Disparity in the Golden Age of Medicine: The Hill-Burton Act and Fetal/Infant Health in the US South

Matthew Purcell, London School of Economics

The Hill-Burton Act of 1946 stands as a cornerstone in US health policy, reshaping the healthcare landscape by directing federal funds towards hospital infrastructure development. However, overlooked within its historical narrative is its entanglement with racial segregation, particularly evident in the US South. This study investigates the Act's ramifications on fetal and infant health, discerning disparities across racial lines. Utilizing county-level data from 1940 to 1960 across six Southern states, the analysis focuses on 362 hospitals constructed with Hill-Burton funding. Regression analyses reveal a nuanced picture: while overall infant mortality rates declined in counties with Hill-Burton hospitals, the effect was markedly disparate between racial groups. White populations experienced substantial reductions in infant mortality and stillbirth rates, whereas the impact on non-white populations was significantly diminished. Furthermore, results underscore the Act's role in exacerbating racial health inequities, as its implementation within a segregated healthcare system perpetuated unequal resource distribution. Moving forward, the study aims to employ instrumental variable strategies to establish causal relationships and delve into the underlying mechanisms driving differential outcomes.

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 Presented in Session 196. Disparities in health care