The Social Rate of Return on Investment in Public Health, 1880–1910

The period 1880–1910 saw great improvement in the health of city dwellers. Life expectancy at birth for males in Boston rose from 37 in 1880 to 46 in 1910; in New York City it rose from 29 in 1880 to 45 in 1910. The improvement in the state of health came largely from a decline in the incidence of infectious disease. Recent studies have suggested that most of this decline is fairly attributable to improvements in the standard of living—especially as reflected in diets and housing—and, for cities, to new public health measures—especially the installation of sanitary sewers and the provision of central supplies of pure drinking water. Government installation of public health projects in the United States was a part of the “sanitation movement,” which began some time around 1880. During the thirty-year period 1880–1910 there was a rapid increase in the fraction of the urban population served by sanitary sewers and improved water systems. For example, in 1875 fewer than 30,000 urban citizens were supplied with filtered water. By 1910 the figure had risen to over 10,000,000. That the improved health resulting from these public health measures must have been regarded by its recipients as an increase in their well being is clear. What is not clear is whether the recipients of improved health would have been even better off if the resources used in constructing and maintaining public health projects had been put to alternative uses unrelated to health. In this article I shall estimate the social rates of return on the cumulated investments in public health projects as could have been perceived by their builders and show that it may have exceeded the market rate of return on capital by several times.