Sanitary Conditions affect Demographic Modernisation


Mortality, especially child and infant mortality, reduced dramatically and life expectancy increased substantially. Hannaliis Jaadla, researcher at Tallinn University and University of Cambridge, illuminated a variety of risk factors affecting the survival of historical urban population in Tartu[1].

Jaadla identified the strong association between the source of water supply and infant survival as one of the most important contributions of her dissertation. “In late 19th century, the first year of life was still the most precarious. The results revealed considerable variation in infant mortality in view of the parents’ demographic, socio-economic and cultural characteristics,” she explained, “being born out of wedlock and using water from the river appeared to be the strongest risk factors for infant death.”

Children had the best chances of survival in households that drew water from artesian wells. Moreover, an elevated risk of infant death was also associated with outdoor privies, cesspits, and unpaved yards. “Although none of these results were unexpected, very few studies have previously been able to link historical mortality outcomes and sanitary conditions on an individual level,” Jaadla said.

Infant mortality rates (per 1,000 live births) in the neighbourhoods of Tartu, 1897–1900. Base map: Berendsen and Maiste (1999).
Infant mortality rates (per 1,000 live births) in the neighbourhoods of Tartu, 1897–1900. Base map: Berendsen and Maiste (1999).

Importance of Public Wells

Allan Puur, Research Professor at the Estonian Institute for Population Studies, University of Tallinn, and thesis supervisor, noted that the dissertation has contributed to bridging the gap between research in demography and social history, bringing benefits to both disciplines. “For demography, the evidence obtained from unique micro-level data has helped to establish a link between demographic outcomes and the inner workings of a society. This link enables the mechanisms that drove early demographic modernisation in the country to be charted to a greater degree,” Puur said.

He added that for social history, variation in demographic measures (death risks) allows the dynamics and differentials of well-being and inequality to be approximated in view of periods for which other measures (incomes, poverty rates, etc.) are not available. “It is anticipated that this could provide improved knowledge about the outcomes of extensive societal change in Estonia in the 19th century for the field of social history,” he explained.

Jaadla mentioned that previous historical studies addressing sanitary conditions have all investigated periods that followed the development of modern waterworks and sewers. The large differences in infants’ survival related to water supply in Tartu suggest that moving away from using surface water may have significantly reduced mortality risks before the construction of central piped water supply and sewer systems (in Tartu only in the 1930s).

Therefore, besides building waterworks and sewer systems, which require heavy investments and technological skills, reducing the consumption of surface water, constructing public wells, and improving basic sanitation facilities should not be overlooked as low-cost solutions with the potential to contribute to a mortality decline according to Jaadla.

Unique Data

Jaadla also analysed adult mortality and focussed on its associations with socio-economic status and ethnicity. “Surprisingly, the adult mortality advantage associated with a higher occupational and educational status was wholly driven by women,” she explained, “men in the upper social strata exhibited no substantial advantage. Having secondary or tertiary education provided no further improvement for men, however, the lack of primary education implied further disadvantage.”

She added that this sex-specific gradient supports the argument that lifestyle factors such as the excessive consumption of food, tobacco, and alcohol might have cancelled out the beneficial influence of greater resources associated with a higher socio-economic status for men. “Even in settings of low living standards and marked social inequality, socio-economic advantages did not automatically translate into survival advantages and additional factors, plausibly those related to lifestyle and health behaviour, need to be taken into consideration,” Jaadla noted.

Jaadla said that despite a large body of literature about changes in mortality during the late 19th century in most parts of Europe, the understanding of the levels and, particularly, differentials of mortality is still limited for Eastern European countries, including Estonia.

In her research she exploited new individual-level data sources. The data on vital events was retrieved from the baptism and burial registers of all the Lutheran parishes in Tartu and digitised. Jaadla explained that the collection of census materials from the first Russian Imperial Census in 1897 provides an individual-level insight into demographic, socio-economic and cultural characteristics for the entire population of the town and includes household-level information on sanitary conditions. “This additional information on sanitary conditions, originally collected by Körber, Professor of Hygiene, University of Tartu, makes my data especially unique for the time period,” she added.

Paths of Demographic Modernisation

Allan Puur mentioned that the applicability of the results helps to improve the knowledge about Estonia’s long-term development. He explained that the combination of the early onset of demographic modernisation and synchronous declines in mortality and fertility resulted in a limited transitional growth of the population, which has had far-reaching implications for the country’s path during the 20th century and beyond. “For instance, features of the demographic modernisation form an important part of the explanation as to why Estonia is among the few countries in the world in which the (native) population size today does not exceed the corresponding number at the eve of World War II,” he said. In recent years, the long-term legacy of demographic modernisation has been underscored in several studies[2] of other settings according to him.

Jaadla said that in order to draw more comprehensive conclusions about the demographic behaviour of the Lutheran population of Tartu and about the demographic modernisation in Estonia in general, it is important to extend the analysis to other demographic processes. She has already started a new project called “Early demographic modernisation in Estonia: a micro-level study of the nineteenth-century rural and urban settings” with colleagues from the Estonian Institute for Population Studies. One of the main aims of this project is to study the fertility decline in Estonia and identify the early adopters of fertility control in the society—the so-called forerunners in the transition to low fertility.

[1]She defended her dissertation in early January in Tallinn.

[2]For example: Skirbekk, V., Stonawski, M., Alfani, G (2015). Consequences of a universal European demographic transition on regional and global population distributions. Working Paper No. 68. Milan: Carlo F. Dondena Centre for Research on Social Dynamics, Università Bocconi

This article was funded by the European Regional Development Fund through Estonian Research Council.

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