Urbanisation and disease: a perspective from nineteenth-century Britain

Romola Davenport. Show Author details

We now live in an urban world, with over half the global population estimated to live in towns and cities. The explosive growth of urban populations in the last half century is often likened to the experience of Britain in the nineteenth century, when the rapid and unplanned growth of ‘new’ industrial and manufacturing cities was accompanied by environmental degradation and supposedly unprecedented health problems. Frederick Engels’ graphic descriptions of conditions in the poorest districts of Manchester in the 1840s were greeted with shock by contemporaries and are still taken to represent an historical nadir of insanitary and dangerous living conditions. But is this perception accurate? Was industrialisation and the onset of modern economic growth associated with unprecedented levels of urban misery? Was the penalty for migrating from the countryside to the city higher in the nineteenth century than in earlier periods?

There is no doubt that urban death rates were higher than those in the rural hinterlands of cities, and that rural to urban migrants traded off health for wealth, especially for their children. In addition, as the population shifted from relatively healthy (but poor) rural areas to towns, then the proportion of the national population that was exposed to higher urban death rates necessarily increased. In fact, as the figure below shows, the percentage of English citizens living in urban areas increased from 30 to 50 percent during the period 1800-1850. As a consequence, life expectancy should have fallen in the national population, simply because of this redistribution of the population from rural to mainly urban locations. But this is not what we observe at the national level: life expectancy did not fall across the period of the Industrial Revolution (c.1760 – 1840). This implies significant improvements in mortality for at least some of the population, contrary to the popular image we have of this period. So what happened? 

Did urban health decline during industrialization?

While evidence is hard-won before the inception of civil registration of births and deaths in 1837, it is clear that the gap in life expectancy between rural and urban populations was much larger before the classic period of the Industrial Revolution in Britain. The graph below shows infant mortality rates (the percentage of babies who died before their first birthday) in rural parishes, small towns and cities between 1550 and 1910. Between 1700 and 1750 35 % of newborns died in infancy in London, compared with c.20 % in the population as a whole. Even in market towns of a few thousand inhabitants, infant death rates were well above the national average, and as higher or higher than rates in the largest industrial cities (Liverpool and Manchester) a century later. After 1750 there was a rapid and profound convergence of infant mortality rates between rural and urban centres, and cities were transformed from ‘demographic sinks’, reliant on migration to sustain their populations, into centres of natural demographic growth. 

Even in the 1830s and 1840s, when urban growth was most rapid, when the English sanitary movement was in its infancy and when real wages remained low, my research finds no evidence for a catastrophic decline in urban life expectancies (see my recent publications here, here and here) There was indeed some rise in mortality amongst young children in this period, but this occurred in rural as well as urban populations, and was driven at least in part by an apparently autonomous rise in the virulence of scarlet fever. 

Why didn’t industrialisation, and the rapid population growth and dramatic reorganisation of English society that accompanied it, drive up urban mortality rates? This remains a puzzle. Real wages rose only very slowly before the mid-nineteenth century, and so it is unlikely that rising living standards were sufficient to outweigh the effects of urbanisation (although it is key to note that living standards did not fall in the face of unprecedented population growth, as would have been expected in any previous period). Instead, we probably need to consider other, non-economic factors. The first of these is public health efforts, most notably in the promotion of vaccination against smallpox from c. 1800. Smallpox accounted for about 10 % of deaths in London in the mid-eighteenth century, and 20 % in Manchester and Glasgow, and the impact of vaccination on urban mortality rates must have been profound. At the local level, there were widespread attempts to control typhus and other fevers by separation of the infected from the healthy, and the intrusive but probably effective cleansing of houses, clothes and bedding. 

Urban growth and sanitary conditions: Past and present

In addition, we need to reconsider our assumptions about the  features of rapid urban growth, such as increasing population density and declines in sanitary conditions. Medieval and early modern towns were generally already very densely populated and insanitary. Rapid growth in the nineteenth century did not in itself induce these conditions, nor was it necessarily correlated with higher rates of waterborne diseases, as shown in one of my projects (see here). 

Looking backwards from the twentieth or twenty-first centuries, nineteenth century English towns appear breathtakingly lethal. However from the vantage point of previous centuries, then nineteenth-century cities appear in a novel light: capable of sustaining great size and rapid growth, without demographic catastrophe. By the early twentieth century greater investments in urban sanitation and housing had abolished the gap between urban and rural populations in Britain. A similar pattern has played out globally in the twentieth century. Across the world, life expectancy is now generally higher in urban centres than in their rural hinterlands, a dramatic reversal of historical norms, and one that began in Britain in the midst of the world’s first industrial revolution.

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