Public health and development: Infrastructure, social norms, and health behaviours

7 Conclusion

Mortality rates have been higher throughout much of human history than they are today.

Technological improvements resulting from the Industrial Revolution and new ideas associated with the Enlightenment in Europe paved the way for massive infrastructure investments between 1850 and the twentieth century. Behavioural campaigns were also successful in achieving better outcomes in terms of hygiene (handwashing, water boiling, breastfeeding). Greater female participation in politics in countries such as the US also increased spending on public health. As a result, mortality fell sharply, first in OECD countries and then in middle-income countries. However, low-income countries still face high mortality rates due to the prevalence of infectious and other diseases for which treatment and cure exists.

The presence of external effects, multiple equilibria, and crowding-out effects influence the level of public and private investment in health. A big push is needed to achieve significant improvements in low-income countries. This will require massive infrastructure investment, such as in clean water and sanitation provision, together with government campaigns that can increase take-up of good health behaviour at a national scale. While poor governance of health institutions, wars and political unrest, and lack of resources make such investments difficult in the short term, there have been some successful sanitation interventions, like the CLTS campaign in Mali. Researchers and policymakers should focus on replicating these successes in other contexts and scaling up promising interventions.