Reexamining the Contribution of Public Health Efforts to 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 foodborne and waterborne diseases. In addition to studying interventions such as treating sewage and setting bacteriological standards for milk, which have received little attention, we provide new evidence on the effects of water filtration and chlorination, extending the work of previous scholars. Although water filtration is associated with an 11–12 percent reduction in infant mortality, none of the other interventions under study appear to have contributed to the observed mortality declines. (JEL H75, I12, I18, J13, Q18, Q51, Q53)

Temperature, Disease, and Death in London: Analyzing Weekly Data for the Century from 1866-1965

“…16 One aspect of nutrition that has received particular attention, both by contemporary observers (e.g., Peters 1910) and in later research (e.g., Beaver 1973), is the availability of uncontaminated milk supplies. The importance of milk has found support in a recent study of the U.S. (Komisarow 2017) but not in others (Anderson, et al 2020a), and the contribution of improvements in milk quality to the decline in British mortality in the decades around 1900 remains disputed (Atkins 1992). A closely connected factor is the level of maternal care, which was thought by some contemporaries to have a large influence on infant mortality during our study period (Newsholme 1899;Newman 1906), particularly among the many poorer mothers that returned to work soon after giving birth.…”

“…The results indicate that the decline in infant mortality in London would have started about five years earlier than indicated by the raw data had it not been for a series of unusually hot years. The fact that temperature events can shift the timing of London's mortality transition by several years has implications for studies, such as Anderson et al (2020a), that rely on the timing of such transitions to identify the mechanisms behind mortality declines.…”

“…Another benefit of being able to generate results using counterfactual temperature patterns is that we can examine the impact of temperature on the timing of the mortality transition. A number of papers, such as Cutler and Miller (2005) and Anderson et al (2020a) compare the timing of public health interventions to annual mortality data, to see if they correspond to the timing of infant mortality declines. In the context of London, however, it has been argued that the timing of the decline in infant mortality may have been substantially affected by several hot summers that occurred in the 1890s (Woods, et al, 1988;Woods 2000, p. 296).…”

“…14 See alsoSzreter (2005). In fairness, while McKeown is best-known for arguing that improving living standards were critical for the overall decline in mortality,McKeown and Record (1962) recognized the critical role played by sanitary measures in reducing digestive disease mortality.15 A parallel literature on the role of water and sewer infrastructure exists for the U.S. See, e.g.,Troesken (2002),Cutler and Miller (2005),Ferrie and Troesken (2008),Beach, et al (2016),Alsan and Goldin (2019),Anderson, et al (2020a) andAnderson, et al (2020b).16 Another explanation, offered byGuha (1994), is that the population of cities may have become more resistant to the effects of diseases over time, through exposure or selection, though this claim is hard to substantiate. However,McKeown and Record (1962) argue that selection is unlikely to have been a critical factor, though their focus is on TB.…”

1918 Every Year: Racial Inequality in Infectious Mortality, 1906–1942

“…The extent to which these systems reduced mortality is the subject of ongoing debate(Cutler and Miller 2005;Anderson, Charles, and Rees, forthcoming;Beach 2022). 2Anderson et al (2021) find that water purification efforts reduced the Black-White infant mortality gap.…”