State Borders and Public Health

• In Event: Navigating Public Health Challenges

Abstract

The question of optimal state size is known to plague defense and commerce, but it also has significant consequences for public health. A state that is too large may misrepresent substantial minorities either by failing to do enough to protect their populations or by being too interventionistic; and a state that is too small may be unable to control disease outbreaks because of a lack of jurisdiction and insufficient coordination capacity. In this paper, I address the latter concern by examining whether the existence of state borders in the United States prolongs outbreaks of foodborne illness.

I use a quasi-natural experimental design in which I vary the cohesion of a metro area’s public health infrastructure by leveraging the secularly determined extent to which state borders fracture the metro’s population; then, while controlling for climate and other factors, I examine whether and how this change affects a metro’s average outbreak duration. I find that outbreaks of chemical foodborne illness—the shortest kind—are prolonged by the presence of state borders. This suggests that, for a given policy area, optimal state size increases as speed becomes more critical for effecting a competent policy response.

Finally, I evaluate the influence of several alternative factors, including population and elite partisan affiliation, partisan discord among elites, and whether a metro area has a port. None of these has an independent effect or shows the main effect to be spurious.

Author

• John M. Chambers, Princeton University