The global sanitary revolution in historical perspective

This survey sheds light on the causes and consequences of the global sanitary revolution that resulted in the spread of waterworks and sewerage projects since the middle of the 19th century, by drawing on research from the fields of economic history, economics, and history. I begin with a discussion of the construction of these infrastructures during the period ca. 1850–1950 showing that their spread was relatively similar in major urban cities across the globe, while diffusion within and between countries, as well as within cities themselves, was markedly unequal. Second, I review research estimating the mortality impact of access to clean water and sanitation. Following the provision of these services, infant mortality declined between ca. 10 and 30 percent. Lastly, I examine the drivers of the sanitary revolution with a new framework that distinguishes between proximate factors (e.g., physical capital) and ultimate factors (e.g., institutions). I argue that the state of knowledge in the literature is insufficient to explain between- and within country differences in access to sanitary services and that more attention should be devoted to the interaction of political and economic factors within broader institutional, cultural and biogeographic contexts.