Clean water provision is considered crucial for eradicating waterborne diseases. However, the benefits of piped water can be limited in environments characterized by the inadequate storage and disposal of waste. This article studies the impact of waterworks and sewerage on mortality in German cities during the period 1877–1913. The results show that the supply of safe drinking water reduced the number of deaths, although to a lower extent than suggested previously. In the absence of efficient systems of sewage removal, contact with faeces and water contamination created a favourable environment for the spread of enteric ailments, offsetting some of the positive effects of waterworks. Moreover, the study shows that sanitary investments had important heterogeneous effects. First, their impact was markedly lower in municipalities with high levels of economic inequality and employment in the textile sector. Second, cities located in non‐Prussian territories experienced lower declines in mortality following the construction of sanitary infrastructures. The results in this article highlight the importance of analysing public health measures jointly as well as their interaction with local socioeconomic and institutional factors to understand historical progress against ill health and premature death.

中文翻译：

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1877年至1913年，德国的卫生基础设施和死亡率下降†

提供干净的水被认为对于消除水传播疾病至关重要。但是，在以废物的存储和处置不足为特征的环境中，自来水的益处可能受到限制。本文研究了1877年至1913年期间，自来水厂和污水处理系统对德国城市死亡率的影响。结果表明，安全饮用水的供应减少了死亡人数，尽管程度低于先前的建议。在缺乏有效的污水清除系统的情况下，粪便和水的污染为肠道疾病的传播创造了良好的环境，抵消了自来水厂的某些积极影响。此外，研究表明，卫生投资具有重要的异质性影响。第一，在具有高度经济不平等和纺织部门就业机会的城市，其影响明显较小。其次，由于卫生基础设施的建设，位于非普鲁士领土上的城市死亡率下降的幅度较小。本文的结果强调了共同分析公共卫生措施以及它们与当地社会经济和制度因素之间的相互作用的重要性，以了解对抗不良健康和过早死亡的历史进展。