Infant Mortality and the Repeal of Federal Prohibition
By: David S. Jacks (Simon Fraser University), Krishna Pendakur (Simon Fraser University), and Hitoshi Shigeoka (Simon Fraser University).
Abstract: Exploiting a newly constructed dataset on county-level variation in Prohibition status from 1933 to 1939, this paper asks two questions: what were the effects of the repeal of federal prohibition on infant mortality? And were there any significant externalities from the individual policy choices of counties and states on their neighbors? We find that dry counties with at least one wet neighbor saw baseline infant mortality increase by roughly 3% while wet counties themselves saw baseline infant mortality increase by roughly 2%. Cumulating across the six years from 1934 to 1939, our results indicate an excess of 13,665 infant deaths that could be attributable to the repeal of federal Prohibition in 1933.
Distributed by NEP-HIS on: 2017-05-21
Review by: Gregori Galofré-Vilà (University of Bocconi and University of Oxford)
In 1919, the National Prohibition Act (also known as Volstead Act), which passed with the support of American rural protestants and social progressives, mandated that “no person shall manufacture, sell, barter, transport, import, export, deliver, furnish or possess any intoxicating liquor.” The 1920s became the decade when Al Capone operated in the Canadian and Mexican borders smuggling alcohol with the well-known subsequent boost to organized crime. President Roosevelt lifted Prohibition in 1933, although its rejection was through local referendums or elections. The repeal of Prohibition in some parts of the country divided the US into ‘dry’ and ‘wet’ areas. In dry areas, people either abstained, or were forced to buy alcohol sometimes from toxic homebrews of methanol at illegal underground bars or from ‘wet’ neighbouring counties. Meanwhile, in ‘wet’ areas, the party was on! Interestingly enough, the end of the Prohibition created what epidemiologists call ‘a natural experiment’. These experiments arise from historical events that affect some people, communities or societies, but not others. This divergence offers the possibility of learning how political choices ultimately affect people’s lives, for better or for worse.
To explore the health impacts of the repeal of the National Prohibition Act, Jacks, Pendakur and Shigeoka (2017) created a newly county-level dataset on variations in prohibition status from 1933 to 1939, and related it to previous data on infant mortality from Fishback et al. (2011) and to additional controls (such as retail sales, New Deal spending, urbanisation and so on). They addressed two questions: (1) what were the effects of the repeal of federal Prohibition on infant mortality?; and (2) were there any significant externalities from the individual policy choices of counties and states on their neighbours? In relation to the first question, they found that the effects were quite small: from 1934 until 1939, there was an excess of 13,665 infant deaths (or 1.2 additional deaths per 1,000 live births) that could be attributed to the repeal of the Prohibition in 1933. Indeed, Fishback found that the effects of the New Deal or climatic variations had greater impact on infant mortality (Fishback 2007; 2011). As for the second question, their results indicated that cross-border policy externalities were likely to be important, and that the impact of the prohibition status of individual county on infant mortality was driven by the prohibition status of its neighbours, with higher results on infant mortality for dry counties bordering with wet neighbours.
A very interesting feature of the paper is the methodological approach used in order to recognise the possibility of policy externalities across county borders. Due to spillovers and the open economy, it was not only the county’s choice (the county’s status with regards to prohibition), but, indeed, the prohibition status of its neighbours. Hence, they distinguished among counties that allow the sale of alcohol within their borders (‘wet’ counties), ‘dry’ countries with also ‘dry’ neighbours, and ‘dry’ counties next to a wet neighbours (‘dryish’ counties). In addition to several robustness tests, I particularly like the border-pair discontinuity design considering neighbouring county-pairs. This approach follows a modification of the methodology developed by Dube et al. (2010). The idea is that given the social and economic similarities between neighbouring counties, these are likely to be a good suitable control group as they share common, but unobserved county characteristics with the treatment group. In other words, in this identification strategy, the prohibition status of counties within a county-pair is uncorrelated with the differences in residual infant mortality in either county. This strategy, in turn, gets rid of the need for instrumental variables to limit biases imparted by unobserved or unmeasured confounders correlated with Prohibition.
While this is a really interesting paper, given the small effects, it is possible that the hypothesised causal mechanism between Prohibition, maternal alcohol consumption during pregnancy (from which no data exist) and infant mortality does not fully capture the effects of the Prohibition on health. If that is the case, the selection of infant mortality data is likely to be underestimating the causal effect of Prohibition on health. For example, in The Body Economic, Stuckler and Basu (2013) argued that during the Great Depression the states with the most stringent Prohibition campaigns lowered adult drinking related deaths by around 20% and also diminished suicides rates substantially. Yet, the fact that Jacks et al. (2017) have been able to find effects of the Prohibition on infant mortality highlights the relevance of the Prohibition on health and warrants further research, a research nested into the wider literature of the Great Depression and the New Deal.
Dube, A., T.W. Lester, and M. Reich (2010), “Minimum Wage Effects Across State Borders.” Review of Economics and Statistics 92(4), 945-964.
Fishback, P.V., M.R. Haines, and S. Kantor (2007), “Births, Deaths, and New Deal Relief during the Great Depression.” Review of Economics and Statistics 89(1), 1-14.
Fishback, P.V., W. Troesken, T. Kollmann, M. Haines, P. Rhode, and M. Thomasson (2011), “Information and the Impact of Climate and Weather on Mortality Rates During the Great Depression.” In The Economics of Climate Change (Eds G. Libecap and R. Steckel). Chicago: University of Chicago Press, 131-168
Jacks, D.S., K. Pendakur, and H. Shigeoka (2017), “Infant Mortality and the Repeal of Federal Prohibition.” NBER Working Paper No. 23372
Stuckler, D. and S. Basu (2015) The Body Economic: Why Austerity Kills. Basic Books.