Were the public health gains associated with the onset of contemporary hygiene norms constrained by barriers to household adoption? I document the evolution of modern hygiene recommendations (e.g., frequent handwashing to prevent disease) that diffused during the New Public Health Era of the 1910s and were made highly salient by the Influenza Pandemic of 1918. Combining household survey data detailing hygiene-related consumption behavior (i.e., soap) and household infrastructure (i.e., running water availability), I exploit the sharp timing of the pandemic’s onset during the survey period to first show that households responded strongly in ways consistent with modern hygiene guidance. Consumption responses, however, appear to have been moderated by household infrastructure availability. Moreover, despite strikingly similar levels and trends in the years leading up to the pandemic, municipal infectious disease mortality rates improved considerably for cities with greater average household infrastructure access relative to those with less in the years following, and these gaps persisted over the long run. Finally, I show the mortality effects appear to be fully driven by variation in “last-mile” rather than “penultimate-mile” access, contributing to the debate over whether private, within-home running water access is necessary or whether shared access is sufficient to meaningfully improve health outcomes.

Workers’ compensation was the first widespread social insurance program in the United States (Fishback & Kantor, 2000), but its long-run effects on injured workers and their families are not well understood. We examine this by leveraging quasi-random variation in both mining accidents and access to workers’ compensation for families in the early-20th-century United States. Matching detailed individual-level data on coal mining accidents with linked Census data, we study how access to workers’ compensation payments may have narrowed income and education gaps between children whose father died in a mining accident and similar children whose father survived. To illuminate possible mechanisms, we also examine effects of access to workers’ compensation on deceased miners’ surviving spouses.  

The prominent decline in urban mortality rates during the late 19th and early 20th centuries in the United States is primarily attributed to reductions in deaths caused by infectious and food- and waterborne diseases. While existing literature has explored the role of public health initiatives in explaining this decline from the latter of these types, this paper focuses on the contribution of innovations in and provision of hygienic technologies and their role in eradication of the former. Specifically, we investigate the health impact of the rapid adoption and utilization of bathhouses in urban working-class neighborhoods following the technological advancement of what we recognize today as the modern-day shower. By exploiting differential timing of bathhouse openings beginning around 1890 and utilizing city-level mortality data for U.S. urban areas, we estimate the mortality effects of these facilities introduced prior to the widespread adoption of modern household sanitation infrastructure and critical implications generated by the germ theory of disease. This paper highlights the role that hygienic infrastructure and behavior may have played in improving public health, shedding light on mechanisms policy makers can utilize when designing interventions aimed at encouraging behavioral take-up today.