Good sewerage systems saves lives

…in particular, of infants and children

From this NBER paper by Marcella Alsan and Claudia Goldin


We explore the first period of decline in infant mortality in the U.S. and provide estimates of the independent and combined effects of clean water and effective sewerage systems on infant mortality. Our case is Massachusetts, 1880-1915, when state authorities developed a sewerage and water district for municipalities in the Boston Greater Metropolitan area. We find that the two interventions were complementary and together accounted for approximately 37 percent of the total decline in log infant mortality among treated municipalities during the 36 years considered. Considerable research has documented the importance of clean water interventions for improvement in population health, but there is less evidence on the importance of sewerage systems. Our findings are directly relevant to urbanization in the developing world and suggest that a dual-pronged approach of safe water and sewerage is important to improving infant and early child survival.

Sanitation, provision of clean water and a working sewerage system – without a system where these three function as interlocking parts, there is little chance of making any significant gains in infant and child mortality. Much of the mortality in that age-group is down to contaminated water. Diarrhoea accounts for 17% of deaths amongst children under five, killing more than 5,000 children every day. The absence of any one of these parts is a recipie of a public health disaster. However, potable water and sanitation get more attention than sewerage systems.

For developing countries like India, struggling with the sanitation challenge, this is an important lesson. Without functional sewerage systems, especially in urban slums, we are sitting on a ticking time-bomb.


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