history - Building the Skyline

November 6, 2023 by Jason Barr Leave a Comment

How Deadly Were Gotham’s Tenements? Infectious Disease in the 19th Century (Part I)

Troy Tassier and Jason M. Barr November 6, 2023

Those sickened must be cured or die off, & being cheifly [sic] of the very scum of the city, the quicker [their] despatch [sic] the sooner the malady will cease.

John Pintard, a founder of the New York Historical Society and a former secretary of the New York Chamber of Commerce wrote these words to his daughter on July 13, 1832. New York City’s first great cholera epidemic had begun just two weeks earlier. The outbreak continued through September and 3,500 cholera deaths were officially recorded within the city. In just three months, 1.5 percent of New York City’s population died from the disease.

Pintard’s crass words matched the feelings of many 19th-century upper-class New Yorkers. For Pintard and others like him, illness from infection, particularly cholera, was a sign of moral turpitude. Those with an upright character were protected from ghastly contagions. In another letter to his daughter, Pintard stated these feelings explicitly: “At present [cholera] is almost exclusively confined to the lower classes of intemperate dissolute & filthy people huddled together like swine in their polluted habitations.”

Location of Officially Recorded Cholera Deaths in 1832. Source: Pulitzer Center.

In part, people of Pintard’s ilk were correct in their belief of the concentration of cholera. The Sixth Ward, the location of the infamous Five Points neighborhood, contained the most severe concentration of cases and deaths as the following map of 1832 cholera deaths reveals. The large red blotch in the middle is in Five Points. Although not known at the time, cholera was a waterborne disease and spread more easily in Five Points because the neighborhood was constructed over the filled-in Collect Pond, creating poor drainage before New York fully built out its water and sewer system. That the poor immigrants were “forced” to live over former swamps and lakes was, certainly, due little to their supposed immorality or “dissolution.” It was simple finance–those in Five Points couldn’t afford to live elsewhere.

The Safety Dance

As a prophylactic, many wealthy, on the other hand, simply fled to safer and more spacious environments. As historian Charles Rosenberg writes,

A hyperbolic and sarcastic observer remarked . . . ‘fifty thousand stout-hearted. . . New Yorkers scampered away in steamboats, stages, carts, and wheel barrows.’ Farmhouses and country homes within a thirty-mile radius of the city were filled. Yet the exodus continued . . ..

However, only the wealthy could afford to escape. Rosenberg further laments, “The poor having no choice, remained.”

The 1832 cholera epidemic wasn’t the first or the last outbreak to roil New York society. Smallpox and yellow fever were persistent concerns throughout the early decades of New York’s growth. Cholera, measles, tuberculosis, typhus, typhoid fever, and other infectious diseases would continue to devastate families throughout the 19^th century.

Poverty as Vice

In the popular consciousness, Manhattan’s Lower East Side tenements became synonymous with filth, poverty, density, and disease. In 1842, Charles Dickens described one dilapidated tenement in his American Notes for General Circulation:

What place is this, to which the squalid street conducts us? A kind of square of leprous houses, some of which are attainable only by crazy wooden stairs without. What lies beyond this tottering flight of steps . . . A miserable room lighted by one dim candle and destitute of all comfort, save that which may be hidden in a wretched bed. Beside it sits a man: his elbows on his knees: his forehead hidden in his hands. ‘What ails that man?’ . . . ‘Fever’ he sullenly replies without looking up.

Jacob Riis provided the most famous descriptions of life in the tenements in his 1890 classic, How the Other Half Lives: Studies among the Tenements of New York. Like Dickens, poverty, density, disrepair, and disease are inexorably intertwined in many of his descriptions. He describes one tenement apartment,

The family’s condition was most deplorable. The man, his wife, and three small children shivering in one room through the roof of which the pitiless winds of winter whistled. The room was almost barren of furniture; the parents slept on the floor, the children in boxes, and the baby was swung in an old shawl attached to the rafters by cords . . . The father, a seaman, had been obliged to give up that calling because he was in consumption, and was unable to provide either bread or fire for his little ones.

“Consumption,” at the time, was the term for tuberculosis.

Blaming the poor, for citywide epidemics, Riis wrote, “In the tenements all the influences make for evil; because they are the hot-beds of the epidemics that carry death to the rich and poor alike.”

Density and Disease: A Deeper Analysis

These quotes and others like them, give a sense that some lower class neighborhoods were continually beset with disease, while the ones housing the prudent and “upright” upper class were disease-free. Yet, the 1832 cholera map displayed above shows that there was clearly disease and suffering throughout the city. So, we thus need to return to the question, were the tenements really that much worse than other districts in terms of infectious disease mortality? Are the conclusions of the rich and the reformers as grim and conclusive as they suggested?

