Working Paper
Marcella Alsan, Luca Bragheri, Sarah Eichmeyer, Joyce Kim, Stefanie Stantcheva, and David Yang. Working Paper. “Civil Liberties in Times of Crises”. Publisher's VersionAbstract

Major crises --- from terrorist attacks to outbreaks of disease --- bring the trade-off between individual civil liberties and national security or well-being into sharp relief. In this paper, we study to what extent individual preferences for protecting rights and civil liberties are elastic to health insecurity. We design and conduct representative surveys involving approximately 550,000 responses across 15 countries, including China and the United States, during many months of the COVID-19 pandemic, from March 2020 until January 2021. We document significant heterogeneity across countries and demographic groups in willingness to sacrifice rights for public welfare. Citizens disadvantaged by income, education, or race are less willing to sacrifice rights than their more advantaged peers in every country, as are those with prior experience in communist regimes. Leveraging naturally-occurring variation as well as experimental approaches, we estimate that a one standard deviation increase in health security concerns increases willingness to sacrifice civil liberties by approximately 72\%-92\% of the difference between the average Chinese and U.S. citizen. Stated preferences correlate with observed behavior including demand for tracing apps, donations, and petitions.


Marcella Alsan and Sarah Eichmeyer. Working Paper. “Experimental Evidence on the Effectiveness of Non-Experts for Improving Vaccine Demand.” NBER Working Paper 28593.Abstract
We experimentally vary signals and senders to identify which combination will increase vaccine demand among a disadvantaged population in the United States -- Black and White men without a college education. Our main finding is that laypeople (non-expert concordant senders) are most effective at promoting vaccination, particularly among those least willing to become vaccinated. This finding points to a trade-off between the higher qualifications of experts on the one hand, but lower social proximity to low socio-economic status populations on the other hand, which may undermine credibility in settings of low trust.
Marcella Alsan and Crystal Yang. Working Paper. “Fear and the Safety Net: Evidence from Secure Communities”. Publisher's VersionAbstract
This paper studies how changes in deportation fear induced by the roll-out of Secure Communities (SC), a far-reaching immigration enforcement program, affected the demand for safety net programs in the United States. We estimate the spillover effect of SC on the take-up of federal means-tested programs by Hispanic citizens, who are not themselves eligible for removal. We find significant declines in SNAP and SSI enrollment, particularly among mixed-citizenship status households. The response is muted for Hispanic households residing in sanctuary cities. Our results are most consistent with network effects that perpetuate fear rather than lack of benefit information, measurement error, or stigma.
Abhijit Banerjee, Marcella Alsan, Emily Breza, Arun Chandrasekhar, Abhijit Chowdury, Esther Duflo, Paul Goldsmith-Pinkham, and Ben Olken. Working Paper. “Messages on COVID-19 Prevention in India Increased Symptoms Reporting and Adherence to Preventive Behaviors Among 25 Million Recipients with Similar Effects on Non-recipient Members of Their Communities”. Publisher's VersionAbstract
During health crises, like COVID-19, individuals are inundated with messages promoting health-preserving behavior. Does additional light-touch messaging by a credible individual change behavior? Do the features of the message matter? To answer this, we conducted a large-scale messaging campaign in West Bengal, India. Twenty-five million individuals were sent an SMS containing a 2.5-minute clip, delivered by West Bengal native and 2019 Nobel laureate Abhijit Banerjee. All messages encouraged reporting symptoms to the local public health worker. In addition, each message emphasizes one health-preserving behavior (distancing or hygiene) and one motivation for action (effects on everyone or just on self). Further, some messages addressed concerns about ostracism of the infected. Messages were randomized at the PIN code level. As control, three million individuals received a message pointing them to government information. The campaign (i) doubled the reporting of health symptoms to the community health workers (p = 0.001 for fever, p = 0.024 for respiratory symptoms); (ii) decreased travel beyond one’s village in the last two days by 20% (p = 0.026) (on a basis of 37% in control) and increased estimated hand-washing when returning home by 7% (p = 0.044) (67.5% in control); (iii) spilled over to behaviors not mentioned in the message – mask-wearing was never mentioned but increased 2% (p = 0.042), while distancing and hygiene both increased in the sample where they were not mentioned by similar amounts as where they were mentioned; (iv) spilled over onto nonrecipients within the same community, with effects similar to those for individuals who received the messages.
Marcella Alsan, Katherine Eriksson, and Gregory Niemesh. Working Paper. “Understanding the Success of the Know-Nothing Party”. Publisher's VersionAbstract
We study the contribution of economic conditions to the success of the first avowedly nativist political party in the United States. The Know-Nothing Party gained control of a number of state governments in the 1854-1856 elections running on a staunchly anti-Catholic and anti-Irish platform. Our analysis focuses on the case of Massachusetts, which had experienced a wave of Irish Famine immigration and was at the forefront of industrialization in the United States. Voters in towns with more exposure to Irish labor market crowdout and deskilling in manufacturing were more likely to vote for Know-Nothing candidates in state elections. These two forces played a decisive role in 1855, but not the other years of the Know Nothings’ success. We find evidence of reduced wealth accumulation for native workers most exposed to labor market crowdout and deskilling, though this was tempered by occupational upgrading.
Marcella Alsan and Amy Finkelstein. 2021. “Beyond Causality: Additional Benefits of Randomized Controlled Trials for Improving Health Care Delivery.” Milbank Quarterly. Publisher's VersionAbstract

