IDEAS home Printed from https://ideas.repec.org/a/bla/ehsrev/v79y2026i2p527-554.html

Public health reforms and the mortality decline in nineteenth‐century Italy

Author

Listed:
  • Francesco Maria Salvatore Fiore Melacrinis
  • Mauro Rota

Abstract

This study examines the impact of Italy's 1887–8 health reforms on mortality, contributing to the historical debate on the state's role in Europe's health transition. Leveraging event‐study‐style difference‐in‐differences approach, we assess the effectiveness of the Crispi–Pagliani reforms, which strengthened public health governance and introduced targeted non‐pharmaceutical interventions to mitigate deaths from infectious diseases. Mortality from targeted diseases decreased by 8.5 per cent relative to non‐targeted diseases within 5 years of the reforms. The results highlight the role of sanitary surveillance and coordinated governance, particularly effective in less‐educated regions, where public authorities compensated for limited health knowledge and prompted information flow in a broader process of top‐down modernization.

Suggested Citation

  • Francesco Maria Salvatore Fiore Melacrinis & Mauro Rota, 2026. "Public health reforms and the mortality decline in nineteenth‐century Italy," Economic History Review, Economic History Society, vol. 79(2), pages 527-554, May.
    • Handle: RePEc:bla:ehsrev:v:79:y:2026:i:2:p:527-554
    DOI: 10.1111/ehr.70021
    as