To investigate this question, we compiled data from the National Bureau of Economic Research (NBER), Historical Urban Ecological data set. The data set contains information on a variety of 19^th– and early 20th-century demographic and health-related data, including deaths from various infectious diseases from 1868 through 1927. The data set does not include all years—in particular data from the 1918-1919 influenza pandemic is missing, as well as infectious disease data for the years 1880-1888—but it does allow for us to study broader trends across time and space.

We focus our analysis during the height of tenement growth from 1868-1910. The data is organized at the level of New York City wards, which were neighborhood demarcations used for elections of various municipal offices, such as aldermen (analogous to today’s city council members). Across Manhattan, there were 22 wards. While they are numbered in a somewhat haphazard fashion (shown on a map below), in general, the lower-numbered wards were closer to the southern tip of the island.

Death Rates

During this period, the data reveal that, on average, about 0.95% of New Yorkers died per year from infectious diseases. Although rates of death certainly varied by age (with the youngest children particularly susceptible), we can think of this as a baseline risk that each person living in the city faced. In other words, unadjusted for age, location, or time period, an individual had just under a 1 in 100 chance of dying from an infectious disease each year. However, from the historical descriptions, we would expect that certain areas had higher risk than others.

To identify these differences, we run statistical tests (regressions) aimed at identifying the New York City wards with the most risk while controlling for yearly trends (mortality was falling over the second half of the 19^th century). (Data sources and results are given here.) The map below shows each ward’s death rate relative to—that is, above or below—the citywide average. The results suggest that the reformers and the wealthy scoffers did not quite have their stories right.

Blue indicates the ward had, on average, a lower death rate than the city average. Red indicates above the city average. White is about the same as the city average. Death Rate = total deaths from infectious disease / population. Source: here.

Across Wards

To focus on the heart of the matter, we have created a “matrix” of topologies by dividing the wards into those that contained relatively high or low density, respectively, and those that were “safe”/low-risk or “unsafe”/high-risk based on their death rates compared to the city average.

Low Density-High Risk: The First Ward

The First Ward sits at the southern tip of Manhattan. While it didn’t have the notoriety of the tenement wards for infectious disease it had the highest rate of infectious disease deaths anywhere in the city over our time of study. In the late 19^th century, before the opening of Ellis Island in 1892, this ward was the literal gateway for the majority of immigrants entering the United States through New York City. It is estimated that eight to twelve million immigrants passed through the Emigrant Landing Depot, known as Castle Garden, during its time of operation from 1855 to 1892.^[1]

Many of the immigrants arrived nearly penniless, and given their lack of funds they could not venture far from the landing when they first entered America. Often, they settled briefly in almshouses and boarding houses nearby as they searched for employment and more permanent housing. Unfortunately for these immigrants, our analysis suggests that the First Ward was the easiest place for contagions to multiply. Here deaths from infectious disease were 52% greater than the citywide average.

Although the First Ward receives far less attention than the Lower East Side tenements, elevated disease risk should not be surprising. During this time, the experience of most immigrants was tortuous. They were stuffed in the cavernous underbelly of a ship without ventilation and, in some instances, even light. It was not uncommon for some of these steerage passengers to die from disease or starvation en route to America. Although many were inspected for disease upon arrival, some infected passengers certainly passed through the port and into the First Ward undetected. Various diseases were thus let loose to fester in the First Ward where many immigrants made their first night’s sleep.

A photograph of New York Harbor, Governor’s Island, Staten Island, and Castle Garden Aquarium, 1894. J.S. Johnston photograph collection, 1890-1899. Source: nyhistory.org.

Low Density–Low Risk

In contrast to the First Ward, the adjacent Second Ward was one of the safest in the city. It sits between the southern port and the notorious tenement districts. John Pintard, whose quote began this post, was elected an Assistant Alderman of the East Ward (which became the Second Ward at a later date). This area was the original seat of affluence in Manhattan and home to many who made their fortunes as Manhattan’s first merchants and bankers.

However, after the Civil War, this district was given over nearly entirely to industry and commerce and had few residents of any stripe. Similarly, the Fifteenth and Sixteenth Wards also contained far lower infectious disease mortality. Each of the Second, Fifteenth, and Sixteenth Wards had infectious disease mortality 16% lower than the citywide average.

