Public Goods and Health Inequality: Lessons from Paris, 1880-1914

Lionel Kesztenbaum, Institut National d'Études Démographiques (INED)
Jean-Laurent Rosenthal, California Institute of Technology

After 1850, mortality began its long term fall in most industrialized countries; that processe has been linked to rising incomes and improved water infrastructure. In this paper we estimate the impact of these two factors jointly. To do so, we assemble a longitudinal data set on mortality and income for each of Paris’ 80 neighborhoods during the health transition (1880-1914). We show that, unsurprisingly, building owners in rich neighborhoods adopted improved sanitation (direct connection to sewers) fastest. We then instrument sewer adoption by taking advantage of the fact all new buildings had to be connected and show that sanitation did reduce mortality. Income and sanitation both contributed to the decrease in mortality, the effect of a standard deviation change of either variable being about the same. We argue that these results give insights on the determinants of the health transition but also on the long-term evolution of health inequality.