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Introduction

1 In the United States in the xixth century, as in Europe in that era, there was a substantial mortality “penalty” to living in urban places (e.g., Williamson, 1982, 1990, ch. 9; Davis, 1973; Weber, 1899, ch 6; Brown, 1991; Vögele, 1994). By 1940, that urban penalty had been largely eliminated; and it was healthier, in many cases, to reside in a city than in the countryside. Part of the study of the great mortality transition in the United States is related to this phenomenon.

2 A significant problem with the history of mortality in the United States stems from the paucity of good statistical information—on levels, trends, and differentials. It is possible, however, using a variety of sources and demographic estimation methods, partially to reconstruct the course of mortality in the United States from 1800 onwards and, more particularly, to provide some insight into differentials. When census data, vital statistics, local records, and genealogical data are culled for what they can reveal, the outlines appear.

3 Although the United States was the first nation to introduce a regular census (taken decennially from 1790 onwards), vital registration was left to state and local governments. Consequently, it was instituted unevenly. A variety of churches kept parish records of baptisms, burials, and marriages, and these have been used to construct demographic estimates for the colonial period, especially for New England and the Middle Atlantic regions. Although some cities (e.g., New York, Boston, New Orleans, Baltimore, Philadelphia) began vital registration earlier in the xixth century, the first state to do so was Massachusetts in 1842. An official Death Registration Area (DRA) consisting of ten states and the District of Columbia was only successfully established in 1900, and data collection from all states was not completed until 1933 [1]. A parallel Birth Registration Area (BRA) was only instituted in 1915, and collection for all states was also achieved in 1933. There were also a significant number of “Registration Cities” outside the DRA and BRA were also included in the data reporting until 1933. The federal census did collect mortality information with the censuses of 1850 to 1900, but there were significant problems with completeness. The data do improve over time, and, after 1880, census information was merged with state registration data (Condran and Crimmins, 1979). Nothing similar, however, was undertaken for birth data.

4 In the early xixth century, the United States was a relatively low mortality regions by the standards of Western Europe. Since it was not particularly urban (only 6.1% in 1800), a crude death rate in the range of 20-25 per 1,000 population would not have been unusual. The low mortality was remarked upon by none other than Thomas Robert Malthus (1798, 104-106). Mortality was likely lowest in New England and rose as the latitude moved further south. Such evidence as we have (mostly for New England the Middle Atlantic states) does indicate a substantial urban penalty. By 1900 within the Death Registration Area (the six New England states, New York State, Pennsylvania, Michigan, Indiana, and the District of Columbia), the expectation of life at birth (e(0)) for the urban white population was 46 years, while it was 54.7 years for the rural white population (Glover, 1921). Estimates of child mortality for the whole United States based on indirect estimates using the 1900 Public Use Micro Sample of the census find that mortality in urban areas was 13% above the national average, and 22% above the average for rural places (Preston and Haines, 1991, Table 3.1). These estimates apply to about 1894. The urban penalty had declined to approximately 6% above the national average and 13% above the rural rate using indirect estimation with the national sample of the 1910 census (Preston, Ewbank, and Hereward, 1994, Table 3.2)(See Table 2). For the Death Registration Area of 1900, urban-rural differentials in e(0) for white males decreased from 10.0 years in 1900/02 to 7.8 years in 1909/11 and to 2.6 years in 1939 for the whole United States (United Nations, 1953, p. 62 and Table 1). Higgs (1973) estimated that urban mortality was 50% higher than rural mortality in the 1880s, and that the urban penalty had dropped to 21% by the period 1910/20. Condran and Crimmins (1978, 1980) and Crimmins and Condran (1983) found that the rural-urban mortality difference was already diminishing in the 1890s, and that the urban penalty was largely due to tuberculosis, diarrheal diseases, and several other infectious, communicable diseases.

5 This paper will look at the phenomenon of the urban mortality transition over the period 1800 to 1940 using a variety of sources. Particular attention will be paid to the xixth and early xxth centuries, when we know considerably less and before many of the most heralded public health innovations had come into play. Using some new data, re-analyzing old data, and looking at the history of public health will provide clues as to the relationship of public health (broadly defined) to the urban mortality transition.

The urban mortality transition in the United States

6 It is clear that, before about 1920, urban mortality was much in excess of rural mortality. In general, the larger the city, the higher the death rate. A variety of circumstances contributed to the excess mortality of cities: greater density and crowding, leading to the more rapid spread of infection; lack of adequate clean fresh water and sewerage disposal; a consequently higher degree of contaminated water and food; garbage and carrion in streets and elsewhere not properly disposed of; larger inflows of foreign migrants, both new foci of infection and new victims; rapid turnover of both goods and people; and also migrants from the countryside who had not been exposed to the harsher urban disease environment (Haines, Weiss, and Craig, 2000; Melosi, 2000; Duffy, 1990). Writing in 1899, Adna Weber commented on the positive relationship between city size and mortality levels for the United States and Europe: “It is almost everywhere true that people die more rapidly in cities than in rural districts… There is no inherent or eternal reason why men should die faster in large communities than in small hamlets… Leaving aside accidental causes, it may be affirmed that the excessive urban mortality is due to lack of pure air, water and sunlight, together with uncleanly habits of life induced thereby. Part cause, part effect, poverty, overcrowding, high rates of mortality, are found together in city tenements (Weber, 1899, 343-348).”

7 According to the Death Registration Area life tables for 1900/02, the expectation of life at birth was 48.2 years for white males overall—44 years in urban areas and 54 years in rural places. The comparable results for females were similar (51.1 years overall, 48 years urban, 55 years rural) (Glover, 1921) (See Table 1). For the seven states with reasonable registration data in both 1890 and 1900, the ratio of urban to rural overall crude death rates reported in the 1890 census was 1.32, and 1.17 in 1900 (See Table 2). Concernig the death rates for young children (aged 1-4) the ratios were much higher, with urban mortality being 94% higher in 1890 and 100% higher in 1900. For infants the excess urban mortality was 88% in 1890 and 48% in 1900. Residence in cities, with poorer water quality, lack of refrigeration to keep food and milk fresh, and close proximity to a variety of pathogens was very hazardous to the youngest inhabitants. The rural-urban differential seems to have been true earlier as well. For seven New York counties in 1865, the probability of dying before reaching age five was.229 in urban areas but.192 in rural locations (Haines, 1977). A study of Massachusetts by Vinovskis found that the largest cities and towns had a lower e(0) in 1859-61, but differentials below that size were less clear. He believed that the differences had been larger in the xviith and xviiith centuries (Preston and Haines, 1991, 36-39; Vinovskis, 1981, ch. 2; Condran and Crimmins, 1980).

8 In the early xixth century, the United States was an area of relatively low mortality by the standards of Western Europe. It was quite rural (only 6.1% urban in 1800); and a crude death rate in the range of 20-25 per 1,000 population would not have been unusual. The low mortality was noted by contemporary observer Samuel Blodget (1806, 76) who suggested crude death rates in the low 20s for rural areas and about 24-26 for the entire nation, but considerably higher in larger cities (in the range 27-30). The Jaffe and Lourie (1942) life tables for 1826/35 (based on local registration materials and census populations for 1830) show that the expectation of life at age 10 (e(10)) was 51.0 years for 44 smaller New England towns, whereas it was 46.0 for Salem, MA and New Haven, CT (medium-sized cities) and 35.9 years for Boston, New York City, and Philadelphia (See Table 2).

9 Given the paucity of vital statistics data in the xixth century, it is difficult to describe the process of the mortality transition. One place to start is with city vital registration. Figures 1 to 5 trace the simple crude death rate for five large cities from the early xixth century: New York City (1804-1920), Boston (1811-1920), Philadelphia ((1802-1920), Baltimore (1811-1920), and New Orleans (1810-1920). The data come from a variety of sources, but seem to be of reasonable quality.

10 New York City (Figure 1) is quite a good case [2]. Prior to about 1870, the approximate point of the onset of the overall mortality transition in the United States, New York City experienced serious mortality peaks, notably from the cholera epidemics of 1832, 1849, 1854, and 1866 (Rosenberg, 1962). Further, baseline mortality appeared to be increasing before the American Civil War (1861-65). This was probably not because of the improving quality of death registration. The mortality statistics seemed to be quite reasonable from early on (Duffy, 1968, 532-534). This is also consistent with the “Antebellum Puzzle”: the finding that heights were declining among adult males born between about 1830 and 1870 at the same time that mortality was rising throughout the United States (Fogel, 1986; Haines, 1998b; Haines, Craig, and Weiss, 2000; Steckel, 1992, 1995; Komlos, 1987, 1994, 1996). This was in the face of quite robust economic growth. One conclusion is that the mortality and disease environments were being made national and international in scope during the xixth century. The more rapid and extensive movement of people and goods due to the “Transportation Revolution” (Taylor, 1951) also brought a negative side (Haines, Craig, and Weiss, 2000). The rapid spread of the Asiatic cholera from 1829 in Russia to 1832 in most of the rest of the world is ample testimony to the new international disease environment (Rosenberg, 1962, ch. 1). This recurred in 1849, 1866, and 1893. The New York City data also indicate a damping of fluctuations after mid-century, as well as finally a sustained decline from about 1890.

11 A somewhat similar picture emerges in Figure 2 for Boston (1811-1920) [3]. Boston experienced, if not an increase in mortality over the first half of the century, at least no decline. Also, mortality was quite variable, notably around the great cholera epidemic of 1849. A sustained diminution in death rates did not begin until the 1880s. Philadelphia’s crude death rate is depicted in Figure 3 [4]. The experience was similar to New York City and Boston in that the first half of the century was characterized by high mortality levels and considerable variability. Philadelphia was hard hit by outbreaks of yellow fever early in the century and then by the Asiatic cholera in 1832, 1849, 1854, and 1866. The sustained mortality decline commenced in the early 1870s, greatly furthered by construction of waterworks and sewers and other public health measures (Condran and Cheney, 1982; Melosi, 2000, passim).

