{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T00:39:07Z","timestamp":1792456747532,"version":"4.5.0"},"reference-count":37,"publisher":"Duke University Press","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2005,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Mortality rates in the United States fell more rapidly during the late nineteenth and early twentieth centuries than in any other period in American history. This decline coincided with an epidemiological transition and the disappearance of a mortality \u201cpenalty\u201d associated with living in urban areas. There is little empirical evidence and much unresolved debate about what caused these improvements, however. In this article, we report the causal influence of clean water technologies\u2014 filtration and chlorination\u2014on mortality in major cities during the early twentieth century. Plausibly exogenous variation in the timing and location of technology adoption was used to identify these effects, and the validity of this identifying assumption is examined in detail. We found that clean water was responsible for nearly half the total mortality reduction in major cities, three quarters of the infant mortality reduction, and nearly two thirds of the child mortality reduction. Rough calculations suggest that the social rate of return to these technologies was greater than 23 to 1, with a cost per person-year saved by clean water of about $500 in 2003 dollars. Implications for developing countries are briefly considered.<\/jats:p>","DOI":"10.1353\/dem.2005.0002","type":"journal-article","created":{"date-parts":[[2005,5,3]],"date-time":"2005-05-03T19:42:36Z","timestamp":1115149356000},"page":"1-22","source":"Crossref","is-referenced-by-count":838,"title":["The role of public health improvements in health advances: The twentieth-century United States"],"prefix":"10.1215","volume":"42","author":[{"given":"David","family":"Cutler","sequence":"first","affiliation":[{"name":"Department of Economics, Harvard University, Littauer Center, 1875 Cambridge Street, Cambridge, MA 02138"},{"name":"National Bureau of Economic Research, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grant","family":"Miller","sequence":"additional","affiliation":[{"name":"Health Policy Program, Harvard University, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"73","reference":[{"key":"2021031615244475900_CR1","volume-title":"The Quest for Pure Water: The History of Water Purification From the Earliest Records to the Twentieth Century","author":"Baker","year":"1948"},{"key":"2021031615244475900_CR2","volume-title":"Water for the Cities: A History of the Urban Water Supply Problem in the United States","author":"Blake","year":"1956"},{"key":"2021031615244475900_CR3","doi-asserted-by":"crossref","first-page":"139","DOI":"10.3917\/adh.101.0139","article-title":"Death and Spending: Urban Mortality and Municipal Expenditure on Sanitation","volume":"1","author":"Cain","year":"2001","journal-title":"Annales de Demographie Historique"},{"issue":"1","key":"2021031615244475900_CR4","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1007\/BF00888565","article-title":"Public Health Measures and Mortality in U.S. Cities in the Late Nineteenth Century","volume":"6","author":"Condran","year":"1978","journal-title":"Human Ecology"},{"key":"2021031615244475900_CR5","doi-asserted-by":"crossref","DOI":"10.3386\/w9396","volume-title":"Changes in the Value of Life: 1940-1980","author":"Costa","year":"2002"},{"key":"2021031615244475900_CR6"},{"key":"2021031615244475900_CR7","doi-asserted-by":"crossref","first-page":"129","DOI":"10.7208\/chicago\/9780226903330.003.0005","article-title":"Mortality, Education, Income, and Inequality Among American Cohorts","volume-title":"Themes in the Economics of Aging","author":"Deaton","year":"2001"},{"key":"2021031615244475900_CR8","first-page":"1357","article-title":"Disease Complementarities and the Evaluation of Public Health Interventions","volume":"89","author":"Dow","year":"1999","journal-title":"American Economic Review"},{"key":"2021031615244475900_CR9","volume-title":"The Sanitarians: A History of American Public Health","author":"Duffy","year":"1990"},{"issue":"1","key":"2021031615244475900_CR10","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/0277-9536(95)00062-3","article-title":"Educational Differentials in Mortality: United States, 1979\u20131985","volume":"42","author":"Elo","year":"1996","journal-title":"Social Science and Medicine"},{"key":"2021031615244475900_CR11","first-page":"116","article-title":"Personal Health Behaviour and the Decline in Infant and Child Mortality: The United States, 1900\u20131930","volume-title":"What We Know About Health Transition: The Culture, Social and Behavioural Determinants of Health, Volume 1","author":"Ewbank","year":"1990"},{"key":"2021031615244475900_CR12","volume-title":"\u201cDeath in the City: Mortality and Access to Public Water and Sewer in Chicago, 1880.\u201d Mimeo. 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