Public Health Programmes, Healthcare and Child Health

Abstract: This thesis consists of three self-contained chapters.Modern Medicine, Public Policy and Infant Health: Evidence from a Preventive Health Programme in Sweden. This paper explores a universal preventive health programme targeting infants that coincided in time with the introduction and availability of an early antibiotic, sulfa. As sulfa only affects infant mortality by reducing pneumonia, the effect of medicine distribution through the program can largely be separated from preventive health inputs. I find that access to the program reduced infant mortality by 7 per cent, which can entirely be attributed to reduced mortality in pneumonia among infants. I find no effect on other infectious diseases. This means that the program was mainly effective through the spread and use of sulfa, facilitated by regular physician contacts and a decentralised health organisation. These findings suggest that universal infant monitoring can be an effective way of providing healthcare to groups with low access to healthcare. However, these gains did not translate to any detectable long-term benefits in health or labour market outcomes.Urban Water Improvement and Health: Evidence from the Early Stages of Industrialisation. Water and sewerage technologies can explain much of the decline in urban mortality during the early 20th century. However, the importance of information on how to use these technologies effectively for positive health effects is still unclear. This paper analyses how water technologies affected health when information on the communicability of infectious diseases was not available. The city of Stockholm introduced a water cleaning system and piped distribution network in 1861, enabling parts of the population in-house access. The historical context allows me to analyse these technologies without sewerage access as no major sewerage system was constructed at the same time. Water cleaning and piped distribution had a large positive impact on health, even without sewerages. However, the effect on infant mortality is smaller and less precise. Infants and small children could therefore be more sensitive than adults to inefficient use of the water technologies due to information constraints.Hospital Crowding and Quality: Evidence from Swedish Delivery Care Units. How hospitals can improve quality has been empirically difficult to establish. I explore resources in delivery care in Sweden as a possible margin for improvement by assessing the relationship between delivery-care crowding and health. Comparing crowded days to average patient volume, I find large effects on neonatal mortality. However, the effect on neonatal mortality is only apparent in large cities, where I find evidence that capacity constraints bind more often. In large city hospitals, crowding is associated with around 50 per cent higher risk of an infant dying in her first month of life. This effect is unrelated to if hospitals have neonatal intensive care units or not. Furthermore, I find that emergency caesarean sections are delayed at times of crowding and argue that delayed medical treatments due to capacity constraints is the most plausible explanation for the findings. These results suggest that there is scope for quality improvements in delivery care at times of high demand.

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