12 The crude death rate for the city of Baltimore is presented in Figure 4 [5]. Baltimore had a very difficult sanitation situation based on its topography (Cain, 1977). It had a low-lying location on the Patapsco River estuary of Chesapeake Bay. Construction of gravity flow sanitary sewers was problematic. Further, the Chesapeake region had been a place with significantly elevated mortality since colonial times (Carr, 1992; Wells, 1985, 65-71). Nonetheless, mortality peaks did dampen after about 1870 and a sustained transition set in.

13 The final Figure 5 is for the remarkable case of New Orleans, Louisiana. The death rates there were so high in the xixth century that the scale of the figure had to be compressed by a factor of three to fit it on the page [6]. Mortality was truly virulent and peaks astonishing before the late xixth century. Yellow fever was especially severe in the marshy, swampy flat area near the delta of the Mississippi River, but cholera, typhoid fever, malaria, dysentery, and other water- and insect-borne diseases were both endemic and epidemic (Pritchett and Tunali, 1995; Bloom, 1993, ch. 3). Despite the possibility of defective death registration, mortality in the city appears to have been astounding. Indeed, it has been characterized as the nation’s “death capital” (Pritchett and Tunali, 1995, 518). It is curious that the city actually would publish these statistics, since they only illustrated the danger of settling in this bustling commercial city. But the city managed to grow robustly over the xixth century at a rate of about 3% per year for the period 1810 to 1910 (and 4.6% per annum for the antebellum decades 1810 to 1860). The baseline mortality was very high, averaging around 50 deaths per 1,000 population in the pre-1860 era. In no year did the crude death rate fall below 25 and only four times went below 30 in the 50 year span. In 12 of the 35 years between 1825 and 1860, more than 1,000 persons died of yellow fever alone, not to mention other infectious and parasitic diseases. In the great epidemic of 1853, more than 8,000 persons perished from this insect-borne disease (out of a total population of about 125,000 at the onset of the epidemic) (Pritchett and Tunali, 1995, 518-519).

14 One must conclude that large American cities had become virtual charnel houses by the middle of the xixth century and that this contributed notably to the rising mortality in the United States before the American Civil War. Some of this may be seen in the estimates of Pope (1992) and Fogel (1986). Some additional evidence on the effect of urbanization and transport on mortality can be found with the county level census death data from the U.S. Census of 1850 (Haines, Craig, and Weiss, 2000) [7]. Counties in 1850 with access to water and/or railroad transportation had crude death rates (adjusted for undercount) of 20.5 deaths per 1,000 population, in contrast to those without such access (at 15.6). Counties with less than 1% of the population living in urban areas had crude death rates of 17.7 per 1,000 population, while those with 1%-25% urban had average death rates of 19.2 and those with more than 25% of the population urban had death rates of 25.4. The zero-order correlation between the estimated county crude death rate was.28 with the variable for transport access and.20 with the percent urban.

15 As Figures 1-5 demonstrate, large cities did not gain significant control over their mortality environments until the latter part of the xixth century. Even then, some smaller New England cities were especially resistant to change, e.g. Holyoke and Northampton in Massachusetts. The situation in New England at this time has been called the “nineteenth-century mortality plateau” (Hautaniemi, Swedlund, and Anderton, 1999, esp. p. 34). Among recent works, there has been strong support for water and sewerage projects as effective in reducing urban mortality from the later xixth century (See, for example, Condran and Cheney, 1982; Hautaniemi, Swedlund, and Anderton, 1999; Cain and Rotella, 1998; Troesken, 1999a, 1999b; Melosi, 2000).

Fig. 1

Crude Death Rate New York City, 1804-1900

Fig. 1

Crude Death Rate New York City, 1804-1900

Fig. 2

Crude Death Rate Boston, MA, 1811-1920

Fig. 2

Crude Death Rate Boston, MA, 1811-1920

Fig. 3

Crude Death Rate Philadelphia, 1802-1920

Fig. 3

Crude Death Rate Philadelphia, 1802-1920

Fig. 4

Crude Death Rate Baltimore, 1812-1920

Fig. 4

Crude Death Rate Baltimore, 1812-1920

Fig. 5

Crude Death Rate New Orleans, 1810-1900

Fig. 5

Crude Death Rate New Orleans, 1810-1900

16 So the excess urban mortality was diminishing from the late xixth century onwards, especially as public health measures and improved diet, shelter, and general living standards took effect. The excess in e(0) for rural white males over those in urban areas was 10 years in 1900. This fell to 7.7 years in 1910, 5.4 years in 1930, and 2.6 years by 1940. In addition, by 1940 the difference between the largest cities (100,000 and over) was very small (an e(0) for white males of 61.6 in the largest cities in contrast to 61.4 in other urban places). This was certainly not true in 1900, when the ten largest cities had mortality 22% above that of the smallest urban places and that of other cities of 25,000 and over was 39% higher (See Table 1; Dublin, Lotka, and Spiegelman, 1949, 324; Preston and Haines, 1991, Table 3.1).

17 The original cause of the rural advantage was unlikely superior knowledge of disease, hygiene, and prevention in rural areas, since farmers were not known to be particularly careful about disease and cleanliness: “There are few occupations (other than farming) in which hygiene is more neglected” (Abbott, 1900, p. 71). The rural advantage seems simply to have been that rural residents were farther from each other, reducing chances of contagion and contamination of water supplies. Rural-urban mortality differentials likely played a role in the deterioration of mortality in the middle of the xixth century, as the population shifted to cities and towns. Also, the xxth century mortality decline was significantly propelled by the elimination of excess urban deaths (Preston and Haines, 1991, 36-39; Taeuber and Taeuber, 1958, 274-275).

18 The black population of the United States certainly experienced higher death rates, both as slaves and then as a free population in the postbellum period than did whites. Tables 1 and 2 provide some information on the expectation of life at birth and the infant mortality rate by race. As of 1920, when reasonably representative data are available for the black population in the official registration states, it is apparent that the mortality of blacks was substantially higher. Ironically, they were protected to some extent by their more rural residence. In 1900, about 80% of the black population was rural, in contrast to about 60% for whites (U.S. Bureau of the Census, 1975, Series A 73-81). Using the 1900/02 DRA life tables alone, the black population could be seen to have had an e(0) of about 33.5 years and an infant mortality rate of about 233 infant deaths per 1,000 live births. But using indirect estimation techniques for the public use sample of the national black population in 1900 revealed considerably more favorable results: an e(0) of 41.8 years and an infant mortality rate (IMR) of 170. This indicated that a great disadvantage was still there but that rural residence had its advantages, even for the poor (Preston and Haines, 1991, ch. 2).

19 Higgs (1973) estimated that urban mortality was 50% higher than rural mortality in the 1880s, and that the urban penalty had dropped to 21% by the period 1910/20. He found the following upper bounds for the ratios of urban to rural mortality by decade from 1870 to 1920:

20 Decade Ratio

21 1870-1880 1.38

22 1880-1890 1.50

23 1890-1900 1.35

24 1900-1910 1.33

25 1910-1920 1.21

26 Condran and Crimmins (1978, 1980) and Crimmins and Condran (1983) found that the rural-urban mortality difference was already diminishing in the 1890s, and that the urban penalty was largely due to tuberculosis, diarrheal diseases, and several other infectious, communicable diseases. Their analysis is augmented and brought forward in time to 1940 in Table 3. For the seven states for which we have consistent information from 1890 onwards, mortality declined over the whole period 1890 to 1940; and rural-urban convergence was complete by 1920 for the overall death rate and by 1930 for the infant mortality rate. Convergence was taking place for the death rates for ages above one, but it was less pronounced. This is consistent with a cohort view of the process. The improvements in mortality were concentrated among the younger cohorts and so convergence was more rapid. Older persons, who had been subjected to the biological insults of earlier, higher mortality regimes, did experience mortality declines, but less dramatically and with less rural-urban convergence. This may also be seen in Table 1, where the relative differences were reduced more for the infant mortality rate and e(0) (which is heavily influenced by infant mortality) than expectation of life at age 10 (e(10)). The results for all states in Table 3 is a bit misleading because there were compositional changes over time as the Death Registration Area was augmented. Nonetheless, the infant mortality rate achieved full convergence in the 1920s; and, by the 1930s, cities were actually better places for infants to survive the first year of life.

27 The results before 1930 based on national vital statistics apply to the Death Registration Area, which did not completely cover the United States until 1933 with the admission of Texas to the system [8]. It is possible, however, to make estimates of childhood mortality for the entire nation from the censuses of 1900 and 1910, using the microdata samples and the questions on children ever born, children surviving, and duration of marriage (Preston and Haines, 1991; Preston, Ewbank, and Hereward, 1994; Haines and Preston, 1997) [9]. The method makes use of an index of child mortality based on the data recorded in the census. The index is the ratio of cumulative child deaths that a woman has experienced (i.e., the difference between her numbers of children born and surviving) to her expected number of child deaths. The expected number of deaths is calculated by multiplying her number of children-ever-born by an expected proportion dead. The expected proportion dead is based in turn on an estimate of the length of her children’s exposure to the risk of mortality, combined with a West model life table. For 1900 the standard used to calculate the expected proportion of children dying is a West Model life table with both sexes combined, level 13.0 (implying an e(0) of 48.5 years). For 1910, it is the same but with the level set at 13.5 (with an implied e(0) of 49.7 years) [10].

