The Role of Public Health Improvements in Health Advances: the 20th Century United States
Summary of the Article

Mortality rates in the United States declined substantially during the late 19th century and early 20th century compared to any period in the US history. However, there is scantly evidence to pin point the causal factors that resulted in these improvements in US mortality rates during that period. In the wake this view, Cutler and Miller (10) embarked on investigating the causal influence that clean water technologies, especially chlorination and filtration, had on improving the mortality rates in major cities in the United States during the early century. Cutler and Miller (2005) conducted their study on the assumption that the introduction of chlorination and water filtration systems resulted in substantial declined in mortality rates, which was adopted as a pre-explanation for the about 50 percent reduction in the mortality cases during the period 190-1936.

In order to have a better understanding of the relationship between mortality and clean water, Cutler and Miller (8) analyzed data regarding the sanitary interventions that were matched to deaths by cause, which was achieved using annual mortality statistics gathered in the selected areas by age, cause (these were available from the Census Bureau’s Mortality Statistics from 1900 to 1936. The results of the study pointed out that that clean water played an integral role in reducing mortality between the years 1900 and 1936, reducing infant mortality by about 75 percent and reducing child mortality by 66 percent. It is apparent that the magnitude of these effects is striking. Basing on these findings, Cutler and Miller (15) asserts that clean water could have played an integral role in almost eradicating typhoid fever during the late 19th century and early 20th century. In addition, Cutler and Miller (12) maintain that the impact of clean water on the total rates of mortality is far much greater than just reducing the typhoid effect alone. Decreases in typhoid fever resulting from clean water accounted for just 2 percent of the total reduction in mortality during the period under study. After this initial analyses, Cutler and Miller (2005) explore the behavioral responses associated with clean water and their findings supported the aspect of a multiplier effect linked to public interventions by: (a) increasing the returns to individual health behaviors; (b) and that public health interventions tend to impose an increase in these individual health behaviors. In addition, estimates pointed out that the social rate of return of clean water technologies was relatively larger than 23 to 1 with cost per life savings of almost $ 500 (equivalent to the 2003 dollar value).

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