The role of public health improvements in health advances: The twentieth-century United States
The role of public health improvements in health advances: The twentieth-century United States
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DOI：
10.1353/dem.2005.0002
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发表时间：
2005-02-01
期刊：
影响因子：
3.5
通讯作者：
Miller, G
中科院分区：
文献类型：
--
作者：
Cutler, D;Miller, G
美国的死亡率在19世纪末和20世纪初下降得比美国历史上任何时期都要快。这种下降与流行病学的转变以及与生活在城市地区有关的死亡率“惩罚”的消失相吻合。然而，关于是什么导致了这些改善，几乎没有经验证据，还有很多悬而未决的争论。在这篇文章中，我们报告了清洁水技术过滤和氯化对20世纪初主要城市死亡率的因果影响。技术采用时间和地点的外生变化被用来识别这些影响，并详细检查了这种识别假设的有效性。我们发现，主要城市的总死亡率降低了近一半，婴儿死亡率降低了四分之三，儿童死亡率降低了近三分之二。粗略计算表明，这些技术的社会回报率大于23比1，以2003年的美元计算，清洁水每年为每人节省的成本约为500美元。简要审议了对发展中国家的影响。
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 "penalty" 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 filtration and chlorination-on 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.