28 Table 4 presents estimates of rural and urban childhood mortality, using these indirect techniques with the censes data from 1900 and 1910. Between about 1894 and about 1904, then, convergence between rural and urban mortality was taking place. As with the more limited data from the Death Registration Area, urban mortality exceed rural, by 22% in 1900 and 13% in 1910. Thus convergence was indeed taking place; or, to state it differently, urban mortality was declining more rapidly than rural mortality (12.1% for urban mortality versus 5% for rural mortality). Interestingly, in 1900 the largest cities (“Top 10 Cities”) had an advantage over the next tier of large cities (“Other Cities 25,000+”). This was most likely because of the greater resources available to those largest cities to undertake the significant infrastructure investments in public health, particularly sanitary water and sewerage systems. But by 1910, this advantage has dissipated. The childhood mortality index had fallen by only 5% in the top ten cities but by over 22% in the other cities of 25,000 and over (and by 12.6% in cities of 5,000 to 25,000 in population) [11]. The top ten cities of 1900 showed rather uneven patterns of change over the decade. Overall, however, these national estimates do show that rural and urban mortality were moving closer together as they both declined around the turn of the century. This confirms the results for the Death Registration Area and specific state data from Table 3.

29 A longer term perspective is presented in Table 5, which has the infant mortality rate, e(0), and e(10) for the state of Massachusetts and for Boston (Suffolk County at most dates) [12]. Although this is not an ideal comparison, since Boston also appears in the state totals, it is useful [13]. Nonetheless, there also appears to be a staged convergence of the largest city with the rest of the state. By the 1870s there is some movement towards a ratio of 1.0 (equality), then a plateau, and finally a roughly complete convergence for the infant mortality rate by the 1890s and a bit later for e(10) and e(0). Also notable is the delayed transition in the infant mortality rate relative to mortality at older ages (e(10)).

30 Finally, Table 6 gives the infant mortality rate for the Birth Registration Area for the period 1915 (when it was created) to 1932 and for 1933 to 1940 for the entire United States. The last three columns provide the ratio of rural to urban infant mortality, using cities of 10,000 and over in population as the urban category [14]. Again bearing in mind that the Birth Registration Area is growing up to 1932 (and hence compositional issues are created) [15], these results also point to convergence by the 1920s for the white population, but later for the nonwhite population (mostly African Americans). Uniformly the nonwhite population had higher infant mortality, in both rural and urban areas, although (except for the first two years) urban mortality exceeded rural. The rural-urban gap was closing, but it had not been eradicated by 1940 as it had been for the white population. And nonwhite infant mortality rates were still higher than those for whites at the end of the 1930s—70% higher overall, 85% higher in urban places, and 53% higher in rural areas. These same results can also been seen in Table 1 for e(0) and e(10) for 1930 and 1939.

31 Some confirmation of this may be obtained from an analysis of county level data from period 1930 to 1940 (Fishback, Haines, and Kantor, 2000). For all the counties of the United States for which we have data, the infant mortality rate for 1930/32 was correlated only.046 with the percent urban in 1930. The same result correlating the infant mortality rate for 1933/39 with the percent urban for 1940 was merely.013. Neither correlation was statistically significantly different from zero. Clearly urbanization did not have an effect by 1930 as it did in 1850. The results were different for the South. There the correlations in 1930 were.117 overall,.156 for whites and.201 for blacks [16]. The results for 1940 were.112 overall,.177 for whites, and.200 for blacks Thus nationally convergence was evident, but this was not the case in the South, especially for the African-American population.

Urban public health and the epidemiological transition

32 What were the origins of the “epidemiologic transition” in the United States? A variety of factors affect mortality. They may conveniently be grouped into ecobiological (i.e., changes is disease vectors and processes), public health, medical, and socioeconomic. These categories are not mutually exclusive, since, for example, economic growth can make resources available for public health projects and advances in medical science can inform the effectiveness of public health. Ecobiological factors were not likely significant. While there may have been favorable changes in the etiology of a few specific diseases or conditions in the xixth century (notably scarlet fever and possibly diphtheria), reduced disease virulence or changes in transmission mechanisms were not apparent (Omran, 1973).

33 The remaining factors, socioeconomic, medical, and public health, are often difficult to disentangle. For example, if the germ theory of disease (a medical/scientific advance of the later xixth century) contributed to better techniques of water filtration and purification in public health projects, then how should the roles of medicine versus public health be apportioned? Medical science did have a rather limited direct role before the xxth century. Public health did, however, play a much more important role and thereby indirectly allowed medicine a part.

34 It is not the case that public authorities in large American cities were unaware of the health issues or unwilling to deal with them. In New York City, for example, a Health Office was established in 1796, although the truly effective Metropolitan Board of Health was not created until 1866. Most other large cities had health office or boards by the early xixth century. In 1844 New York City brought the vital Croton Reservoir and 40 miles Croton Aqueduct into service, bringing large quantities of clean water into the burgeoning metropolis. Boston secured an abundant municipally controlled external fresh water supply with the opening of the Cochituate Aqueduct in 1846. Chicago, which drew on Lake Michigan for its water, also had to cope with sewage disposal directly into its water supply from the Chicago River. Water intakes were moved further offshore in the 1860s, requiring tunnels several miles long driven through solid rock. But this was only a temporary solution. Finally, the city had to reverse the flow of the Chicago River, using locks and the Illinois Sanitary and Ship Canal, and send the effluent down to the Illinois River. The entire downtown area also had to raised by one story to facilitate gravity sewage flow (Cain, 1977; Galishoff, 1980; Melosi, 2000). Most cities were making efforts to establish better sources of fresh water and to dispose of sewerage, animal waste, garbage, and trash before the Civil War (Duffy, 1990, chs. 3 and 8; Melosi, Section I, passim).

35 Nevertheless, public works and public policy were hampered by inadequate knowledge and theories of disease and disease process. Prior to about 1880, disease was frequently attributed to miasmas and vapors arising from filth, to poor moral character or behavior, or to the judgement of God. But late in the xixth century, the “bacteriological revolution” began to inform public works and public health policy and to provide them both with more effective practice and greater legitimacy (Melosi, 2000, ch. 6). Previous activity was sometimes effective. Bad tasting water, and then the demonstration (by John Snow in London in 1854) that Asiatic cholera was spread by contaminated water, led to the improvement of public water supplies. The miasmatic theories also encouraged waste removal and the construction of sewerage systems. But these policies were adventitious. The early rise in mortality in the urban United States before the Civil War was not thus surprising. The negative mortality externalities of rapid population growth, combined with large numbers of immigrants and the increased movement of goods and people, could not be overcome until more precise knowledge informed practice [17]. The overall American mortality transition and the even more rapid urban mortality transition could only begin in the last decades of the xixth century with the new knowledge.

36 A pattern was emerging in the late xixth century—massive public works projects in larger metropolitan areas to provide clean water and proper sewage disposal. But progress was uneven. By 1900, public water supplies were available to 42% of the American population and sewers to 29%, although many households were not connected to the pipes running under the streets and roads in front of their houses. It took longer for filtered water to reach many families. In 1870 almost no water was filtered in the United States. By 1880 about 30,000 persons in urban areas (places over 2,500 persons) were receiving it. The number had grown to 1.86 million in 1900, 10.8 million in 1910, and over 20 million in 1920, about 37% of the whole urban population and a much higher proportion of those living in large cities. In earlier years, almost all these public works were in urban places. In a study of the mortality decline in Philadelphia 1870-1930, Condran and Cheney showed the drastic reduction in typhoid mortality on a ward by ward basis as water filtration was progressively introduced after the turn of the century (Abbott, 1900; Whipple, 1921; Condran and Cheney, 1982).

37 Progress in public health was not confined to water and sewer systems, though they were among the most effective weapons in the fight to prolong and enhance human life. Simply by reducing the incidence and exposure to disease in any way, overall health, net nutritional status, and resistance to disease was improved. Other areas of public health activity from the late xixth century onward included vaccination against smallpox; use of diphtheria and tetanus antitoxins (from the 1890s); more extensive use of quarantine (as more diseases were identified as contagious); cleaning urban streets and public areas to reduce disease foci; physical examinations for school children; health education; improved child labor and workplace health and safety laws; legislation and enforcement efforts to reduce food adulteration and especially to obtain pure milk; measures to eliminate ineffective or dangerous medications (e.g., the Pure Food and Drug Act of 1906); increased knowledge of and education concerning nutrition; stricter licensing of physicians, nurses, and midwives; more rigorous medical education; building codes to improve heat, plumbing, and ventilation in housing; measures to alleviate air pollution in urban settings; and the creation of state and local boards of health to oversee and administer these programs.

38 Much of the mortality decline since the Civil War originated in reductions in death from infectious and parasitic diseases, both of the respiratory (usually air-borne) and gastro-intestinal (usually water-borne) types. Reliable cause of death information for larger areas of the nation become available in 1900 with the initiation of the Death Registration Area (Preston, Keyfitz, and Schoen, 1972). Calculated from these data, the crude death rate declined by 38% between 1900 and 1940, while mortality from all infectious and parasitic diseases was reduced by 88%. Infectious and parasitic diseases declined from 43% of all deaths to only 15%. The decline in mortality from infectious disease actually exceeded that from all causes combined because mortality from chronic, degenerative diseases (cancer, cardiovascular disease) increased. Although this is for the United States as a whole, it is quite consistent with the results found by Crimmins and Condran (1983) that excess urban mortality was attributable to tuberculosis, diarrhea, and a number of other infectious diseases.

Concluding comments

39 It is clear that, before about 1920, urban mortality was much in excess of rural mortality. In general, the larger the city, the higher the death rate. A variety of circumstances contributed to the excess mortality of cities: greater density and crowding, leading to the more rapid spread of infection; a higher degree of contaminated water and food; garbage and carrion in streets and elsewhere not properly disposed of; larger inflows of foreign migrants, both new foci of infection and new victims; and also migrants from the countryside who had not been exposed to the harsher urban disease environment. The excess urban mortality was diminishing from the late xixth century onwards, especially as public health measures and improved diet, shelter, and general living standards took effect. The excess in expectation of life at birth for rural white males over those in urban areas was 10 years in 1900. This fell to 7.7 years in 1910, 5.4 years in 1930, and 2.6 years by 1940.

