ABSTRACT
Local institutions have long been regarded as key drivers of economic development. However, little is known about the role of institutions in preparing places to cope with public health crises and pandemics. This paper sheds light on how the nature of a local institution, city autonomy, influenced variations in the incidence of the Black Death —possibly the worst pandemic ever recorded— across cities in Western Europe between 1347 and 1352. We examine urban autonomy not only because it represented a major political shift in medieval times, but because, more importantly, it also represents a key prototype of modern political institution. By exploiting data on the spatial variation of Black Death's mortality rates and duration using OLS and 2SLS methods, we uncover that city autonomy reduced mortality rates by, on average, almost 10 percent. Autonomous cities were in a better position to adopt swift and efficient measures against the pandemic than those governed by remote kings and emperors. This relationship has been confirmed by a series of placebo tests and robustness checks. In contrast, there is no evidence to suggest that city autonomy was a factor in reducing the duration of the pandemic in European cities.