Late in the 19^th century, the northern wards of the city were at the heart of a great migration. As the lower wards became overcrowded, transportation options (such as the horse-drawn streetcars and later the elevated railways and the subway) allowed for faster and easier commutes from homes to places of work. Much of New York’s middle-class population moved north. As they did so they skipped over the dense tenement and manufacturing districts that populated Lower Manhattan above the Second and Third Wards.

Many of the affluent landed in places like the 15^th and 16^th Wards, along Broadway, Fifth Avenue, and around such parks as Washington Square and Madison Square. Throughout this period the northern wards had relatively low density and infectious disease mortality was near average or slightly below. Even the 22^nd Ward, home to Hell’s Kitchen, with shanty towns along the Hudson River docks, had infectious disease risk lower than the city average.

The High-Density Neighborhoods

Focusing now on the high-density neighborhoods, we see something that is not, in fact, obvious. Some of the densest wards had infectious disease death rates that were far lower than the city average. In fact, some of the most-dense tenement districts had the lowest infectious disease mortality in the entire city. This certainly suggests that density, in and of itself, was not the great evil that reformers portrayed it to be, at least in terms of infectious disease risk.

In particular, the tenement neighborhoods of the Lower East Side had two clusters—a higher-risk zone and a lower-risk one. The higher-risk zone was located in the central wards of Lower Manhattan that included Five Points, Little Italy, and Greenwich Village. The lower-risk zone, on the other hand, was located on the east side, and included dense Jewish and German neighborhoods. In fact, in 1900, the Tenth Ward, home to many Jewish immigrants, was arguably the densest neighborhood on the planet, with some blocks having densities as high as 1,000 people per acre. Yet, the Tenth Ward had infectious disease mortality 19% lower than the city average.

The Infection Puzzle

This variance in rates of infectious disease mortality across the tenement districts offers up a puzzle. Density and poverty were not uniform predictors of disease mortality. What was going on? Why did the reformers seem to overgeneralize and misunderstand what was happening in the 19^th century? We will provide the answers in Part II of this blog post, coming soon.

Continue reading Part II of the post here.

Troy Tassier is a professor of economics at Fordham University. He is the author of the forthcoming book, The Rich Flee and the Poor Take the Bus: How Our Unequal Society Fails Us During Outbreaks. He also writes the At the Margin Substack newsletter.

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^[1]Unfortunately, a fire at Ellis Island destroyed most of the Castle Garden immigration records in 1897 so precise counts and much history of entry through Castle Garden are lost.

December 27, 2022 by Jason Barr Leave a Comment

Book Review: Slouching Towards Utopia: An Economic History of the Twentieth Century by J. Bradford DeLong. Basic Books, 2022

Jason M. Barr December 27, 2022

Slouching Towards Utopia is a “grand narrative” of the “long 20^th century” from 1870 to 2010. It focuses on the economic and political evolution of the global north, particularly Western Europe until the end of World War II, and the United States since then. The unifying theme is that Western world history can be understood by the evolution of technology, free markets, globalization, and the ability of governments to deal with them (or not).

Our Tour Guides

On the tour, however, we are not alone. Holding our right hand is the free marketeer Austrian economist Friedrich August von Hayek (1899-1992). Holding our left hand is the moral philosopher and socialist thinker Karl Polanyi (1886-1964). As we walk through history, each whispers in our ears about how to make sense of what we see.

Hayek tells us that the mistakes of history emerge from government overreach. In attempts to correct the market’s dislocations, officials made the problems worse. Socialism and Fascism were master projects designed to intervene to the benefit of some, but they led to “serfdom” for all. Governments, he argues, cannot micromanage our economy without micromanaging our lives. Planning and totalitarianism are just two sides of the same coin.

Karly Polanyi says, “nuts to that!” The state is here to guard what we hold dear, such as fairness, stability, dignity, and social connectivity. While the market can help us, the government must do what the market cannot. DeLong, paraphrasing Jesus, summarizes Polanyi’s position that the “market was made for man, not man for the market.” (This puts Hayek in the role of the Gospel’s Pharisees.)

Polanyi points to the rise and collapse of the Gold Standard and the Great Depression as to why capitalism cannot be left to its own devices. The market’s seeming quest for efficiency ultimately leads to instability and dehumanization.

Heroes and Villains

And so, with Professor DeLong at the lead, and Polanyi and Hayek by our sides, we stroll through the major events in Western political economics. DeLong’s hero is John Maynard Keynes. In his 1919 book, The Economic Consequences of the Peace, he rightly scolded the Allied Powers after World War I for their rapaciousness and vindictiveness. In his 1936 classic, The General Theory of Employment, Interest and Money, he showed why depressions might not automatically self-correct to boom times. He offered useful advice on how governments can right the economic ship through “Keynesian” spending programs.