40 Overall, by 1940 the advantage of rural areas over urban places had virtually disappeared. Indeed now urban areas were healthier, especially for infants. This process had taken a long time. It is likely that cities were relatively insalubrious, even in colonial times. The low level of urbanization early in the nation’s history help make the United States a comparatively low mortality environment. The situation in cities, certainly some of the largest ones, worsened in the antebellum period (1800 to 1860) as a consequence of nationalization and internationalization of the disease environment. Smithian growth from specialization and division of labor cause by improvements in transportation and commercialization had very beneficial effects economically. But the demographic consequences were not so positive. Mortality rose in the rural areas in antebellum America as well, and the decline in heights of native-born white military recruits is a testimony to these deleterious effects (Haines, Craig, and Weiss, 2000).

41 The overall sustained modern mortality transition began in the 1870s. There is evidence that urban mortality rates, especially in the largest cities, began to decline more rapidly than rural rates from about 1890 or so assisted by significant public works improvements and advances in public health and, eventually, medical practice. By the early decades of the xxth century, other large cities began to accelerate the pace of mortality decline as public works projects for pure water and sanitary sewers came on line for a greater proportion of the city populations. The declines were more pronounced for the younger age groups, including infants after the turn of the century. A cohort process was occurring in which older persons experienced fewer of the benefits to an improved disease environment which had not been prevalent throughout their lives. Thus reductions in infant mortality were more rapid than in e(10). Convergence of rural and urban mortality took place for the white population by the 1920s for infants and by the 1930s for the rest of the population. For the nonwhite (mostly black) population, there were mortality declines, but from a much higher level. And the gap between rural and urban rates was still present by 1940, though rapidly disappearing. The specifically urban mortality transition had become simply the national mortality transition.

42 Where to go from here? There is a need to look at more disaggregated data (e.g., states, counties, and specific cities). Public health programs need more attention, and cause of death data will have to be considered. But, despite deficiencies in the data, the basic outlines of the American urban mortality transition can be drawn.

43 Michael Haines

Tab. 1 -
Tab. 1
e(0) e(10) IMR Whites Blacks/ Nonwhites Whites Blacks/ Nonwhites Whites Blacks/ Nonwhites Male Female Male Female Male Female Male Female Male Female Male Female 1900/02 Urban 44.0 47.9 47.5 50.3 151.0 109.0 Rural 54.0 55.4 54.4 54.4 109.0 89.8 Ratio 1.227 1.157 1.145 1.082 1.385 1.214 Difference 10.0 7.5 6.9 4.1 42.0 19.2 1909/11 Urban 47.3 51.4 49.1 52.2 133.8 111.2 Rural 55.1 57.4 54.5 55.5 103.3 85.0 Ratio 1.165 1.117 1.110 1.063 1.296 1.309 Difference 7.8 6.0 5.4 3.3 30.5 26.3 1930 Urban 56.7 61.0 42.2 45.6 53.1 56.4 40.8 43.1 69.9 55.2 117.6 94.8 Rural 61.0 65.0 50.9 51.8 57.4 59.6 47.7 47.5 55.4 44.2 82.2 68.1 Ratio 1.076 1.066 1.206 1.136 1.081 1.057 1.169 1.102 1.263 1.247 1.430 1.393 Difference 4.3 4.0 8.7 6.2 4.3 3.2 6.9 4.4 14.6 10.9 35.4 26.7 1939 Cities 100,000+ 61.6 66.3 51.0 54.6 55.3 59.4 46.6 49.5 42.7 33.4 76.5 59.8 Other Urban Places 61.4 66.2 46.9 51.0 56.1 60.2 44.3 47.3 52.4 42.3 100.5 79.3 Rural 64.1 67.5 55.2 57.2 58.7 61.3 51.9 52.8 50.4 39.8 80.2 64.8 Ratio (a) 1.044 1.020 1.177 1.122 1.046 1.018 1.172 1.116 1.040 1.063 1.253 1.224 Difference 2.7 1.3 8.3 6.2 2.6 1.1 7.6 5.5 2.0 2.5 20.3 14.5 (a) Ratio to “Other Urban Places”.
Expectations of Life and Infant Mortality. By Rural-Urban Residence.
United States. 1900-1939
Source: Table 2.
Tab. 2 -

