Preventing the White Death: Tuberculosis Dispensaries

Abstract

Abstract Tuberculosis (TB) is a leading cause of death worldwide and while treatable by antibiotics since the 1940s, drug resistant strains have emerged. This article estimates the effects of the establishment of a pre-antibiotic public health institution, known as a TB dispensary, designed to prevent the spread of the disease. Our annual difference-in-differences estimation reveals that the rollout of the dispensaries across Danish cities led to a 19% decline in the TB mortality rate, but no significant impacts on other diseases when performing placebo regressions. We next take advantage of the dispensaries explicit targeting on TB to setup a triple-differences model which exploits other diseases as controls and obtain a similar magnitude of the effect. As for the mechanism, the evidence highlights the dispensaries’ preventive actions, such as information provision. At an estimated cost as low as 68 dollars per saved life-year, this particular public-health institution was extraordinarily cost effective. Overall, our evidence suggests a policy for developing countries to combat drug resistant TB.