Buchanan Hall (formerly Mason Hall), #D135
May 25, 2017, 11:00 AM to 07:00 AM
These essays develop an institutional framework to epidemiology that highlights the conditions under which private actors resolve collective action problems associated with the prevention of infectious diseases. This framework is applied to a number of historical and modern cases from the United States and across the world to show that despite the theoretical problems of externalities and free riding, private coordination is more likely than previously thought. This is the case when people can capture the benefits of prevention and lower the cost of coordination. The main conclusion is that private and alternative disease prevention can be important means of mitigating the burden of infectious diseases, especially when people do not have access to functional governmental health institutions.
Contrary to the standard model of disease prevention, which relies on an omniscient and benevolent health planner, the first essay explains how a broad array of institutions influence potentially preventative behavior. The institutional approach highlights how different rules incentivize behavior to mitigate the burden of infectious diseases. These incentives come from a variety of institutional sources, from formal governmental public health agencies and firms in the private sector to legal rules and informal cultural norms and rituals. Relevant institutions and incentives are described. Their effect on preventative behavior and prevalence rates is demonstrated with varying outbreaks and epidemics: preventing Malaria in the United States and in sub-Saharan Africa; preventing Ebola in Liberia; fleeing from Yellow Fever in Memphis, Tennessee; and preventing Plague in Manchuria. The implication is that resolving the collective action problems of disease prevention can be achieved through a variety of institutions beyond a narrow focus on government.
The second essay explains how a railroad company in Texas and cotton mills in North Carolina successfully prevented malaria in the early twentieth century in the absence of capable government services. Focus is placed on the incentives these firms faced to privately coordinate malaria prevention during this time but not after. These firms, motivated by potential productivity improvements and profit opportunities, implemented extensive anti-malaria programs and used their hierarchical organizational structures to monitor performance. The factors underlying the decline of private prevention include a fall in the overall rate of malaria, the increasing presence of the federal government, and technological innovations that lowered exposure to mosquitos. Understanding how, why, and when firms can prevent diseases has important implications for current disease policy, especially where governments, international organizations, and technologies are not enough.
The final essay explains why large concession firms in Liberia helped to prevent Ebola during the 2014-2015 epidemic. Primarily, these firms held better defined and enforced property rights relative to smaller firms and individual Liberians. With such rights, the owners of larger firms have more of an incentive to care for the health and safety of their workers, as well as their dependents and local communities. To assess the role property rights have, concession agreements are analyzed for the largest Liberian firms in agriculture, mining, and oil and gas. 11 of the concessions actively responded to the epidemic, and most reported zero cases of infection; about half of the largest, relevant concessions in Liberia were responsive. 10 of the largest concessions were unresponsive for reasons unrelated to the epidemic, while information was not available for 9 of the concessions. As an industry, agricultural concessions were more responsive as 7 of the 11 agricultural concessions responded, whereas 3 of the 15 mining concessions responded. Additional factors like the relative scarcity of labor and public health alternatives are also considered. Thus, one of the main implications is that property rights, in the form of concession agreements, are an important factor in explaining why large Liberian firms faced incentives to prevent Ebola.