Heterogeneous treatment effects of safe water on infectious disease: Do meteorological factors matter?

Mortality from waterborne infectious diseases remains a serious issue globally. Investigating the efficient laying plan of waterworks to mitigate the risk factors for such diseases has been an important research avenue for industrializing countries. While a growing body of the literature has revealed the mitigating effects of water-purification facilities on diseases, the heterogeneous treatment effects of clean water have been understudied. The present study thus focuses on the treatment effect heterogeneity of piped water with respect to the external meteorological environment of cities in industrializing Japan. To estimate the varying effects, we implement fixed-effects semivarying coefficient models to deal with the unobservable confounding factors, using a nationwide city-level panel dataset between 1922 and 1940. We find evidence that the magnitude of safe water on the reduction in the typhoid death rate is larger in cities with a higher temperature, which is consistent with recent epidemiological evidence. These findings underscore the importance of the variations in the external meteorological conditions of the municipalities that install water-purification facilities in developing countries.