Essays in Economic History and Public Health

Malik Hussain

Advisor: Noel D Johnson, PhD, Department of Economics

Committee Members: Alex Tabarrok, Mark Koyama, Vincent Geloso

Online Location, https://gmu.zoom.us/j/99302148562?pwd=aclbEekZihojGG7sS8dDoiY5Wqxoma.1 --- Meeting ID: 993 0214 8562, Passcode: 376720.
July 18, 2025, 12:00 PM to 01:00 PM

Abstract:

This dissertation examines how the effectiveness of public health interventions depends on the interaction between formal institutions, cultural and religious beliefs, and physical infrastructure. I analyze smallpox vaccination campaigns introduced by the British in colonial India (1868–1919), where the same medical intervention produced varying outcomes across regions. Differences in outcomes across regions can be traced to local conditions, such as religious composition, the degree of trust between communities and state authorities, and the development of transportation networks. Through three essays, I trace how these factors shaped both vaccination uptake and broader public health outcomes in colonial India.

Essay I investigates how religious and cultural beliefs affect public health adoption. Using newly digitized district-level vaccination records (1868–1878), I find that areas with higher Hindu population shares had lower vaccination rates. A one standard deviation increase in Hindu population share reduced Hindu vaccination uptake by 0.89 to 1.98 percentage points at the district level, with persistent effects on demographic outcomes decades later. To address endogeneity, I instrument for Hindu population share using pre-colonial temple desecration events, which shifted the spatial distribution of religious communities. These results suggest that when public health interventions conflict with existing religious and cultural practices, community beliefs significantly influence adoption rates even in the presence of state implementation efforts.

Essay II (with Noel Johnson) examines how historical violence shapes institutional trust. We exploit spatial variation in exposure to British retribution following the 1857 rebellion in India to analyze how collective trauma affects vaccination adoption. Using least-cost travel distance to Lucknow, one of the epicenters of the revolt and subsequent reprisals, we measure districts' differential exposure to state violence. Districts with greater accessibility to Lucknow, both geographic and linguistic, had lower infant vaccination rates over subsequent decades, with the relationship strongest in the 1880s and 1890s. To address the mechanical decline in adult vaccination rates as cumulative coverage increases, we focus on infant vaccination. The persistence of these effects corresponds with the demographic survival of cohorts who experienced the 1857 violence, gradually weakening as this generation aged out of decision-making roles or died due to aging. The results suggest that collective trauma operates through intergenerational transmission, creating barriers between communities and state institutions that persist long after the initial violence.

Essay III examines how transportation infrastructure affects public health in developing economies. This chapter examines the impact of railway expansion on communicable disease mortality in colonial India's Bombay Presidency (1885–1919). Using town-level mortality data for cholera, smallpox, and plague, combined with a spatially weighted railway density measure for each town, I estimate panel data fixed effects regressions. I find an inverted U-shaped relationship: mortality peaked at moderate railway density (log density ≈ 2.95), suggesting that initial railway expansion increased disease transmission through enhanced mobility and connectivity, but mortality declined at higher densities, consistent with improved access to medical care and food supplies. Robustness checks, including spatial clustering and placebo tests for non-communicable mortality, confirm this non-linearity. These findings contribute to the infrastructure and development literature by showing that transportation networks exhibit non-monotonic health effects, challenging the linear relationships assumed in previous studies and reconciling conflicting evidence on whether colonial railways were beneficial or harmful to population health.