Child Mortality and Expectations of Life. United States, 1826-1941

Tab. 2
Child Mortalitya Source Region Period Sex q(1) q (2) q (5) e0 e10 e20 Jaffe & 44 New Eng- 1826-35 Total 51.0 42.9 Lourie gland Towns [1942] Salem, MA & 1826-35 Total 46.0 37.8 New Haven, CT Boston, New 1826-35 Total 35.9 28.0 York City & Philadelphia Estimated U.S. 1826-35 Total 49.8 41.7 Jacobson Massachusetts- 1850 Male .16064 .21394 .27245 40.4 47.8 40.1 [1957] Maryland, White Female .13079 .18262 .24122 43.0 48.6 41.7 Meech United States, 1830-60 Male .16195 .21569 .27468 41.0 48.4 40.9 [1898] Whites Female .13430 .18752 .24769 42.9 48.8 41.4 Kennedy Massachusetts 1850 Male 38.3 48.0 40.1 [1853] Female 40.5 47.2 40.2 Elliot Massachusetts 1855 Total .15510 .22670 .28540 39.8 47.1 39.9 [1857] (166 towns) Haines Massachusetts 1855-56 Total .12994 .24262 44.2 49.8 42.2 Haines Massachusetts 1859-61 Male .14246 .24846 43.5 49.6 41.9 Female .13643 .22466 45.1 52.8 42.4 Vinovskis Massachusetts 1859-61 Male .22646 46.4 51.6 44.0 [1972] Female .19193 47.3 50.1 43.0 Haines Seven New York 1850-65 Male .14655 .18067 .21268 45.9 49.2 [1977] Counties Female .12389 .15821 .19105 48.9 51.4 Total .13549 .16972 .20213 47.4 50.3 Haines United States 1850 Male .24092 .28396 .32195 37.2 46.2 38.4 [1979] [U.S. Model] Female .21712 .25937 .29845 39.4 47.5 39.8 1860 Male .20210 .23979 .27361 41.6 48.3 40.3 Female .19153 .23041 .26684 42.1 48.7 40.9 1870 Male .19210 .22788 .26007 43.0 49.2 41.1 Female .17724 .21234 .24531 44.9 50.6 42.6 1880 Male .22015 .25997 .29538 39.7 47.5 39.6 Female .22980 .27175 .31019 39.1 48.0 40.3 1890 Male .16334 .19744 .22875 44.8 49.1 41.0 Female .15765 .19232 .22546 45.6 50.0 41.9 1900 Male .13356 .16480 .21252 47.1 49.4 41.1 Female .12476 .15572 .18611 48.4 50.5 42.3
Tab. 2
United States, 1850 Male .22829 .26997 .30697 38.4 46.6 38.8 White Female .20596 .24684 .28486 40.6 51.4 43.9 [U.S. Model] 1860 Male .18774 .22351 .25579 43.2 49.1 41.0 Female .17515 .21158 .24598 44.1 49.6 41.7 1870 Male .18513 .21955 .25056 44.1 49.9 41.8 Female .16633 .19968 .23114 46.4 51.4 43.3 1880 Male .21436 .25326 .28794 40.4 47.9 40.0 Female .21526 .25553 .29268 40.6 48.6 40.9 1890 Male .15675 .18926 .21914 46.0 50.0 41.7 Female .14490 .17722 .20829 47.4 51.0 42.8 1900 Male .12784 .15730 .18497 48.5 50.4 42.0 Female .11206 .14012 .16781 50.7 51.9 43.5 Fogel United States, 1850-60 Male 46.7 [1986] Pope United States 1820-29 Male 43.3 [1992] [Genealogies] Female 44.9 1830-39 Male 44.6 Female 44.6 1840-49 Male 41.5 Female 37.1 1850-59 Male 40.8 Female 39.5 1860-69 Male 41.2 Female 42.2 1870-79 Male 44.3 Female 42.2 1880-89 Male 45.8 Female 42.9 Haines Massachusetts 1864-66 Male .16002 .22431 .28639 38.4 45.8 38.7 Female .14267 .20352 .26706 41.6 48.7 41.8 Haines Massachusetts 1869-71 Male .16675 .21849 .26214 42.6 49.3 41.5 Female .16090 .19413 .23881 44.4 49.8 42.5 Haines Massachusetts 1874-76 Male .17941 .24772 .29812 40.0 48.9 41.3 Female .15449 .21967 .27050 41.8 49.4 42.2 Haines Massachusetts 1879-81 Male .17086 .22341 .27712 41.7 49.5 41.6 Female .16535 .19633 .25045 43.3 49.6 42.3 Billings Massachusetts 1878-82 Male .18080 .23250 .28342 41.7 49.9 42.2 [1886] Female .15257 .20245 .25408 43.5 50.0 42.8 Billings New Jersey 1879-80 Male .15153 .19398 .24132 45.6 51.6 43.3 [1886] Female .13121 .16939 .21217 48.0 52.5 44.5
Tab. 2
Haines Massachusetts 1884-86 Male .16923 .22925 .27210 41.9 49.0 41.1 Female .14507 .20531 .24668 43.9 49.8 42.2 Haines Massachusetts 1889-91 Male .17615 .23742 .27354 41.8 49.0 41.1 Female .14957 .20973 .24613 44.0 49.9 42.2 Glover Massachusetts 1890 Male .16777 .20851 .25322 42.5 48.4 40.7 [1921] Female .14755 .18738 .23415 44.5 49.6 42.0 Abbott Massachusetts 1893-97 Male .17233 .20726 .24234 44.1 49.3 41.2 [1898] Female .14699 .18115 .21593 46.6 50.7 42.8 Haines Massachusetts 1893-97 Male .17466 .23913 .27331 42.1 49.2 41.0 Female .14660 .21036 .24417 44.8 50.6 42.7 Glover DRA, Total 1900-02 Male .13574 .16614 .19452 47.9 50.4 42.0 [1921] Female .11267 .14092 .16881 50.7 51.9 43.6 Total .12448 .15383 .18196 49.2 51.1 42.8 DRA, Whites 1900-02 Male .13345 .16331 .19136 48.2 50.6 42.2 Female .11061 .13832 .16574 51.1 52.2 43.8 DRA, Blacks 1900-02 Male .25326 .31098 .35615 32.5 41.9 35.1 Female .21475 .26990 .31944 35.0 43.0 36.9 DRA, Urban, 1900-02 Male .15097 .18683 .22128 44.0 47.5 39.1 Whites Female .12545 .15883 .19195 47.9 50.3 41.9 DRA, Rural, 1900-02 Male .10900 .13065 .15043 54.0 54.4 46.0 Whites Female .08979 .10967 .12983 55.4 54.4 46.1 Preston/ U.S., Total 1895/00 Male .12973 .15836 .18522 49.7 50.6 42.1 Haines Female .11029 .13930 .16706 51.6 52.8 44.5 [1991] Total .12047 .14906 .17636 50.1 51.6 43.3 U.S., Whites 1895/00 Male .11988 .14569 .16990 50.4 51.4 42.9 Female .10120 .12702 .15174 53.4 53.7 45.3 Total .11076 .13658 .16104 51.8 52.5 44.1 U.S., Blacks 1895/00 Male .18346 .22656 .26698 40.4 46.2 38.3 Female .15657 .20040 .24234 43.3 48.3 40.7 Total .17034 .21380 .25496 41.8 47.2 38.5 Haines/ U.S., Total 1905/10 Male .11300 .13687 .15925 51.5 52.0 43.4 Preston Female .09488 .11840 .14121 54.7 54.4 45.9 [1997] Total .10416 .12786 .14689 53.1 53.2 44.7 U.S., Whites 1905/10 Male .10497 .12660 .14689 53.0 52.8 44.1 Female .08757 .10846 .12911 56.2 55.3 46.7 Total .09648 .11775 .13822 54.6 54.0 45.4 U.S., Blacks 1905/10 Male .15402 .19009 .22392 44.7 48.5 40.4 (West Model) Female .13051 .16682 .20157 47.7 50.8 42.8 Total .14255 .17874 .21302 46.2 49.6 41.6 U.S., Blacks 1905/10 Male .12714 .15555 .18980 41.8 42.6 34.6 (Far East Mode l) Female .10946 .13808 .17068 44.6 44.6 36.6 Total .11852 .14702 .18047 43.2 43.6 35.6
Tab. 2
Glover DRA, Total 1909-11 Male .12495 .15016 .17282 49.9 51.1 42.5 [1921] Female .10377 .12743 .14883 53.2 53.3 44.7 Total .11462 .13908 .16113 51.5 52.2 43.5 DRA, Whites 1909-11 Male .12326 .14799 .17028 50.2 51.3 42.7 Female .10226 .12545 .14651 53.6 53.6 44.9 DRA, Blacks 1909-11 Male .21935 .27155 .31411 34.0 40.6 33.5 Female .18507 .23303 .27232 37.7 42.8 36.1 DRA, Urban 1909-11 Male .13380 .16247 .18815 47.3 49.1 40.5 Whites Female .11123 .13831 .16266 51.4 52.2 43.5 DRA, Rural 1909-11 Male .10326 .12105 .13777 55.1 54.5 45.9 Whites Female .08497 .10119 .11679 57.4 55.5 46.9 NCHS DRA, Whites 1919-21 Male .08025 .09815 .11158 56.3 54.2 45.6 [1997] Female .06392 .07757 .09279 58.5 55.2 46.5 DRA, Blacks 1919-21 Male .10501 .12782 .14805 47.1 46.0 38.4 Female .08749 .10851 .12851 46.9 44.5 37.2 DRA, Whites 1929-31 Male .06232 .07163 .08262 59.1 55.0 46.0 Female .04963 .05798 .06784 62.7 57.6 48.5 DRA, Blacks 1929-31 Male .08732 .10245 .11588 47.6 44.3 36.0 Female .07204 .08538 .09815 49.5 45.3 37.2 Dublin, et al. [1949] DRA, Urban 1930 Male .06994 56.7 53.1 44.2 Whites Female .05517 61.0 56.4 47.4 DRA, Rural 1930 Male .05537 62.1 57.4 48.3 Whites Female .04423 65.1 59.6 50.4 DRA, Urban 1930 Male .11756 42.2 40.8 33.0 Nonwhites Female .09482 45.6 43.1 35.3 DRA, Rural 1930 Male .08220 50.9 47.7 39.2 Nonwhites Female .06808 51.8 47.5 39.3 NCHS U.S., Total 1939-41 Male .05238 .05762 .06376 61.6 56.1 46.9 [1997] Female .04152 .04621 .05152 65.9 59.7 50.4 Total .04710 .05206 .05780 63.6 57.8 48.5 U.S., Whites 1939-41 Male .04812 .05276 .05850 62.8 57.0 47.8 Female .03789 .04204 .04691 67.3 60.8 51.4 U.S., Blacks 1939-41 Male .08238 .09088 .09918 52.3 48.3 39.5 Female .06584 .07328 .08094 55.6 50.8 42.0 Dublin, et al. [1949] U.S., Cities 100,000+ 1939 Male .04270 61.6 55.3 46.0 Whites Female .03340 66.3 59.4 49.9
Tab. 2
U.S., Other Urban Places 1939 Male .05240 61.4 56.1 47.0 Whites Female .04230 66.2 60.2 50.8 U.S., Rural Areas 1939 Male .05040 64.1 58.7 49.5 Whites Female .03980 67.5 61.3 51.9 U.S., Cities 100,000+ 1939 Male .07650 51.0 46.6 38.0 Nonwhites Female .05980 54.6 49.5 41.0 U.S., Other Urban Places 1939 Male .10050 46.9 44.3 35.8 Nonwhites Female .07930 51.0 47.3 38.9 U.S., Rural Areas 1939 Male .08020 55.2 51.9 43.0 Nonwhites Female .06480 57.2 52.8 44.0 Selected Cities Haines Rochester, NY 1838-42 Male .12727 .29258 40.2 46.0 38.0 & Higgins Female .11340 .22919 41.8 46.3 38.7 [1997] 1853-57 Male .14534 .23457 43.9 48.7 40.6 Female .11883 .19973 47.0 49.9 42.1 Haines Suffolk Co., 1855-56 Total .17384 .34455 34.5 44.4 37.0 MA (Boston) Haines Suffolk Co., 1859-61 Male .18027 .34388 36.3 44.4 36.7 MA (Boston) Female .15940 .29495 39.1 46.8 39.0 Haines Suffolk Co., 1864-66 Male .19414 .28120 .35732 32.3 41.7 34.4 MA (Boston) Female .19747 .28115 .35300 35.6 46.8 39.3 Haines Suffolk Co., 1874-76 Male .20041 .29428 .35731 34.0 45.1 37.5 MA (Boston) Female .18387 .27161 .33309 36.5 47.1 39.9 Billings Boston, Whites 1879-80 Male .21739 .28518 .34218 37.0 47.5 39.6 [1886] Female .18873 .25365 .30823 39.1 48.4 40.7 Haines Suffolk Co., 1884-86 Male .20160 .28245 .33710 34.8 44.0 36.3 MA (Boston) Female .17732 .25915 .31453 37.1 45.9 38.4 Haines Suffolk Co., 1894-96 Male .17870 .26501 .31567 36.0 44.0 36.1 MA (Boston) Female .15023 .23576 .28472 39.8 47.3 39.5 Glover Boston 1900-02 Male .15736 .19875 .24002 41.6 46.0 37.8 [1921] Female .13548 .16983 .21017 45.1 48.5 40.2 Glover Boston 1909-11 Male .13527 .16333 .19050 46.0 47.7 39.1 [1921] Female .11330 .13851 .16181 50.3 50.9 42.4 Haines Suffolk Co., 1929-31 Male .07230 .10094 54.6 51.5 42.5 MA (Boston) Female .07979 .08220 58.4 54.3 45.2 Haines Suffolk Co., 1939-41 Male .0 .1 0094 54 .6 51 .5 42 .5 MA (Boston) Female .07979 .08220 58.4 54.3 45.2
Tab. 2
Haines Philadelphia 1860-61 Total .18531 .32837 37.3 47.9 40.1 Philadelphia 1869-71 Total .21300 .33249 36.2 45.7 38.0 Philadelphia 1879-81 Total .21915 .32047 38.1 46.8 39.0 Philadelphia 1889-91 Total .19668 .29722 39.5 47.6 39.7 Glover Philadelphia 1900-02 Male .15027 .18978 .23006 42.5 46.3 38.1 [1921] Female .12741 .16369 .20232 46.2 49.1 40.9 Glover Philadelphia 1909-11 Male .14174 .17456 .20558 45.5 48.1 39.5 [1921] Female .11926 .14959 .17796 49.6 51.2 42.6 Haines Philadelphia 1919-21 Total .08540 .12526 52.7 51.0 42.5 Philadelphia 1929-31 Total .06304 .08693 57.3 53.2 44.2 Billings New York City 1878-81 Male .26278 .35464 .42751 29.0 42.4 34.4 [1886] Female .22411 .31513 .38744 32.8 45.3 37.3 Billings New York City, 1879-80 Male .23421 .32245 .38085 33.3 44.9 36.6 [1886] Whites Female .20427 .28527 .34167 36.8 46.9 38.6 Billings Brooklyn, 1879-80 Male .19477 .27036 .33101 37.5 48.1 39.8 [1886] Whites Female .16424 .24336 .30545 39.7 49.1 41.0 Glover New York City 1900-02 Male .15673 .20308 .24435 40.6 44.9 36.4 [1921] Female .13298 .17564 .21542 44.9 48.2 39.7 Glover New York City 1909-11 Male .13186 .16799 .19907 45.3 47.4 38.7 [1921] Female .11405 .14762 .17708 49.5 50.9 42.2 Billings Chicago, 1879-80 Male .20526 .27950 .34394 38.1 50.6 42.7 [1886] Whites Female .15107 .22919 .29958 41.3 51.6 43.8 Glover Chicago 1900-02 Male .12010 .15142 .18191 46.3 47.7 39.5 [1921] Female .09762 .12764 .15676 50.8 55.0 42.9 Glover Chicago 1909-11 Male .13066 .16079 .18980 45.9 51.5 39.0 [1921] Female .10431 .13196 .15959 51.7 52.4 43.8 a q(1) is the probability of dying before reaching age 1. It is the infant mortality rate. q(2) and q(5) are the probabilities of dying before reaching ages 2 and 5, respectively. e0, e10, and e20 are the expectations of life at birth and at ages 10 and 20.

