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 fixedeffects 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.