Policy Points:


  • Policymakers at federal and state agencies, health systems, payers, and providers need rigorous evidence for strategies to improve health care delivery and population health. This is all the more urgent now, during the COVID-19 pandemic and its aftermath, especially among low-income communities and communities of color.
  • Randomized controlled trials (RCTs) are known for their ability to produce credible causal impact estimates, which is why they are used to evaluate the safety and efficacy of drugs and, increasingly, to evaluate health care delivery and policy. But RCTs provide other benefits, allowing policymakers and researchers to: 1) design studies to answer the question they want to answer, 2) test theory and mechanisms to help enrich understanding beyond the results of a single study, 3) examine potentially subtle, indirect effects of a program or policy, and 4) collaborate closely to generate policy-relevant findings.
  • Illustrating each of these points with examples of recent RCTs in health care, we demonstrate how policymakers can utilize RCTs to solve pressing challenges.
Emily Breza, Abhijit Banerjee, Marcella Alsan, Burak Alsan, Sarah Liegl, Arun Chandrasekhar, Paul Goldsmith-Pinkham, Kelly Holland, Emily Hoppe, Carlos Torres, Pierre-Luc Vautrey, Lucy Ogbu-Nwobodo, Susan Wootton, Ben Olken, Erica T. Warner, Tristan Loisel, Sarah Eichmeyer, Traci Glushko, and Esther Duflo. 2021. “Effects of a large-scale social media advertising campaign on holiday travel and COVID-19 infections: a cluster randomized controlled trial.” Nature Medicine, 2021. Publisher's VersionAbstract
During the Coronavirus Disease 2019 (COVID-19) epidemic, many health professionals used social media to promote preventative health behaviors. We conducted a randomized controlled trial of the effect of a Facebook advertising campaign consisting of short videos recorded by doctors and nurses to encourage users to stay at home for the Thanksgiving and Christmas holidays (NCT04644328 and AEARCTR-0006821). We randomly assigned counties to high intensity (n = 410 (386) at Thanksgiving (Christmas)) or low intensity (n = 410 (381)). The intervention was delivered to a large fraction of Facebook subscribers in 75% and 25% of randomly assigned zip codes in high- and low-intensity counties, respectively. In total, 6,998 (6,716) zip codes were included, and 11,954,109 (23,302,290) users were reached at Thanksgiving (Christmas). The first two primary outcomes were holiday travel and fraction leaving home, both measured using mobile phone location data of Facebook users. Average distance traveled in high-intensity counties decreased by −0.993 percentage points (95% confidence interval (CI): –1.616, −0.371; P = 0.002) for the 3 days before each holiday compared to low-intensity counties. The fraction of people who left home on the holiday was not significantly affected (adjusted difference: 0.030; 95% CI: −0.361, 0.420; P = 0.881). The third primary outcome was COVID-19 infections recorded at the zip code level in the 2-week period starting 5 days after the holiday. Infections declined by 3.5% (adjusted 95% CI: −6.2%, −0.7%; P = 0.013) in intervention compared to control zip codes. Social media messages recorded by health professionals before the winter holidays in the United States led to a significant reduction in holiday travel and subsequent COVID-19 infections.
Amitabh Chandra Kosali Simon and Marcella Alsan. 2021. “The Great Unequalizer: Initial Health Effects of COVID-19 in the United States.” Journal of Economic Perspectives, 35, 3, Pp. 25-46. Publisher's Version jep.35.3.25.pdf
Vincenzo Atella, Marcella Alsan, Jay Bhattacharya, Valentina Conti, Iván Mejía-Guevara, and Grant Miller. 2021. “Technological Progress and Health Convergence: The Case of Penicillin in Post-War Italy.” Demography, 58, 4, Pp. 1473-1498. Publisher's VersionAbstract