Child Mortality and Expectations of Life. United States, 1826-1941

Source : Jaffe & Lourie [1942]. Jacobson [1957]. Meech [1898]. Pope [1992]. Meeker [1972], Table 1. Glover [1921]. Haines [1977, 1979a, 1998]. Preston & Haines [1991], ch. 2. Haines and Preston [1997]. Vinovskis [1972]. Fogel [1986], Table 3. U.S. Bureau of the Census [1886] (Billings). Abbott [1898]. NCHS [1997]. Dublin, Lotka, and Spegelman [1949]. Various Massachusetts, New York, and Philadelphia vital statistics and census data (Haines)
Tab. 3 -

Death Rates in the Rural and Urban Parts of Registration States, 1890 to 1940.(1) (Rates per 1,000 population per annum)

Tab. 3
Overall Death Rates Infant Mortality Rates(2) Child Death Rates (Under 1 year) (1-4 years) Area/Date Rural Urban Ratio of urban to rural Rural Urban Ratio of urban to rural Rural Urban Ratio urban to rural 1890 Connecticut 19.4 23.1 1.19 173.1 233.9 1.35 21.3 33.4 1.56 Massachusetts 17.5 21.0 1.20 138.3 247.9 1.79 17.5 31.3 1.79 New Hampshire 20.3 20.9 1.03 168.8 290.4 1.72 18.2 37.1 2.03 New Jersey 19.6 26.0 1.33 211.9 346.9 1.64 20.7 41.0 1.98 New York 16.1 25.8 1.60 115.5 324.5 2.81 16.2 38.9 2.39 Rhode Island 23.3 23.7 1.02 233.4 300.5 1.29 39.3 37.4 0.95 Vermont 18.4 20.5 1.11 138.9 248.6 1.79 16.7 18.9 1.13 Total (7 states) 18.6 24.6 1.32 162.8 306.1 1.88 19.3 37.4 1.94 All Regis. States 18.8 24.7 1.31 155.4 319.0 2.05 19.6 37.5 1.91 1900 Connecticut 16.9 17.0 1.01 128.9 148.9 1.15 13.4 17.5 1.31 Massachusetts 17.1 17.9 1.05 118.1 170.7 1.45 13.8 22.7 1.65 New Hampshire 17.5 18.8 1.08 131.4 187.4 1.43 13.4 28.7 2.15 New Jersey 15.5 18.8 1.21 129.1 165.9 1.29 15.6 26.4 1.69 New York 15.2 19.2 1.26 96.0 163.4 1.70 11.4 28.2 2.48 Rhode Island 18.8 19.2 1.02 166.3 182.1 1.10 22.6 28.3 1.25 Vermont 16.9 17.6 1.05 103.7 160.6 1.55 10.6 18.4 1.72 Total (7 states) 16.0 18.7 1.17 112.0 165.4 1.48 13.0 26.1 2.00 All Regis. States 15.4 18.6 1.21 108.7 165.8 1.52 12.9 25.5 1.97 1910 Connecticut 15.0 15.9 1.06 Massachusetts 16.1 16.0 0.99 New Hampshire 17.1 17.5 1.02 New Jersey 14.3 16.1 1.13 New York 16.0 16.2 1.01 Rhode Island 16.5 17.2 1.05 Vermont 15.8 17.2 1.09 Total (7 states) 15.7 16.2 1.03 All Regis. States 13.4 15.9 1.18 1920 Connecticut 12.7 13.8 1.09 88.0 92.8 1.05 Massachusetts 14.2 13.7 0.97 82.9 92.3 1.11 New Hampshire 15.4 15.0 0.98 78.3 97.1 1.24 New Jersey 12.8 13.0 1.02 80.8 87.1 1.08 New York 15.2 13.4 0.88 78.2 88.1 1.13 Rhode Island 12.8 14.6 1.14 82.1 93.0 1.13 Vermont 15.5 17.4 1.12 92.1 117.5 1.28 Total (7 states) 14.4 13.5 0.94 81.0 89.6 1.11 All Regis. States 11.9 14.1 1.18 80.5 91.0 1.13 1930 Connecticut 9.7 11.2 1.16 54.3 56.5 1.04 Massachusetts 11.9 11.5 0.97 65.4 59.5 0.91 New Hampshire 13.7 13.4 0.98 21.9 63.5 2.91 New Jersey 11.1 10.6 0.96 57.4 56.2 0.98 New York 12.8 11.4 0.89 59.3 58.7 0.99 Rhode Island 11.2 11.7 1.04 68.4 61.1 0.89 Vermont 12.7 14.7 1.15 63.8 68.5 1.07 Total (7 states) 12.0 11.3 0.94 57.9 58.5 1.01 All Regis. States 10.4 12.3 1.18 66.3 62.8 0.95 1940 Connecticut 7.8 11.9 1.53 32.9 34.2 1.04 0.7 2.3 3.14 Massachusetts 11.1 12.0 1.08 33.9 37.8 1.11 1.3 2.3 1.79 New Hampshire 12.6 12.8 1.02 39.8 40.1 1.01 2.2 3.0 1.40 New Jersey 10.8 10.8 1.00 39.9 34.8 0.87 1.3 2.3 1.81 New York 12.2 10.8 0.89 42.4 36.3 0.86 1.8 2.0 1.16 Rhode Island 9.8 11.4 1.17 40.5 38.1 0.94 0.8 2.5 3.04 Vermont 12.2 16.3 1.34 44.4 46.4 1.04 1.9 2.5 1.30 Total (7 states) 11.3 11.2 0.99 40.6 36.4 0.90 1.5 2.2 1.42 (1) Urban is defined in this table as places with population of 10,000 & over. The exceptions are 1890 and 1900, where the urban thresholds were 5,000 and 8,000 population respectively. Deaths for 1890 adjusted for underregistration according to Condran and Crimmins (1980). (2) Infant deaths (below one year of age) are related to births. Births were estimated for 1890 and 1900 in the census.

Death Rates in the Rural and Urban Parts of Registration States, 1890 to 1940.(1) (Rates per 1,000 population per annum)

Source: U.S. Bureau of the Census (1896), Table 1; (1902), Table 19. Various issues of MORTALITY STATISTICS and BIRTH STATISTICS OF THE UNITED STATES (for 1910-1930). VITAL STATISTICS OF THE UNITED STATES (for 1940). Linder and Grove (1947), Table IV
Tab. 4 -

Mortality Index by Residence. United States, 1900 and 1910

Tab. 4
1900 1910 Residence Mort. Index Total Women Total CEB Implied q(5) Mort. Index Total Women Total CEB Implied q(5) % Decline in q(5) 1900/1910 Ratio to rural 1900 Ratio to rural 1910 Total Population 1.009 13429 41386 0.19287 1.000 46766 172938 0.17800 7.71 1.09 1.06 Urban 1.126 6302 17292 0.21534 1.063 24528 81507 0.18921 12.13 1.22 1.13 Rural 0.923 7023 23742 0.17647 0.942 22172 91132 0.16768 4.98 1.00 1.00 Top 10 Cities 1.144 1765 4934 0.21882 1.168 6294 21275 0.20790 4.99 1.24 1.24 Other Cities 25,000+ 1.281 1781 4874 0.24497 1.070 8454 27277 0.19046 22.25 1.39 1.14 Cities 5,000-24,999 1.099 1408 3763 0.21019 1.032 5069 16921 0.18370 12.61 1.19 1.10 Cities 1,000-4,999 0.927 1348 3721 0.17723 0.942 4711 16034 0.16768 5.39 1.00 1.00 Top 10 Cities (1900) New York City 1.242 667 1932 0.23736 1.218 2524 8828 0.21680 8.66 1.35 1.29 Chicago 1.096 309 820 0.20947 1.089 1111 3714 0.19384 7.46 1.19 1.16 Philadelphia 1.148 229 590 0.21939 1.316 795 2754 0.23425 -6.77 1.24 1.40 St. Louis 0.960 106 324 0.18345 1.016 357 1117 0.18085 1.42 1.04 1.08 Boston 1.327 85 211 0.25369 1.125 334 1114 0.20025 21.07 1.44 1.19 Baltimore 1.256 101 314 0.24008 1.271 284 1004 0.22624 5.76 1.36 1.35 Cleveland 0.576 79 204 0.11018 0.978 286 947 0.17408 -58.00 0.62 1.04 Buffalo 1.030 68 195 0.19700 1.003 211 688 0.17853 9.37 1.12 1.06 San Francisco 0.999 51 114 0.19100 0.861 199 541 0.15326 19.76 1.08 0.91 Cincinnati 1.107 70 230 0.21172 1.200 193 568 0.21360 -0.89 1.20 1.27

