The contribution of infrastructure investment to Britain's urban mortality decline, 1861–1900

Abstract

It is well-recognized that both improved nutrition and sanitation infrastructure are important contributors to mortality decline. However, the relative importance of the two factors is difficult to quantify since most studies are limited to testing the effects of specific sanitary improvements. This article uses new historical data regarding total investment in urban infrastructure, measured using the outstanding loan stock, to estimate the extent to which the mortality decline in England and Wales between 1861 and 1900 can be attributed to government expenditure. Fixed effects regressions indicate that infrastructure investment explains approximately 30 per cent of the decline in mortality between 1861 and 1900. Since these specifications may not fully account for the endogeneity between investment and mortality, additional specifications are estimated using lagged investment as an instrument for current investment. These estimates suggest that government investment was the major contributor to mortality decline, explaining up to 60 per cent of the reduction in total urban mortality between 1861 and 1900. Additional results indicate that investment in urban infrastructure led to declines in mortality from both waterborne and airborne diseases.B etween 1851 and 1900 mortality rates in Britain declined by almost 20 per cent. Over the same period, local government expenditure on urban infrastructure increased rapidly so that by 1890 spending by local authorities accounted for over 41 per cent of total public expenditure, with much of the money used for water supply and sewers. 1 This simple pattern leads to the natural conclusion that government sanitation expenditure was the driving force behind the improvement in life expectancy. This belief is also supported by evidence from other countries showing that investment in sanitary infrastructure, such as clean water supply, can have positive effects on mortality, both in the present day 2 and historically. 3

Urban sanitation and the decline of mortality

“…Cain and Rotella (2001) argued that 'expenditures on sanitation had a large impact on reducing the waterborne disease death rate' in 48 United States cities between 1900and 1929and Szreter (1988) identified a direct link between increases in the value of the loans sanctioned by the Local Government Board in England and Wales after 1870 and the onset of a sustained decline in mortality after that date. More recently, Jonathan Chapman (2017Chapman ( , p. 1, 2019 has tried to estimate the level of municipal sanitary intervention by examining the value of municipal debts accumulated in England and Wales between 1867 and 1900. He concluded that the investments associated with these debts helped to explain up to sixty per cent of the decline in urban mortality between 1861 and 1900, and approximately 88 per cent of the decline in mortality between 1861 and 1890.…”

“…The final three papers are all concerned with the history of sanitary intervention and mortality change in England and Wales. As we have already seen, a number of authors have tried to use the loans contracted by English and Welsh sanitary authorities to measure the extent of sanitary intervention (Chapman, 2019;Millward & Bell, 1998;Szreter, 1988). Harris and Hinde try to take this approach a stage further by providing detailed estimates of the value of the loans which were either sanctioned by central government or approved by Parliament in each year from just after the end of the Napoleonic Wars to the outbreak of the First World War.…”

“…Bailey, Hatton, & Inwood, 2018;Beach & Hanlon, 2018), whilst others have continued to highlight the importance of sanitary advances (e.g. Chapman, 2019;Kesztenbaum & Rosenthal, 2017). However, the precise extent of the contributions made by different factors continues to be debated.…”

Elite Structure and the Provision of Health-Promoting Public Goods

“…A growing number of empirical studies suggests that public infrastructure investments are crucial for reducing infant mortality and improving public health in developing and emerging countries (see Alsan and Goldin, 2019, Beach et al, 2016, Cutler and Miller, 2005, Chapman, 2019, Duflo et al, 2015, Gamper-Rabindran et al, 2010, Gallardo-Albarrán, 2020, Watson, 2006). An urgent question is consequently why governments differ in the extent to which they undertake investments in health infrastructure projects.…”

“…The difficulty in this respect is that focusing on a single health-promoting public good (e.g. public hospitals or sewage systems) is inappropriate since a sophisticated health infrastructure system has various pillars (Chapman, 2019). In addition, the reasons for why elites oppose or support health infrastructure investments might vary for different types of health-promoting public goods.…”