Public goods and health inequality: lessons from Paris, 1880-1914.

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, income, and connection to sewer 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.