Basically, what I am asking is whether clean water and sewage contributed more to increasing life span than advances in medicine. The latter includes, but is not limited to, antibiotics and vaccines.
Also food access and dental care should be on the list.
Hmmm.. I’d guess medicine if we’re including antibiotics and vaccines. Related (and I think significant) are the rates of death in childbirth, either of the mother or the child.
One way to find out might be to find similar villages where new medicines were introduced but not new sanitation methods and compare them to villages where both were introduced. Though the two together might be something larger than the sum of its parts.
Medicine. Because, even in the most sanitized, sterile places, you’ll still encounter enough bacteria that you could get an infection. For that, you need antibiotics and whatnot to kill what’s already gotten into and ailing your body.
Through the early 19th Century, life expectancy was stuck at around 40 years. In the next hundred years, life expectancy increase to about age 50. That was the period of sanitation and the first vaccines.
Since World War 2, life expectancy has increased to about 73, double the increase of the previous century, and it coincides with antibiotics, improved surgical practices and earlier, more accurate diagnostics.
Medicine (especially antibiotics) can compensate for a lot of bad sanitation. Good sanitation only address a few of the ills that can be treated by medicine. In other words, medicine is duplicative of the advantages sanitation provides, but not really the other way around.
On the other hand, good sanitation is often more affordable/available than good medication, so on a global scale I can imagine sanitation having more influence on longevity.
India wiped out polio in just a couple decades using modern medicine (vaccine). Sanitation during that time didn’t improve much.
(I bring this up because anti-vaxxers claim “better sanitation” is responsible for less people dying from diseases, and not vaccines. They’re completely wrong, and wiping out polio in India is one example that proves they’re wrong.)
The cite I’ve heard is that life expectancy grew in the developed world by 30 years in the 20th century. Public health added 25 years to life expectancy in the 20th century, while medicine added 5 years to life expectancy.
Medicine is broken down into primary care and pharmaceuticals (18 months) while hospitals added 42 months.
That info is from this book from what I remember.
Looking online, the book got it from this.
During the 20th century, the health and life expectancy of persons residing in the United States improved dramatically. Since 1900, the average lifespan of persons in the United States has lengthened by greater than 30 years; 25 years of this gain are attributable to advances in public health (1). To highlight these advances, MMWR will profile 10 public health achievements (see box) in a series of reports published through December 1999.
However public health includes vaccines. According to this article that is behind a paywall, supposedly about half of the increase in public health was from clean water and sanitation.
So about half of that 25 years was probably due to clean water and sanitation while the other half was other public health initiatives (vaccines, safer cars, quarantines, food safety, adding micronutrients to foods, etc)
They’re not wrong to credit public health achievements; they are wrong to discount the impact of vaccination programs and effective interventions. BOTH are currently under threat.
Public health interventions have been, and are, of major impacts. My favorite one:
Garland Brinkley, an associate professor of public health at Touro University in California, argues that hookworm disease worsened in the years following the Civil War, thanks to deteriorating conditions and economic setbacks, and that the rise of those parasites only served to slow recovery even further. Following the war, poverty and hookworms were even more closely linked. While wealthy and city-bred Southerners in the late 19 th and early 20 th century wore shoes and used bedpans, those of a more modest social standing often went barefoot and either used latrines or went in the woods. Many poor Southerners were also renters and did not have control over the land they lived on or the services provided there. “Your Mimi,” my mom often points out, “was raised without a toilet.” …
… Stiles was convinced that ridding the South of hookworms would make the region more productive, but local doctors would not listen, dismissing him as arrogant or pointing out that his expertise was in animals, not people. “He was an interesting guy, but testy and hard to like,” Ettling says. “He didn’t suffer fools.”
Word of Stiles and his discovery, however, soon reached John D. Rockefeller, who was actively looking for a certain type of philanthropy project. Hookworms fit the bill. “Rockefeller didn’t want to put money into things that would bring the American capital system into question, like income inequality,” Ettling says. “Health, on the other hand, is not controversial: no one wants their kids growing up sick.”
Southerners, however, were not on board in the beginning. …
… All sat and listened to the doctor’s presentations about hookworms—usually carried out on a Saturday or Sunday so no one would have to miss work—and to his instructions about how to build a proper outhouse to avoid re-infection. “The doctors couldn’t give the townspeople indoor plumbing and running water, but they could teach them how to construct what they called sanitary privies,” Ettling says. “And they couldn’t buy everyone shoes, but they could tell people to be careful about where they walk.”
