Selective sanitation and racial health inequality

We study how selective sanitation investments reshaped racial health inequality in one twentieth-century South African town. Combining a complete transcription of geo-linked death notices and intercensal birth imputation, we construct annual race- and cause-infant mortality rates and track the rollout of a municipal storm-water drainage scheme. Importantly, drainage was targeted and had distributional consequences: large, persistent reductions in white infant mortality from sanitation-sensitive disease on treated streets, but little improvement (and sometimes worsening outcomes) for coloured infants. Triple-difference estimates, event-study evidence, and cause-of-death patterns thus reveal a ‘reversal-of-fortunes’ effect: turning high-risk streets safe and concentrating preventable mortality among coloured households.