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The Role of Public Health Improvements in Health Advances: The 20th Century United States

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  • David M. Cutler
  • Grant Miller

Abstract

Mortality rates in the US fell more rapidly during the late 19th and early 20th Centuries than any other period in American history. This decline coincided with an epidemiological transition and the disappearance of a mortality "penalty" associated with living in urban areas. There is little empirical evidence and much unresolved debate about what caused these improvements, however. This paper investigates the causal influence of clean water technologies - filtration and chlorination - on mortality in major cities during the early 20th Century. Plausibly exogenous variation in the timing and location of technology adoption is used to idetify these effects, and the validity of this identifying assumption is examined in detail. We find that clean water was responsible for nearly half of the total mortality reduction in major cities, three-quarters of the infant mortality reduction, and nearly two-thirds of the child mortality reduction. Rough calculations suggest that the social rate of return to these technologies was greater than 23 to 1 with a cost per life-year saved by clean water of about $500 in 2003 dollars. Implications for developing countries are briefly considered.

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Bibliographic Info

Paper provided by National Bureau of Economic Research, Inc in its series NBER Working Papers with number 10511.

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Date of creation: May 2004
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Publication status: published as Cutler, David M. and Grant Miller. "The Role of Public Health Improvements in Health Advances: The 20th Century United States." Demography 42, 1(February 2005): 1-22.
Handle: RePEc:nbr:nberwo:10511

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  1. Robert W. Fogel, 1994. "Economic Growth, Population Theory, and Physiology: The Bearing of Long-Term Processes on the Making of Economic Policy," NBER Working Papers 4638, National Bureau of Economic Research, Inc.
  2. Angus Deaton & Christina Paxson, 1999. "Mortality, education, income and inequality among American cohorts," Working Papers 279, Princeton University, Woodrow Wilson School of Public and International Affairs, Center for Health and Wellbeing..
  3. William H. Dow & Jessica Holmes & Tomas Philipson & Xavier Sala-i-Martin, 1995. "Disease Complementarities and the Evaluation of Public Health Interventions," NBER Working Papers 5216, National Bureau of Economic Research, Inc.
  4. Adriana Lleras-Muney, 2002. "The Relationship Between Education and Adult Mortality in the United States," NBER Working Papers 8986, National Bureau of Economic Research, Inc.
  5. Aldy, Joseph E. & Viscusi, W. Kip, 2003. "The Value of Statistical Life: A Critical Review of Market Estimates throughout the World," Working paper 282, Regulation2point0.
  6. Samuel H. Preston & Michael R. Haines, 1991. "Fatal Years: Child Mortality in Late Nineteenth-Century America," NBER Books, National Bureau of Economic Research, Inc, number pres91-1.
  7. repec:reg:rpubli:282 is not listed on IDEAS
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Cited by:
  1. David Cutler & Grant Miller, 2005. "Water, Water, Everywhere: Municipal Finance and Water Supply in American Cities," NBER Working Papers 11096, National Bureau of Economic Research, Inc.
  2. Sonia Bhalotra, 2007. "Spending to Save? State Health Expenditure and Infant Mortality in India," The Centre for Market and Public Organisation 07/169, Department of Economics, University of Bristol, UK.
  3. Joseph P. Ferrie & Werner Troesken, 2005. "Death and the City: Chicago's Mortality Transition, 1850-1925," NBER Working Papers 11427, National Bureau of Economic Research, Inc.
  4. Karen Clay & Werner Troesken, 2006. "Deprivation and Disease in Early Twentieth-Century America," NBER Working Papers 12111, National Bureau of Economic Research, Inc.
  5. David Cutler & Angus Deaton & Adriana Lleras-Muney, 2005. "The Determinants of Mortality," Working Papers 164, Princeton University, Woodrow Wilson School of Public and International Affairs, Research Program in Development Studies..
  6. Okunade, Albert A., 2004. "Concepts, measures, and models of technology and technical progress in medical care and health economics," The Quarterly Review of Economics and Finance, Elsevier, vol. 44(3), pages 363-368, July.
  7. Alan Martina, 2007. "A Class of Poverty Traps: A Theory and Empirical Tests," ANU Working Papers in Economics and Econometrics 2007-482, Australian National University, College of Business and Economics, School of Economics.
  8. Nejat Anbarci & Monica Escaleras & Charles Register, 2005. "From Cholera Outbreaks to Pandemics: The Role of Poverty and Inequality," Working Papers 05003, Department of Economics, College of Business, Florida Atlantic University, revised Feb 2006.
  9. Michael Kremer & Alix Peterson Zwane, 2007. "Cost-Effective Prevention of Diarrheal Diseases: A Critical Review," Working Papers 117, Center for Global Development.
  10. Steve E. Hrudey, 2011. "Safe Drinking Water Policy for Canada - Turning Hindsight into Foresight," C.D. Howe Institute Commentary, C.D. Howe Institute, issue 323, February.
  11. Yusuf, Shahid & Nabeshima, Kaoru & Wei Ha, 2007. "What makes cities healthy ?," Policy Research Working Paper Series 4107, The World Bank.

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