Those who tested positive were sent home with Epsom salt and thymol—frequently their first encounter with pharmaceuticals …
… By 1985, hookworm had all but disappeared in the South, thanks to a combination of factors: a rise in cheap but relatively healthy food, an increase in indoor plumbing, Franklin Roosevelt’s New Deal, a push toward urbanization, the end of sharecropping following World War II, and the advent of agricultural mechanization. “The reason hookworm is not a scourge today is because people live in cities, wear shoes, eat better than they did 110 years ago, and have indoor plumbing,” Ettling says. “Those factors, more than anything else, are responsible for the fact that hookworm is no longer a major problem in this country.” …
Public health is an aspect of medicine, not separate of it; immunization programs and infrastructure/environmental improvements are synergistic.
Yeah but the question was about what increased longevity. Polio only kills about 1 out of every 1000 people it infects so its impact on overall life expectancy is probably only a few weeks.
A lot of what medicine does isn’t about improving longevity, it is about improving healthspan and quality of life. Polio vaccines help with that, but they don’t really improve life expectancy since most people don’t die from polio.
Smallpox eradication by comparison probably added much more to life expectancy.
I don’t mean to dominate the thread, but now that I look into it more, its closer and more interesting.
Supposedly clean water and sanitation added ~7-15 years to life expectancy.
But all medicine adds ~5 years. However if we didn’t have vaccines, I’m sure medicine would add more years by treating bacterial infections with antibiotics and antivirals. If we didn’t have a smallpox vaccine, we’d still have various drugs like tecovirimat that work against smallpox.
All vaccines combined supposedly added several years to life expectancy.
Basically, I don’t know. It sounded cut and dried but if people were constantly getting various pathogenic infections from unclean water and sewage, theres a lot of medications to help with those.
Point being, that 7-15 years of life expectancy added would likely be a smaller number (not sure by how much) if people had access to antibiotics, antivirals and supportive care (like hydration therapy for cholera).
Got to disagree. Basic medicines are way easier to distribute than clean water and sewerage systems are to install. Plenty of places without running water where the kids are nevertheless vaccinated.
Are we counting surgery and medical devices as “medicine”? Appendectomies, pacemakers, respirators, transfusions?
And what about food hygiene? Does that come under sanitation?
“Life expectancy” is largely driven by infant and young child mortality. Due to the statistical leverage exerted by dying very young, a modest decrease in infant mortality rates can add many years to statistical “life expectancy” even though people who survive to age 10 don’t live any longer than they used to.
Both sanitation and vaccination greatly reduced the once horrific toll of contagion that often killed the very young. Vaccination more through the herd effect than through actually vaccinating the very young. vaccination was what got them from ages e.g. 2 to 10.
Actually polio is a bad example. Until modern sanitation came along virtually everyone caught polio during the first year of life and it was very rarely paralytic. When it was, it was called infantile paralysis, which is what polio was called when I was growing up. With the growth of modern sanitation, more and more people caught it a later age when it was much more severe. In an infant it was typically just a cold.
Incidentally, I once saw an exhibit about the development of modern American and Canadian cities (it was at the Montreal architecture museum) that made the point that it was during the second half of the 19th century that water and sewage systems became ubiquitous and that landlords fought it every inch of the way. It was anathema to them that they should pay taxes whose only purpose was to make their tenants healthier.
It could also be instructive to compare life expectancy in notoriously crowded and filthy premodern cities with that in rural areas that were recognized to be cleaner and healthier. Except when you had an actual infectious disease epidemic ravaging the city, AFAIK there’s not much difference.
My knowledge is pretty much confined to early modern England, but there definitely was a difference. London could not have sustained its population without a steady stream of immigrants from the countryside, because the death rate was actually higher than the birth rate, which wasn’t the case elsewhere in the country.
Aha, TIL, thanks!
This observation also explains why sanitation and other infrastructure improvements and immunization worked synergistically.
Point being that herd effect and sanitation both work to reduce exposures. Herd effect is very difficult to achieve if there is still constant exposure by poor sanitation or otherwise. With decent sanitation it is more achievable.