We explore how access to modern hospitals and medicine affects mortality by leveraging efforts of the Duke Endowment to modernize hospitals in the early twentieth century. The Endowment helped communities build and expand hospitals, obtain state-of-the-art medical technology, attract qualified medical personnel, and refine management practices. We find that Duke support increased the size and quality of the medical sector, fostering growth in not-for-profit hospitals and high-quality physicians. Duke funding reduced both infant mortality—with larger effects for Black infants than White infants—and long-run mortality. Finally, we find that communities aided by Duke benefited more from medical innovations.

In the United States, elections are often administered by directly elected local officials who run as members of a political party. Do these officials use their office to give their party an edge in elections? Using a newly collected dataset of nearly 5,900 clerk elections and a close-election regression discontinuity design, we compare counties that narrowly elect a Democratic election administrator to those that narrowly elect a Republican. We find that Democrats and Republicans serving similar counties oversee similar election results, turnout, and policies. We also find that reelection is not the primary moderating force on clerks. Instead, clerks may be more likely to agree on election policies across parties than the general public and selecting different election policies may only modestly affect outcomes. While we cannot rule out small effects that nevertheless tip close elections, our results imply that clerks are not typically and noticeably advantaging their preferred party.