Throughout history, technological progress has transformed population health, but the distributional effects of these gains are unclear. New substitutes for older, more expensive health technologies can produce convergence in population health outcomes, but may also be prone to “elite capture” leading to divergence. This paper studies the case of penicillin using detailed mortality statistics and exploiting its sharply-timed introduction in Italy after World War II. We find penicillin reduced both the mean and standard deviation of infectious diseases mortality, leading to substantial convergence across disparate regions of Italy. Our results do not appear to be confounded by competing risks or mortality patterns associated with World War II.

Marcella Alsan, Fatima Cody Stanford, Abhijit Banerjee, Emily Breza, Arun Chandreshakar, Sarah Eichmeyer, Paul Goldsmith-Pinkham, Lucy Ogbu-Nwobodo, Benjamin Olken, Carlos Torres, Anirudh Sankar, Pierre-Luc Vautre, and Esther Duflo. 12/21/2020. “Comparison of Knowledge and Information-Seeking Behavior After General COVID-19 Public Health Messages and Messages Tailored for Black and Latinx Communities: A Randomized Trial.” Annals of Internal Medicine . Publisher's Version
Marcella Alsan, Stefanie Stantcheva, David Yang, and David Cutler. 6/18/2020. “Disparities in Coronavirus 2019 Reported Incidence, Knowledge, and Behavior Among US Adults.” JAMA Netw Open., 2020, 3. Publisher's Version
Nagamani Kammili, Manisha Rani, Madhavi latha, Panduranga Rao Pavuluri, Ashley Styczynski, Vishnuvardhan Reddy, and Marcella Alsan. 5/8/2020. “Plasmid-mediated antibiotic resistance among uropathogens in primigravid women—Hyderabad, India.” PLOS One. Publisher's Version
Edna Idan, Anlu Xing, Javarcia Ivory, and Marcella Alsan. 2/2020. “Sociodemographic Correlates of Medical Mistrust among African American Men Living in the East Bay.” Journal of Health Care for the Poor and Underserved, 31, 1, Pp. 115-127. Publisher's Version
Marcella Alsan, Marianne Wanamaker, and Rachel Hardeman. 1/2020. “The Tuskegee Study of Untreated Syphilis: A Case Study in Peripheral Trauma with Implications for Health Professionals.” Journal of General Internal Medicine, 35, 1, Pp. 322-325. Publisher's Version
Marcella Alsan, Owen Garrick, and Grant Graziani. 12/2019. “Does Diversity Matter for Health? Experimental Evidence from Oakland .” The American Economic Review , 109:12, 12, Pp. 4071-411. Publisher's Version
Marcella Alsan, Anjali Adukia, Kim Babiarz, Lea Prince, and Jeremy Goldhaber-Fiebert. 2019. “Religion and Sanitation Practices.” World Bank Economic Review .
Jason Andrews, Stephen Baker, Florian Marks, Marcella Alsan, and Denise Garrett et al. 2019. “Typhoid conjugate vaccines: a new tool in the fight against antimicrobial resistance.” Lancet Infectious Diseases, 19, 1, Pp. E26-E30. Publisher's Version
Marcella Alsan and Claudia Goldin. 2019. “Watersheds in Child Mortality: The Role of Effective Water and Sewerage Infrastructure.” Journal of Political Economy , 127, 2, Pp. 586-638. Publisher's Version
Marcella Alsan, Nagamani Kammili, Jyothi Lakshmi, Anlu Xing, Manisha Rani, Afia Khan, Prasanthi Kolli, David Relman, and Doug Owens. 8/2018. “ Poverty and Community-Acquired Antimicrobial Resistance with Extended-Spectrum β-Lactamase-Producing Organisms, Hyderabad, India.” Emerging Infectious Diseases , 24, 8, Pp. 1490-1496. Publisher's Version
Marcella Alsan and Marianne Wanamaker. 2018. “Tuskegee and the Health of Black Men.” The Quarterly Journal of Economics , 133, 1, Pp. 407-455. Publisher's Version