Health, Disease, and Sanitation in American Economic History

Long-run changes in public health and well-being have been remarkable; Americans are living healthier, longer, and more productive lives. This chapter begins with a consideration of health trends over the past three hundred years. The shift from the miasmatic to the germ theory of disease ushered in a period of significant improvement. The second section considers the disease environment for both chronic and infectious diseases, how it has changed over time, and how those changes impacted the economy. Models of health based on selection, cumulative effects, and critical periods are contrasted. The final section focuses on the sanitary systems that have played a major role in improving health. The evolution of water supply and wastewater removal systems from simple wells and sewers to today’s complex treatment systems have improved health and reduced mortality. Estimates of the economic effectiveness of these systems suggest these large investments in public capital have been justifiable.