Mortality Index by Residence. United States, 1900 and 1910

Source: 1900: Preston and Haines (1991), Table 3.1 1910: Preston, Ewbank, & Hereward (1994), Table 3.2. For an explanation of the child mortality index, see text.
Tab. 5 -

Selected Life Table Values. Massachusetts & Boston/Suffolk County. 1850-1940

Tab. 5
Massachusetts Suffolk Co./Boston (1) Ratio Boston/Massachusetts Dates IMR e(0) e(10) IMR e(0) e(10) IMR e(0) e(10) 1849/51 Males 137.6 42.3 49.8 181.9 28.2 39.3 1.32 0.67 0.79 Females 122.3 43.3 49.0 167.6 30.9 41.2 1.37 0.71 0.84 Both Sexes 130.2 42.9 49.6 174.9 29.5 40.2 1.34 0.69 0.81 1854/56 Both Sexes 130.7 43.8 49.5 173.6 34.1 43.6 1.33 0.78 0.88 1859/61 Males 142.4 43.5 49.6 180.3 36.3 44.5 1.27 0.83 0.90 Females 123.7 45.1 49.7 159.4 39.1 46.8 1.29 0.87 0.94 Both Sexes 133.4 44.3 49.7 170.1 37.7 45.7 1.28 0.85 0.92 1864/66 Males 160.0 38.4 45.8 194.1 32.3 41.7 1.21 0.84 0.91 Females 142.7 41.6 48.7 197.5 35.6 46.8 1.38 0.86 0.96 Both Sexes 151.8 40.1 47.3 195.8 34.0 44.4 1.29 0.85 0.94 1874/76 Males 179.4 40.0 48.9 200.4 34.0 45.1 1.12 0.85 0.92 Females 154.5 41.8 49.4 183.9 36.5 47.1 1.19 0.87 0.95 Both Sexes 167.3 40.8 49.1 192.3 35.3 46.1 1.15 0.87 0.94 1879/81 Males 170.8 41.7 49.5 196.0 35.9 45.6 1.15 0.86 0.92 Females 145.7 43.3 49.6 173.1 37.9 46.9 1.19 0.88 0.95 Both Sexes 158.5 42.5 49.6 184.8 36.9 46.3 1.17 0.87 0.93 1884/86 Males 169.2 41.9 49.0 201.6 34.8 44.0 1.19 0.83 0.90 Females 145.1 43.9 49.8 177.3 37.1 45.9 1.22 0.85 0.92 Both Sexes 157.4 42.9 49.4 189.8 36.0 45.0 1.21 0.84 0.91 1894/96 Males 174.7 42.1 49.2 178.7 36.0 44.0 1.02 0.86 0.89 Females 146.6 44.8 50.6 150.2 39.8 47.3 1.02 0.89 0.93 Both Sexes 170.0 43.5 49.9 164.8 37.8 45.6 0.97 0.87 0.91 1900/02 Males 158.8 46.1 50.2 157.4 41.6 46.0 0.99 0.90 0.92 Females 131.2 49.4 52.1 135.5 45.1 48.5 1.03 0.91 0.93 1904/06 Males 151.2 46.6 50.5 156.9 42.3 46.7 1.04 0.91 0.92 Females 122.8 50.4 52.7 124.5 46.9 49.8 1.01 0.93 0.94 Both Sexes 137.4 48.5 51.6 141.2 44.6 48.2 1.03 0.92 0.93 1909/11 Males 137.1 49.3 51.1 135.3 46.0 47.7 0.99 0.93 0.93 Females 113.0 53.1 53.6 113.3 50.3 50.9 1.00 0.95 0.95 1914/16 Males 113.0 51.2 51.4 108.8 47.9 48.1 0.96 0.94 0.94 Females 91.7 55.2 54.3 90.7 52.3 51.8 0.99 0.95 0.95 Both Sexes 102.6 53.2 52.9 100.0 50.0 49.9 0.97 0.94 0.94 1929/31 Males 65.4 58.9 55.0 72.3 54.6 51.5 1.11 0.93 0.94 Females 52.4 62.3 57.5 55.8 58.4 54.3 1.06 0.94 0.94 Both Sexes 59.1 60.6 56.3 64.2 56.5 52.9 1.09 0.93 0.94 1939/41 Males 41.4 63.2 56.8 45.2 60.8 54.5 1.09 0.96 0.96 Females 31.7 67.5 60.5 33.2 65.7 58.7 1.05 0.97 0.97 Both Sexes 36.7 65.4 58.7 39.2 63.2 56.6 1.07 0.97 0.96 (1) City of Boston for 1900/02 and 1909/11. Otherwise, Suffolk County.

Selected Life Table Values. Massachusetts & Boston/Suffolk County. 1850-1940

Source: 1900/02 & 1909/11, Glover (1921). Other life tables calculated from the state and federal censuses of Massachusetts and the vital statistics of Massachusetts.
Tab. 6 -

Infant Mortality Rate, by Residence & Race. Birth Registration Area, 1915-1932. United States, 1933-1940

Tab. 6
Total Cities 10,000 & Over Cities 2,500 to 9,999 Rural Ratio of Urban to Rural Year Total White Nonwhite Total White Nonwhite Total White Nonwhite Total White Nonwhite Total White Nonwhite 1915 99.9 98.6 181.2 103.3 101.6 181.0 94.4 93.8 182.2 1.09 1.08 0.99 1916 101.0 99.0 184.9 103.7 101.8 176.6 96.7 94.6 202.8 1.07 1.08 0.87 1917 93.8 90.5 150.7 99.6 96.4 185.3 87.9 84.3 133.5 1.13 1.14 1.39 1918 100.9 97.4 161.2 108.1 104.7 196.8 93.7 89.8 142.8 1.15 1.17 1.38 1919 86.6 83.0 130.5 89.3 86.3 147.6 84.1 79.7 122.8 1.06 1.08 1.20 1920 85.8 82.1 131.7 91.0 87.5 158.5 80.5 76.3 118.1 1.13 1.15 1.34 1921 75.6 72.5 108.5 77.6 74.7 128.2 73.6 70.1 99.8 1.05 1.07 1.29 1922 76.2 73.2 110.0 79.9 77.3 127.0 72.4 68.7 101.7 1.10 1.12 1.25 1923 77.1 73.5 117.4 78.2 74.5 138.1 76.0 72.3 106.0 1.03 1.03 1.30 1924 70.8 66.8 112.9 72.4 68.7 126.6 69.2 64.7 104.9 1.05 1.06 1.21 1925 71.7 68.3 110.8 73.0 69.4 125.0 70.3 67.2 100.5 1.04 1.03 1.24 1926 73.3 70.0 111.8 74.2 70.5 127.2 72.4 69.4 100.8 1.02 1.02 1.26 1927 64.6 60.6 100.1 65.0 61.0 113.1 64.1 60.3 92.3 1.01 1.01 1.23 1928 68.7 64.0 106.2 69.2 64.6 121.3 68.3 63.4 98.5 1.01 1.02 1.23 1929 67.6 63.2 102.2 66.2 61.9 114.4 68.8 64.4 95.9 0.96 0.96 1.19 1930 64.6 59.6 102.4 62.8 58.4 110.7 66.3 60.9 97.9 0.95 0.96 1.13 1931 61.6 56.7 95.6 61.0 56.4 105.4 62.2 57.1 90.2 0.98 0.99 1.17 1932 57.6 53.3 86.2 56.7 52.5 95.5 58.4 54.1 81.3 0.97 0.97 1.17 1933 58.1 52.8 91.3 57.1 52.4 97.8 59.6 54.5 107.2 58.8 52.9 85.8 0.97 0.99 1.14 1934 60.1 54.5 94.4 58.1 53.4 99.2 62.4 57.7 102.9 61.5 55.0 90.7 0.94 0.97 1.09 1935 55.7 51.9 83.2 54.0 50.5 89.5 58.6 56.1 91.9 57.0 52.4 79.1 0.95 0.96 1.13 1936 57.1 52.9 87.6 55.3 51.3 96.8 60.5 57.4 107.1 58.4 53.6 81.0 0.95 0.96 1.19 1937 54.4 50.3 83.2 52.0 48.3 89.8 57.7 54.2 105.7 56.5 51.9 77.2 0.92 0.93 1.16 1938 51.0 47.1 79.1 47.9 44.5 82.9 55.3 52.0 103.0 53.7 49.1 74.5 0.89 0.91 1.11 1939 48.0 44.3 74.2 45.3 42.2 75.8 51.6 48.5 94.6 50.5 45.9 71.1 0.90 0.92 1.07 1940 47.0 43.2 73.8 43.8 40.7 75.5 51.0 48.1 89.4 50.3 45.6 70.7 0.87 0.89 1.07

Infant Mortality Rate, by Residence & Race. Birth Registration Area, 1915-1932. United States, 1933-1940

Source: Birth Statistics of the United States, 1915-1936. Vital Statistics of the U.S., 1937-1940.
Table A-1 -

Growth of Birth- and Death-Registration Area 1900 to 1933 (Coterminous United States, midyear populations)

