innovation to knowledge but the fact that it was not even recognized in America is good reason to believe this as a natural experiment of a massive funding by The Rockefeller Sanitary Commission (RSC) which was not augmented with public health expenditures at the time but later on followed-upon to eradicate the infection.

This intervention serves well to fit the design to evaluate the impact since the timing of the program was relatively short, well-defined and effective; the geographical differences in the incidence of infection serves well for a treatment/control grouping design; the intervention was back in 1910 and hence we have several data sources starting from the intervention itself to the census data to evaluate long-run effects of economic consequences.

As the author admits, the paper is not a guide on how to design a de-worming program nor is it a paper to assess the debates on sanitation versus publicity of program etc. This paper is evaluating the reduction in hookworm infection and its effect on socioeconomic consequences. Hence, this is another addition to the evidence of the burden of tropical diseases in impending development which has received fair attention in the last decade or so.

The primary outcomes of interest can be broadly categorized into short-run impact of treatment (school enrollment, attendance) for kids and adults, and long-run effects (literacy