SHARI ELI UNIVERSITY OF TORONTO History of Health

History of Health

  What are the key factors which explain the mortality transition in the West over the last 300 years?  Public Health Interventions   Improvements in the standard of living  Role of Education

  Lessons which can be applied to developing countries today?

Crude Death Rate of Infectious Diseases

Public Health Interventions

 Acceptance of the Germ Theory of Disease in the 1890s

 New investments in collective goods - paid for by taxes - such as water treatment   In 1900, 44% of deaths in major cities are from

infectious diseases (18% in 1936), 25% from waterborne diseases

 Cutler and Miller (2005) find that the chlorination and filtration of water accounts for ½ the mortality reduction between 1900 and 1936 in the US

Other public health interventions

  Public Health Campaigns:  washing hands & food  breast-feeding & boiling milk

  Large-scale interventions:   sewage treatment and chlorination   regulations for milk/meat  garbage collection

Increases in the Standard of Living

  Many of the public health campaigns/interventions of the early 20th century were targeted at urban populations

  But we see great gains in life expectancy outside of urban areas too   1900-1940: Life expectancy rises from 47 to 63 in the US

  Both rural and urban populations experience great improvements in the standard of living in this period

Increases in GDP per capita

Native Born US Male Height

Role of Increased Income

  Eli (2012) looks at effect of increases in Civil War veteran pensions on health status between 1893 and 1906

  Finding: Extra $1 of monthly pension income - 9% of the average veteran’s monthly pension - lowers probability of contracting a respiratory illness by 19%   Equivalent to a decline in the hazard rate from 9 in 1000

to 7 in 1000   Extra $1 of monthly pension income lowers the hazard

rate of dying from any illness from 28 in 1000 to 20 in 1000

Why such large effects?

  With extra income, one can have improve his  Nutrition  Living Conditions  Working Conditions

  One can also work less or retire early

Choices regarding health

  Large-scale public health interventions run by city governments are the result of new information and technology on health

  But improvements in health that come from increases in socioeconomic status are most likely not the result of individuals making conscious investments in their health

Role of Education

  Part of the benefit of education is simply in gathering children in the same place each day (“High School Movement” 1910 – 1940)

  Good opportunities for disseminating information on the benefits of hand-washing, etc. as well as for mass vaccinations

  Example: Rockefeller Sanitation Commission’s de-worming campaign in the U.S. South, 1905 – 1910

  RSC surveyed infection rates in affected areas and found that an avg. of 40% of school-aged children suffered from hookworm infection

  Sponsored treatment dispensaries that traveled these areas providing de-worming medications and educating local physicians and the public about prevention

  Great effects on school enrollment, literacy and earnings in adulthood

Conclusions

 U.S. Public Health Interventions which were beneficial were ones   Imposed by local government (water treatment)  Very specific targets (de-worming)

 Much of the gains to life expectancy were not the result of individuals making better decisions with regard to their health   Instead, better health was a byproduct of increases in SES or

the result of public health interventions