    Download full text from publisher

    File URL: https://doi.org/10.1111/ehr.70021
    Download Restriction: no
    File URL: https://libkey.io/10.1111/ehr.70021?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. D. Mark Anderson & Kerwin Kofi Charles & Daniel I. Rees, 2022. "Reexamining the Contribution of Public Health Efforts to the Decline in Urban Mortality," American Economic Journal: Applied Economics, American Economic Association, vol. 14(2), pages 126-157, April.
    2. Kesztenbaum, Lionel & Rosenthal, Jean-Laurent, 2017. "Sewers’ diffusion and the decline of mortality: The case of Paris, 1880–1914," Journal of Urban Economics, Elsevier, vol. 98(C), pages 174-186.
    3. Jonathan Chapman, 2019. "The contribution of infrastructure investment to Britain's urban mortality decline, 1861–1900," Economic History Review, Economic History Society, vol. 72(1), pages 233-259, February.
    4. Dora L. Costa, 2015. "Health and the Economy in the United States from 1750 to the Present," Journal of Economic Literature, American Economic Association, vol. 53(3), pages 503-570, September.
    5. D. Mark Anderson & Kerwin Kofi Charles & Daniel I. Rees, 2022. "Reexamining the Contribution of Public Health Efforts to the Decline in Urban Mortality: Reply," American Economic Journal: Applied Economics, American Economic Association, vol. 14(2), pages 166-169, April.
    6. Stefan Bauernschuster & Anastasia Driva & Erik Hornung, 2020. "Bismarck’s Health Insurance and the Mortality Decline [Disease and Development: The Effect of Life Expectancy on Economic Growth]," Journal of the European Economic Association, European Economic Association, vol. 18(5), pages 2561-2607.
    7. Jiafeng Chen & Jonathan Roth, 2024. "Logs with Zeros? Some Problems and Solutions," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 139(2), pages 891-936.
    8. Chapman, Jonathan, 2022. "Interest Rates, Sanitation Infrastructure, and Mortality Decline in Nineteenth-Century England and Wales," The Journal of Economic History, Cambridge University Press, vol. 82(1), pages 175-210, March.
    9. Marcella Alsan & Claudia Goldin, 2019. "Watersheds in Child Mortality: The Role of Effective Water and Sewerage Infrastructure, 1880–1920," Journal of Political Economy, University of Chicago Press, vol. 127(2), pages 586-638.
    10. Chesnais, Jean-Claude, 1992. "The Demographic Transition: Stages, Patterns, and Economic Implications," OUP Catalogue, Oxford University Press, number 9780198286592.
    11. David Cutler & Grant Miller, 2005. "The role of public health improvements in health advances: The twentieth-century United States," Demography, Springer;Population Association of America (PAA), vol. 42(1), pages 1-22, February.
    12. Bengtsson, Tommy & van Poppel, Frans, 2011. "Socioeconomic inequalities in death from past to present: An introduction," Explorations in Economic History, Elsevier, vol. 48(3), pages 343-356, July.
    13. Emanuele Felice & Michelangelo Vasta, 2015. "Passive modernization? The new human development index and its components in Italy's regions (1871–2007)," European Review of Economic History, European Historical Economics Society, vol. 19(1), pages 44-66.
    14. Federico, Giovanni, 2003. "Heights, calories and welfare: a new perspective on Italian industrialization, 1854-1913," Economics & Human Biology, Elsevier, vol. 1(3), pages 289-308, December.
    15. Federico, Giovanni & Nuvolari, Alessandro & Vasta, Michelangelo, 2019. "The Origins of the Italian Regional Divide: Evidence from Real Wages, 1861–1913," The Journal of Economic History, Cambridge University Press, vol. 79(1), pages 63-98, March.
    16. Simon Szreter & Graham Mooney, 1998. "Urbanization, Mortality, and the Standard of Living Debate: New Estimates of the Expectation of Life at Birth in Nineteenth-century British Cities," Economic History Review, Economic History Society, vol. 51(1), pages 84-112, February.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Gallardo Albarrán, Daniel, 2024. "The Global Sanitary Revolution in Historical Perspective," CEPR Discussion Papers 18754, Centre for Economic Policy Research.
    2. Toke S. Aidt & Romola J. Davenport & Felix Gray, 2023. "New perspectives on the contribution of sanitary investments to mortality decline in English cities, 1845–1909," Economic History Review, Economic History Society, vol. 76(2), pages 624-660, May.
    3. Daniel Gallardo‐Albarrán, 2020. "Sanitary infrastructures and the decline of mortality in Germany, 1877–1913," Economic History Review, Economic History Society, vol. 73(3), pages 730-757, August.
    4. Claire Lepault, 2023. "Is urban wastewater treatment effective in India? Evidence from water quality and infant mortality," CIRED Working Papers hal-04232407, HAL.
    5. Luque de Haro, Víctor Antonio, 2024. "Social inequalities in adult mortality across Europe (18th-21st centuries): A critical analysis of theories and evidence," Economics & Human Biology, Elsevier, vol. 55(C).
    6. Michail Raftakis, 2023. "Urban mortality in Greece: Hermoupolis (1859–1940)," Economic History Review, Economic History Society, vol. 76(3), pages 728-758, August.
    7. Benjamin Bridgman, 2025. "A Century of Super–Rich Longevity," BEA Papers 0135, Bureau of Economic Analysis.
    8. Knutsson, Daniel, 2025. "The effect of water filtration on cholera mortality," Journal of Urban Economics, Elsevier, vol. 147(C).
    9. Jerch, Rhiannon L. & Phaneuf, Daniel J., 2024. "Cities and water quality," Regional Science and Urban Economics, Elsevier, vol. 107(C).
    10. Jesse McDevitt-Irwin & James R. Irwin, 2025. "Infant mortality among US whites in the 19th century: New evidence from childhood sex ratios," Demographic Research, Max Planck Institute for Demographic Research, Rostock, Germany, vol. 52(10), pages 303-350.
    11. Troesken, Werner & Tynan, Nicola & Yang, Yuanxiaoyue Artemis, 2021. "What are the health benefits of a constant water supply? Evidence from London, 1860–1910," Explorations in Economic History, Elsevier, vol. 81(C).
    12. Antman, Francisca M. & Flynn, James M., 2024. "When beer is safer than water: Beer availability and mortality from waterborne illnesses," Journal of Development Economics, Elsevier, vol. 171(C).
    13. D. Mark Anderson & Kerwin Kofi Charles & Daniel I. Rees, 2018. "Public Health Efforts and the Decline in Urban Mortality," NBER Working Papers 25027, National Bureau of Economic Research, Inc.
    14. Alberto Batinti & Joan Costa‐Font & Timothy J. Hatton, 2022. "Voting Up? The Effects of Democracy and Franchise Extension on Human Stature," Economica, London School of Economics and Political Science, vol. 89(353), pages 161-190, January.
    15. Anderson, D. Mark & Charles, Kerwin Kofi & Rees, Daniel I., 2018. "Public Health Efforts and the Decline in Urban Mortality," IZA Discussion Papers 11773, IZA Network @ LISER.
    16. Krieger, Tommy, 2020. "Elite structure and the provision of health-promoting public goods," ZEW Discussion Papers 20-064, ZEW - Leibniz Centre for European Economic Research.
    17. Michael Haylock & Martin Karlsson & Maksym Obrizan, 2024. "Pollution and Mortality: Evidence from early 20th Century Sweden," Papers 2412.01532, arXiv.org, revised Dec 2024.
    18. Jonathan Chapman, 2019. "The contribution of infrastructure investment to Britain's urban mortality decline, 1861–1900," Economic History Review, Economic History Society, vol. 72(1), pages 233-259, February.
    19. Beach, Brian, 2022. "Water infrastructure and health in U.S. cities," Regional Science and Urban Economics, Elsevier, vol. 94(C).
    20. Alex Hollingsworth & Krzysztof Karbownik & Melissa A. Thomasson & Anthony Wray, 2024. "The Gift of a Lifetime: The Hospital, Modern Medicine, and Mortality," American Economic Review, American Economic Association, vol. 114(7), pages 2201-2238, July.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:bla:ehsrev:v:79:y:2026:i:2:p:527-554. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Wiley Content Delivery (email available below). General contact details of provider: https://edirc.repec.org/data/ehsukea.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.