Urbanization, Sanitation, and Mortality in the Progressive Era, 1899–1929

Abstract

Between 1899 and 1929, deaths from waterborne diseases declined dramatically in American cities. The major cause of such declines was spending on sanitation systems (water, sewers, and refuse collection). Cities spent enormous amounts to build and maintain water and sewer systems, and to collect and dispose of refuse. We first estimate the size of the payoff to cities of such expenditures, where the payoff is measured in averted deaths. Using a panel of annual mortality and municipal expenditure data from 152 cities, we estimate that a 1% increase in sanitation expenditures was associated with a 3% decline in the mortality rate. In the second section of the paper, we ask whether the mortality reducing effects of sanitation expenditures differed by the type of water resources available to the city (ocean, lake, river). The answer is unambiguously yes, with cities located on lakes facing the most difficult sanitary situation.