Public Health Efforts and the Decline in Urban Mortality

Abstract

Using data on 25 major American cities for the period 1900-1940, we explore the effects of municipal-level public health efforts that were viewed as critical in the fight against food-and water-borne diseases. In addition to studying interventions such as treating sewage and setting strict bacteriological standards for milk, which have received little attention in the literature, we provide new evidence on the effects of water filtration and chlorination, extending the work of previous scholars. Contrary to the consensus view, we find that none of the interventions under study contributed substantially to the observed declines in total and infant mortality.

Regional and Racial Inequality in Infectious Disease Mortality in U.S. Cities, 1900–1948

“…Some scholars have attributed the initial drop in mortality to improved nutrition (Fogel 2004;McKeown and Record 1962), but others have emphasized the introduction of public health initiatives instead (e.g., Szreter 1988). Improvement in public health has been the leading explanation for the decline in mortality after 1870 (Cutler et al 2006;Haines 2001; but see Anderson et al 2018). Cutler et al (2006) divided public health interventions into two categories: (1) large public works projects, such as water filtration and chlorination (Cutler and Miller 2005), sanitation infrastructure (Alsan and Goldin 2019;Melosi 1999), milk pasteurization (Lee 2007), and mass vaccinations; and (2) changes in behavior promoted by the public sector, such as "boiling bottles and milk, protecting food from insects, washing hands, ventilating rooms and keeping children's vaccinations up to date" (Cutler et al 2006:102).…”

Comment on 'Pubic Health Efforts and the Decline in Urban Mortality'

“…Column 1 shows the original specification as estimated in Cutler and Miller (2005), with standard errors clustered at the city level. Column 2 adopts newly proposed water santiation intervention dates as given in Anderson, Charles, and Rees (2018). Column 3 revises CM intervention dates, changing the year of water filtration in Philadelphia to 1909.…”

“…Column 1 shows the estimates using corrected infant mortality rates intervention dates as original specification in Cutler and Miller (2005), revising Philadelphia's filtration date to 1909. Column 2 shows estimates using corrected infant mortality rates and and and newly proposed water santiation intervention dates as given in Anderson, Charles, and Rees (2018) (revising the date of filtration in Philadelphia to 1909). Column 3 shows the 95% confidence set for preferred results (using corrected infant mortality rates, and CM (2005) intervention dates revised for Philadelphia) using the wild bootstrap method with 1000 replacations.…”

Chain effects of clean water: The Mills–Reincke phenomenon in early 20th-century Japan

“…Second, we complement the discussion on the role of water purification technology in mitigating the historical mortality declines. The recent study by Anderson et al (2018) found more moderate impacts of water purification technology on crude and infant mortality rates than those shown by . 4 By expanding strategy to capture the mechanisms responsible for the appearance of the phenomenon, we find that the overall impacts of clean water were still considered to be substantial in pre-war Japan.…”