Table A-1
Birth Registration Area Death Registration Area Total U.S. Year Population (thousand) Population (thousand) % of Total Number of States(1) Population (thousand) % of Total Number of States(1) 1900 76,094 19,965 26.2 11 1901 77,585 20,237 26.1 11 1902 79,160 20,583 26.0 11 1903 80,632 20,943 26.0 11 1904 82,165 21,332 26.0 11 1905 83,820 21,768 26.0 11 1906 85,437 33,782 39.5 16 1907 87,000 34,553 39.7 16 1908 88,709 38,635 43.6 18 1909 90,492 44,224 48.9 19 1910 92,407 47,470 51.4 21 1911 93,868 53,930 57.5 23 1912 95,331 54,848 57.5 23 1913 97,227 58,157 59.8 24 1914 99,118 60,963 61.5 25 1915 100,549 31,097 30.9 11 61,895 61.6 25 1916 101,966 32,944 32.3 12 66,971 65.7 27 1917 103,266 55,198 53.5 21 70,235 68.0 28 1918 103,203 55,154 53.4 21 79,008 76.6 31 1919 104,512 61,212 58.6 23 83,158 79.6 34 1920 106,466 63,597 59.7 24 86,079 80.9 35 1921 108,541 70,807 65.2 28 87,814 80.9 35 1922 110,055 79,561 72.3 31 92,703 84.2 38 1923 111,950 81,072 72.4 31 96,788 86.5 39 1924 114,113 87,000 76.2 34 99,318 87.0 40 1925 115,832 88,295 76.2 34 102,032 88.1 41 1926 117,399 90,401 77.0 36 103,823 88.4 42 1927 119,038 104,321 87.6 41 107,085 90.0 43 1928 120,501 113,636 94.3 45 113,636 94.3 45 1929 121,770 115,317 94.7 47 115,317 94.7 47 1930 123,077 116,545 94.7 47 117,238 95.3 48 1931 124,040 117,455 94.7 47 118,149 95.3 48 1932 124,840 118,904 95.2 48 118,904 95.2 48 1933 125,579 125,579 100.0 49 125,579 100.0 49 (1) Includes the District of Columbia.

Growth of Birth- and Death-Registration Area 1900 to 1933 (Coterminous United States, midyear populations)

Source: U.S. Bureau of the Census (1975), p. 44
Table A-2 -

Dates of Entry to the Birth & Death Registration Areas. United States. 1900 to 1933

StateBirth Registration AreaDeath Registration AreaNotes
Alabama19271925
Arizona19261926
Arkansas19271927
California19191906
Colorado19281906
Connecticut19151900
Delaware19211919
Dist. Columbia19151900
Florida19241919
Georgia19281922(1)
Idaho19261922
Illinois19221918
Indiana19171900
Iowa19241923
Kansas19171914
Kentucky19171911
Louisiana19271918
Maine19151900
Maryland19161906
Massachusetts19151900
Michigan19151900
Minnesota19151910
Mississippi19211919
Missouri19271911
Montana19221910
Nebraska19201920
Nevada19291929
New Hampshire19151900
New Jersey19211900
New Mexico19291929
New York19151900
North Carolina19171916(2)
North Dakota19241924
Ohio19171909
Oklahoma19281928
Oregon19191918
Pennsylvania19151906
Rhode Island19151900(3)
South Carolina19191916(4)
South Dakota19321930(5)
Tennessee19271917
Texas19331933
Utah19171910
Vermont19151900
Virginia19171913
Washington19171908
West Virginia19251925
Wisconsin19171908
Wyoming19221922
(1) Georgia withdrew from the DRA for the years 1925-1927.
(2) North Carolina reported deaths in places of 1,000 & over for the years 1910-1915.
(3) Rhode Island withdrew from the BRA for the years 1919-1920.
(4) South Carolina withdrew from the BRA for the years 1925-1927.
(5) South Dakota was briefly in the DRA for the years 1906-1909.

Dates of Entry to the Birth & Death Registration Areas. United States. 1900 to 1933

Notes

  • [*]
    Michael R. Haines is Banfi Vintners Professor of Economics, Department of Economics, Colgate University, Hamilton, NY and Research Associate, National Bureau of Economic Research, Cambridge, MA. This paper was prepared for “The Demographic Forum 1999”, Oslo, Norway, June 10-13, 1999 and for the 19th International Congress of Historical Sciences, Oslo, Norway, August 6-13, 2000. This research was funded in part by the National Institute of Aging AG 10120.
  • [1]
    Appendix Tables A-1 and A-2 provide some characteristics of the Death and Birth Registration Areas and the dates at which various states entered.
  • [2]
    The mortality data come from Rosenwaike (1972). The population data come from the federal and state censuses for New York.
  • [3]
    The data are from Shattuck (1846) and from various reports of the vital statistics of Massachusetts. Federal and state censuses were used to make the annual population estimates.
  • [4]
    The vital data originated in the compilation of vital data in Klepp (1991) and in various volumes of the Mayor’s Reports. Annual population estimates are based on federal census returns. Adjustments were made for the changing boundaries of the city.
  • [5]
    These data come from Howard (1924).
  • [6]
    The mortality statistics were furnished by Jonathan Pritchett and come from various city reports (Pritchett and Tunali, 1995). The population estimates were based on federal census results.
  • [7]
    Despite the fact that these data undercount actual deaths by about 40%, they are usable (Haines, 1979). It is likely that differences in reporting were consistent across space.
  • [8]
    See Appendix Tables A-1 and A-2.
  • [9]
    The estimates actually apply to a period about five to six years before each census, i.e. 1894 and 1904 respectively.
  • [10]
    For more precise details on the calculation of the index, see Haines and Preston (1997), Appendix.
  • [11]
    It should be noted that there are compositional effects here, since the set of cities differs between 1900 and 1910 because of population growth.
  • [12]
    Boston made up about 90% or more of the population of Suffolk County throughout.
  • [13]
    Boston was 95% of the population of Suffolk County in 1850, and Suffolk County was 14.5% of the population of Massachusetts at the same date. The same percentages were 89% and 21% for 1930.
  • [14]
    One is constrained to use the categories in which the data are presented. Clearly 10,000 and over is a rather high urban threshold.
  • [15]
    See Appendix Table A-1.
  • [16]
    The data reported in the vital statistics did not report race separately outside the South.
  • [17]
    On the effects of immigrants on mortality, see Higgs (1979), Meckel (1985) and Preston and Haines (1991), passim. On the “commercial revolution” in antebellum America, see Haines, Craig, and Weiss (2000).
English

Summary

In the United States in the xixth and early xxth centuries, there was a substantial mortality “penalty” to living in urban places. This circumstance was shared with other nations. By around 1940, this penalty had been largely eliminated, and it was healthier, in many cases, to reside in the city than in the countryside. Despite the lack of systematic national data before 1933, it is possible to describe the phenomenon of the urban mortality transition. Early in the xixth century, the United States was not particularly urban (only 6.1% in 1800), a circumstance which led to a relatively favorable mortality situation. A national crude death rate of 20-25 per thousand per year would have been likely. Some early data indicate that mortality was substantially higher in cities, was higher in larger relative to smaller cities, and was higher in the South relative to the North. By 1900, the nation had become about 40% urban (and 56% by 1940). It appears that death rates, especially in urban areas, actually rose (or at least did not decline) over the middle of the xixth century. Increased urbanization, as well as developments in transport and commercialization and increased movements of people into and throughout the nation, contributed to this. Rapid urban growth and an inadequate scientific understanding of disease processes contributed to the mortality crisis of the early and middle nineteenth century in American cities. The sustained mortality transition only began about the 1870s. Thereafter the decline of urban mortality proceeded faster than in rural places, assisted by significant public works improvements and advances in public health and eventually medical science. Much of the process had been completed by the 1940s. The urban penalty had been largely eliminated and mortality continued to decline despite the continued growth in the urban share of the population.

Français

Résumé

Si l'on considère le niveau de la mortalité, vivre dans les villes constituait un handicap dans les États-Unis du xixe et du début du xxe siècle, tout comme dans d'autres pays. Vers 1940, non seulement cette surmortalité a disparu mais, dans de nombreux cas, il est devenu plus sain de vivre dans les villes qu'à la campagne. En dépit de l'absence de données systématiques avant 1933, il est possible de décrire le phénomène de la transition de la mortalité urbaine. Au début du xixe siècle, la population des États-Unis n'était pas particulièrement urbaine (6,1% en 1800), ce qui conduisait à une situation relativement favorable de la mortalité : probablement 20-25 pour mille de taux brut de mortalité. Les données les plus anciennes indiquent néanmoins que la mortalité était plus élevée dans les villes, plus forte dans les grandes que dans les petites villes, et dans le Sud que dans le Nord. Vers 1900, la population est à 40 % urbaine et cette proportion grimpe à 56 % en 1940. Les taux de mortalité, en particulier dans les zones urbaines, s'élèvent, ou tout au moins stagnent, à partir du milieu du xixe siècle. La progression de l'urbanisation, le développement des transports et du commerce, les plus fortes migrations internes mais aussi internationales ont contribué à ce phénomène. La croissance urbaine rapide et une méconnaissance des processus morbides contribuèrent à laisser libre cours aux crises de mortalité des villes américaines jusque vers le milieu du xixe siècle. La transition de la mortalité se met seulement en place dans les années 1870. Désormais, la baisse de la mortalité urbaine est plus rapide que celle des campagnes, soutenue par les progrès des travaux publics, des avancées de la santé publique et peut-être de la médecine. La majeure partie du processus est achevée dans les années 1940. Le handicap urbain a été largement éliminé et la mortalité continue à baisser en dépit de la poursuite de la croissance de la part de population urbaine.

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Michael R. Haines
Department of Economics
Colgate University
13 Oak Drive
Hamilton, NY 13346 USA
mhaines@ mail. colgate. edu
Mis en ligne sur Cairn.info le 01/09/2005
https://doi.org/10.3917/adh.101.0033
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