Public goods and health inequality - Lessons from Paris, 1880-1914

Sep 5, 2026

Around 1900, as urban conditions improved after centuries of disadvantage, life expectancy in cities rose beyond rural levels. The process is linked to two forces: rising incomes and strengthened sanitation. The study analyzes Paris from 1880 to 1914 using longitudinal neighborhood data for mortality and income across 80 districts, showing large gaps between best and worst neighborhoods and a pattern of divergence then convergence driven by the diffusion of sewers adopted sooner in richer areas.

LanguageEnglish

CategoryGeneral

FormatPDF

Pages48

Reading Time17 min

AccessFree to download

Introduction

Health inequality in nineteenth-century Paris

Sources of differential mortality: income and infrastructure

Distinguishing income, knowledge, and sanitation

Conclusion

Public goods and health inequality; Lessons from Paris, 1880-1914 . Lionel Kesztenbaum Jean-Laurent Rosenthal* Abstract Around 1900, after centuries of disadvantage, urban life expectancy passed its rural counterparts. The process can be linked with two broad phenomena: rising incomes and improved sanitation. We focus on Paris during the key period of the health transition (1880- 1914) and assemble a longitudinal data set on mortality and income for each of the city’s 80 neighborhoods. We show that life expectancy in Paris was not very different from the rest of the country –around 50 years at age 5– but the difference between best and worst neighborhoods exceeded 10 years. These huge mortality differentials are strongly related to a variety of income indicators. Over time, mortality across neighborhoods first diverged and then converged. This pattern cannot be explained by variation in income or fixed neighborhood characteristics. It is due to the gradual diffusion of sewers that were adopted faster in rich neighborhoods than in poor ones. Keywords: differential mortality, wealth, urbanization, Paris JEL codes: N33, N34 Words: 15,577 The authors would like to thank Leah Brooks, Tracy Dennison, Edward Glaeser, Timothy Guinnane, Philip Hoffman, Samantha Myers, Jim Oeppen, and William Summerhill and the participants at seminars at PSE, UCLA and Stanford for helpful comments. * Corresponding author: Jean-Laurent Rosenthal, Caltech, 200 E California Blvd Pasadena CA [91031 USA.](91031 USA. jlr@hss.caltech.edu)[ ](91031 USA. jlr@hss.caltech.edu)[jlr@hss.caltech.edu](91031 USA. jlr@hss.caltech.edu). Introduction In nineteenth century Paris life was both brutally short and massively unequal. In the 1820s, Parisians had a life expectancy at age five of about 44, some five years less than other French people. As late as the 1890s, Parisians in the toniest neighborhoods could expect to live 12 years longer than those in the poorest ones (a difference that was almost twice as large as that between the best and worst French departments) . Similarly large differences are found in age at death between the bottom and the top part of the wealth distribution. The capital city’s disadvantage did not begin to narrow until the 1860s and it did not close until the 1930s. Inequality in lifespan within Paris persisted stubbornly but, starting in the 1850s, the city began to address some of its worst environmental problems. The process began with the general delivery of clean water (by a concessionary company) and continued in the 1860s with a vast and prolonged public program of sewer construction. By the 1930s nearly all buildings in Paris had running water, their waste water discharged directly in the sewers, and life expectancy was beginning to converge within the city. While even today differences in life span based on wealth or neighborhood remain, they are tiny relative to a century ago. Increased longevity, it seems, has been one of the more widely distributed benefits of long-term economic growth. Paris’ experience, which is similar to that of most large cities in the western world, raises questions about the sources and evolution of differential mortality. In this paper we examine two critical forces behind the closing of the rural urban mortality gap and of inequality in life span within cities: income and infrastructure. More specifically we chart how increases in income and the diffusion of sewers let to a significant decline in urban mortality. This work connects to amore general literature that emphasizes that life span in the western world before WWII was caught between the downward pressure of the ever increasing share of the population living in crowded and adverse urban and industrial environments and the lift provided by increases in income and knowledge. In the long run the second force triumphed and offset the negative effects of urban living. In their pure form income and knowledge are quite distinct.

FAQs

What time period and geographic focus does the paper examine?

The paper focuses on Paris during the health transition period from 1880 to 1914 and studies neighborhoods within the city.

How does the paper explain the widening and later closing of mortality differences across neighborhoods?

Mortality differentials first diverged and then converged over time; the paper argues this pattern results from the gradual diffusion of sewers adopted faster in richer neighborhoods.

Why are sanitation and clean water treated as distinct from public goods in the paper?

Sanitation and clean water have externalities, but they are excludable services whose provision can follow different schemes, unlike public goods provided uniformly.

Sep 5, 2026

Upload by Quinn Holloway