Public water and sewerage investments and the urban mortality decline in Sweden 1875-1930

The mortality decline that started in the eighteenth century led to an unprecedented rise in life expectancy in Europe and other parts of the world. The Swedish mortality decline, starting in the early nineteenth century, had a distinct delay in urban areas and occurred simultaneously as a sharp increase in the share of urban population. Despite the importance of the mortality decline for modern economic growth, research on its determinants is still relatively inconclusive. Using a newly digitized city-level data source, this article quantifies the contribution of public investments in water and sewerage to the Swedish urban mortality decline between 1875 and 1930. A control strategy with a fixed-effects maximum likelihood model is used to isolate the treatment variable, which is represented with high accuracy in the data. Our results show a 9 percent reduction in waterborne disease mortality associated with the implementation of water and/or a sewerage system in Swedish cities, for the whole study period. This result is also present for infant mortality (6 percent) and all-cause mortality (5 percent). The implementations of these systems, however, do not affect airborne disease mortality, which strengthens the reliability of the results on waterborne disease mortality. A sub-analysis of water processing shows that both simple and advanced processing are associated with reductions in water-borne disease mortality. A specific analysis of the cities that had a slow incremental implementation of first a sewerage system, then both water and sewerage systems, suggests that there are complementary gains from having both systems implemented. The magnitude of the main results is smaller compared to previous research on larger cities, which is in line with expectations both according to theory and previous research on the Swedish urban mortality decline.