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

Jonas Helgertz, Martin Önnerfors

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)307-338
Number of pages32
JournalHistory of the Family
Issue number2
StateAccepted/In press - Jan 1 2019

Bibliographical note

Funding Information:
We thank Jonas Wallin and Siddartha Aradhya as well as referees and the editor for helpful comments. For the digitization of data, we acknowledge the assistance of Federica Braccioli, Magda du Toit, Anita Terzic and Glen Williams. Financial support has been obtained from the Crafoord foundation for the project 'Effects of exposure to health shocks and interventions during the fetal stage and the first year of life on labor market outcomes in Sweden 1900-2012? (Crafoordska Stiftelsen [20140569]) as well as from the Handelsbanken project 'The provision of water and sewage and its effect on health and economic outcomes. Sweden, 1875-1960? (Jan Wallanders och Tom Hedelius Stiftelse [P16-0171]). Support has also come from the Minnesota Population Center, which receives core funding (P2C HD041023) from the Eunice Kennedy Shriver National Institute for Child Health and Human Development (NICHD). An earlier version of the paper has been presented at seminars at the Department of Economic History, Lund University (2015), at the Minnesota Population Center, University of Minnesota (2015) and at the CEDAR seminar series at Ume? University. The paper has furthermore been presented at the Social Science and History Association conference (2015, 2016), EpiDem workshop (2017), IUSSP International Population Conference (2017), IUSSP Urban Health Transformations conference (2017), NordicEpi conference (2017) and the Population Association of America conference (2018). Helpful comments and suggestions are gratefully acknowledged.

Publisher Copyright:
© 2018, © 2018 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.


  • Mortality decline
  • Sweden
  • urban penalty
  • waterborne disease mortality


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