Abstract
AbstractClean water provision is considered crucial for eradicating waterborne diseases. However, the benefits of piped water can be limited in environments characterized by the inadequate storage and disposal of waste. This article studies the impact of waterworks and sewerage on mortality in German cities during the period 1877–1913. The results show that the supply of safe drinking water reduced the number of deaths, although to a lower extent than suggested previously. In the absence of efficient systems of sewage removal, contact with faeces and water contamination created a favourable environment for the spread of enteric ailments, offsetting some of the positive effects of waterworks. Moreover, the study shows that sanitary investments had important heterogeneous effects. First, their impact was markedly lower in municipalities with high levels of economic inequality and employment in the textile sector. Second, cities located in non‐Prussian territories experienced lower declines in mortality following the construction of sanitary infrastructures. The results in this article highlight the importance of analysing public health measures jointly as well as their interaction with local socioeconomic and institutional factors to understand historical progress against ill health and premature death.
Highlights
Clean water provision is considered crucial for eradicating waterborne diseases
This study examines crude death rates as well as mortality among the youngest to assess whether the mechanisms of disease protection provided by sanitary infrastructures differed due to age.[14]
This article has studied the causes of the first sustained decline in mortality in Germany by looking at the role of public health infrastructures
Summary
Clean water provision is considered crucial for eradicating waterborne diseases. the benefits of piped water can be limited in environments characterized by the inadequate storage and disposal of waste. The effectiveness of waterworks may fall short because of contamination of the water source or during transport.[6] Second, in the absence of efficient systems of waste disposal the incidence of enteric ailments may still remain high due to the inadequate storage of human excrement This can attract vectors transmitting diseases and contaminate the food or water supply when flooding occurs.[7] Third, the use of inadequate toilets or open defecation increases the exposure of the population to diarrheal ailments.[8] In sum, these mechanisms cast doubt on the effectiveness of clean water alone, and call for an integrative analysis considering both waterworks and sewerage systems. These parallel developments in the public health and mortality domains present an interesting and relevant case study for assessing the contribution of sanitary infrastructures to long-term mortality decline
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