Shari Eli, assistant professor at the University of Toronto, explores the historic relationship between wealth and health.

1. SHARI ELI
UNIVERSITY OF TORONTO
History of Health

2. History of Health
 What are the key factors which explain the
mortality transition in the West over the last 300
years?
 PublicHealth Interventions
 Improvements in the standard of living
 Role of Education
 Lessons which can be applied to developing
countries today?

3. Crude Death Rate of Infectious Diseases

4. 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

5. 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

6. 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

7. Increases in GDP per capita

8. Native Born US Male Height

9. 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

10. 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

11. 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

12. 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

13. 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