After World War II, at the Bretton Woods Conference, he helped construct the modern economic order, which not only created the International Monetary Fund and the World Bank but also established the U.S. Treasury and the Federal Reserve as the world’s de facto central bank.

By the 1950s, Keynesian economics, in one form or another, was deeply embedded in Western economic thinking and policy. Keynes thus becomes the modern Jesus—the man who points us to the economic kingdom come.

The story’s villain is Keynes’ arch nemesis, Inflation (or extreme changes in currency values more broadly, including deflation). Inflation robs us of our ability to predict the future and measure value; it’s the insidious devil in our midst. And when governments print money for their own ends, it leads only to dystopia. Or, as Keynes has put it, “There is no subtler, no surer means of overturning the existing basis of society than to debauch the currency. The process engages all the hidden forces of economic law on the side of destruction, and does it in a manner which not one man in a million is able to diagnose.”

Attempts to control it using the Gold Standard led us to World War I. The “quick fix” of printing money ultimately led to World War II. The Stagflation of the 1970s led to the triumph of Neoliberalism, which has generated unchecked income inequality, lower economic growth, and renewed social divisions.

The Long 20^th Century

DeLong divides the “Long 20^th Century” into four periods. The first—1870 to 1914—can be called Slouching 1.0. 1914 to 1945 is Dystopia 2.0 (whereas Dystopia 1.0 lasted from time immemorial to 1869). Next is Post-World War II to 1973, a time he calls the “Thirty Glorious Years of Social Democracy,” but can otherwise be called Slouching 2.0. Lastly is 1973 to 2010, the period of the Neoliberal turn, which might be called Supinetopia—neither slouching nor falling, but not standing upright either.

Slouching 1.0

In Period 1, humanity has firmly hitched its wagon to economic growth—or, more specifically, to the suite of institutions and economic endeavors that obliterate the Curse of Malthus, that population expansion will ever exceed caloric production. The key trick was learning how to harness inventions to improve our lives. Western societies developed the right institutions. They created the bureaucratic corporate form of businesses, which developed organized research and development labs. Near-universal education for the masses helped to generate these innovations and spread access to them from rising wages. Governments imposed (or allowed) market orientations to guide the resource allocation problem.

The trifecta of trade, innovation, and governmental economic “liberalism” produced, for the first time in human history, a whiff that material “utopia” was just around the corner.

Dystopia 2.0

However, this period of slouching unwittingly set the seeds for a major setback. The embrace of capitalism generated new uncertainties. The old world, to be sure, had its problems, from kings’ wars to famines and plagues, but being tied to the farm was the one great constant. Peasants had their land, their economic obligations, and their religious rituals. Little changed from decade to decade. But then, agrarian life was swept away by economic tides that no one could stop.

The farmers went off to cities seeking work, and in exchange, they gained uncertainty and exploitation. Not quite knowing what to do, governments groped, and often mismanaged, their way through, be it via tariffs, printing money, or gaming the Gold Standard.

Globalization, the rise of the bourgeois, and the absorption of technology into society led the old “balance of power” to collapse. Nationalistic states replaced empires and monarchies and produced total war—entire populations drafted into the effort, either as fighters, factory workers, or propagandists. The end was unimaginable destruction, as each side was stalemated by its stockpiles of industrial death machines.

Ideology

The Industrial Revolution also generated an intellectual flowering of thought that tried to understand what was happening and whether it was “good” or not. And if not, what were the blueprints to utopia? In the marketplace of ideas arose new ideologies—systems of “total belief” that could carry the masses into the Promised Land. If Jesus was a Jewish apocalyptic preacher who told the peasants of Roman Palestine that the Kingdom of God was on its way to righteous believers, then Marx and Engels, Lenin, Mussolini, and Hitler offered their versions of utopian kingdoms provided by the nation-state.

They could only succeed by draining the pools of despair that washed over the masses. Lenin created his version of the Dictatorship of the Proletariat, which appropriated private property and distributed it “from each according to their ability; to each according to their need.” To the right of Lenin, but to the left of the “Hayekians,” were the Fascists. They promised utopia by creating a highly socialized economy for the “right” people at the expense of the “inferior other.”

On the economic right—fighting back against totalitarianism—were the disciples of Adam Smith. Smith did not set out to form a new ideology or economic religion. Rather he aimed to loosen the old order created by the “divine right” of kings to form monopolies and subject his people to economic restrictions and wars for his own benefit. But Smith’s disciples in Austria, Britain, and America spread the good news of the Gold Standard and “laisse-faireism.”

