Intra-Urban Health Disparities: Survival in the Wards of 19th-Century American Cities

Survival rates were low in large 19th-century American cities. We ask whether this was attributable to a few “bad” wards or whether urban wards were uniformly bad. The paper employs two datasets. The Union Army database has been augmented with veterans who enlisted in and/or resided in Boston, Chicago, New York City (including Brooklyn), and Philadelphia. Additionally, the Historical Urban Ecology (HUE) database has been created containing ward-level data on health indicators, the expansion of public infrastructure, and socio-economic indicators. These data are used to construct a “Ward Development Index” which identifies “good” versus “bad” wards and is part of hazard ratio regressions. Preliminary results suggest there is little difference between good and bad wards in 1860. By 1900, however, the urban mortality penalty remains in bad wards and is much reduced in good wards. Understanding why this difference emerged is vital to understanding the urban mortality transition. Most economic historians are aware that in the late nineteenth century urban areas were far less healthy places to live than rural areas, but far fewer are aware that urban health conditions varied more within America’s largest cities than between them. Within the cities, measured death and reportable disease rates by wards—the cities’ most common political division— demonstrated wide disparities between the “best” and “worst” wards with respect to a variety of indicators. For example, in 1890 the average gap in the infant death rate between wards of cities was 317 per 1,000, while the average gap between cities was 165 infant deaths per 1,000.