Access to Healthcare, Human Capital and Economic Growth in France

This project investigates how access to healthcare has shaped demographic change, human capital formation, and long-term economic development in France. Focusing on the period from the mid-19th to early 20th century—a key phase of industrialisation and demographic transition—it provides new historical evidence on the long-run consequences of unequal access to medical services.

Research Objectives

The project addresses three central questions:

• Demographic impact: Did improved access to healthcare reduce infant mortality and influence fertility patterns during the demographic transition? 

• Individual outcomes: How did early-life exposure to healthcare affect education, occupation, migration, and lifespan? 

• Economic development: Did better healthcare access contribute to local economic growth through human capital accumulation? 

 

​​By linking these dimensions, the project aims to deliver a unified understanding of how healthcare access influences both individual life trajectories and broader economic development.

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Data Innovation

A major contribution of the project is the creation of a new, large-scale dataset measuring healthcare access across all French municipalities (1849–1913). This dataset is built from historical medical directories listing doctors, pharmacists, and other practitioners.

• Covers ~36,000 municipalities over 66 years 

• Generates ~2.4 million observations 

• Uses AI-based text extraction (OCR) to digitise historical records 

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This dataset is combined with:

• Genealogical data (births, deaths, fertility, migration) 

• Census data (occupation and socio-economic status) 

• Municipal financial data (local economic conditions) 

Together, these sources allow for detailed analysis linking individuals to their local healthcare environment over time.

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Methodology

The project applies modern econometric techniques to historical data, including:

• Panel data analysis across municipalities and time 

• Difference-in-differences and event-study approaches 

• Instrumental variable strategies to identify causal effects 

• Individual-level exposure models focusing on early-life conditions 

This approach enables robust estimation of the causal impact of healthcare access on demographic and economic outcomes.

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Key Contributions

The project makes an important contribution to the literature on health and economic growth by providing new evidence on the role of local healthcare access in shaping long-term development. Rather than focusing solely on national improvements in health conditions, it highlights how disparities in the local availability of medical services could generate persistent differences in economic trajectories.

It also contributes to the study of the demographic transition by examining the role of medical practitioners in reducing mortality and influencing fertility behaviour. In doing so, it offers new insights into how improvements in healthcare may have interacted with broader changes in family structure and population dynamics.

A further contribution lies in the field of human capital and inequality. The project investigates how early-life health conditions affected later educational attainment, labour market outcomes, and regional disparities, thereby shedding light on the long-run consequences of unequal childhood environments.

 

It also delivers a new reusable data infrastructure for future research.

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Outputs and Impact

The research will produce three main academic studies:

• A dataset and descriptive analysis of healthcare diffusion 

• A causal analysis of healthcare access on mortality and fertility 

• An evaluation of long-term effects on human capital and local development 

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Beyond academia, the project directly informs current policy debates on “medical deserts” and unequal healthcare access. Its findings will support policymakers in designing effective regional health strategies by quantifying the long-term economic and social returns of healthcare provision.

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Results will be shared through academic publications, policy briefs, public articles, and open-access datasets to maximise impact.