World War II was as much a war of ideologies as it was a war of nations.

Rebuilding the House: Slouching 2.0

From the wreckage of 1914 to 1945, the global north got its act together—or rather, the Western democracies demonstrated that the road to utopia was a form of Keynsian-Polanyism. States would intervene to minimize the dislocations of the business cycle and provide a basket of resources that the market would not—unemployment benefits, health insurance, old-age pensions, public goods, scientific research, universal suffrage, and so on.

Thus, the post-war period saw the rise in the democratic “welfare state” as the alternative to totalitarian socialism (or what DeLong calls really-existing socialism). America, left unscathed by the two total wars, replaced the British Empire as an economic and political “hegemon.” Its new role as the great centralizer and stabilizer (and bulwark against the Soviet Union) helped maintain a period of peace, economic stability, and prosperity. And the road to utopia, according to DeLong, was now open.

The Neoliberal Replacement

But then, a series of economic shocks disrupted the bright future. High inflation in the 1960s and the Oil Crises of the 1970s led to Stagflation. But governments were reluctant to raise interest rates lest it reduces the full employment that was now part of the social contract.

The Stagflation problem gave renewed impetus to the Hayekians, whose new prophet was Milton Friedman. He argued the state had no business trying to micromanage or “fine-tune” the economy, as the “cure” was often worse than the disease. Simultaneously, and almost by accident, Paul Volker was appointed Chairman of the Federal Reserve, and his mandate was clear: spike interest rates to “bleed” inflation out of the economy. It achieved its purpose but came with great economic pain.

Reaganism

The resurgence of neo-classical economics helped give rise to Ronald Reagan and Margaret Thatcher, who aimed to dismantle the welfare state by slashing taxes on the rich. They sought to win the Cold War through defense spending and arms races (while paying lip service to the need for fiscal austerity).

DeLong argues that the resulting deficit spending jacked up interest rates and created an unnaturally strong dollar. This wiped out American manufacturing, spurring widening income inequality and lower economic growth (the supplysiders never lived up to their hype). The collective response, however, was a shrugging of the shoulders.

Since the 1970s, the Neoliberal paradigm, which says that “man was made for the market,” has reigned supreme. When the Great Recession came in 2008-09, triggered by a financial crisis of epic proportions, few in power called for rethinking our reliance on the market. Rather governments did what they could to shore up those “too big to fail,” pumped liquidity into the system, and produced a Keynesian stimulus package to comfort workers. But when the tsunami finally passed—after nearly a decade—it was all but forgotten. In its wake was the rise of Trumpism and a new period of division and uncertainty.

The book thus ends on a pessimistic note. After World War II, we had utopia in our grasp, but we let it slip away because we were too hypnotized by the Siren song of the free market.

Big Thinkers. Upper left: Friedrich Hayek. Upper right: Karl Polanyi. Bottom: John Maynard Keynes

The Grand Narrative

As a grand narrative, the book is well-written, well-researched, and enjoyable to read. But what are we to make of it as a contribution? An important book should either be a story or an argument. It should delve deeply into either the whats of history or the whys. It is here that Slouching struggles to find its path. As a 500-plus-page book on 140 years of the success and failures of modernization, it attempts to do both things at once and yet does not quite succeed in either. It’s too grand by half.

In telling the big story—both intellectually and historically—the book is neither broad enough nor specific enough. It leaves the reader feeling a little alienated from the deeper meaning and trajectory of our material existence. Providing both an array of small (but interesting) details and large brushstrokes, the narrative slides quickly through the main changes in human history: the budding shoots of innovation, markets, and global trade; the drastic reversal in the first half of the 20^th century; the battle between socialism and capitalism; the “winning of the West”; and finally, the Neoliberal turn.

Along the way, it travels from the Global North to the Global South and spends a spell in China, Japan, and the Soviet Union. It breezes through the rise of Civil Rights in America and abroad (yet DeLong spends nearly 30 pages on Hitler’s war strategy).

I wish it had either gone up—into a bigger but briefer unifying picture—or down into a few key detailed strands. Overall, it reads like we are watching Dancing with the Stars featuring the 20^th century’s Great Leaders and Economic Thinkers. Think of Hayek tangoing with Polanyi and then Hitler waltzing with Churchill. The show is mesmerizing to watch because we don’t know who might fall or who might pirouette with sublime elan, but overall it’s not as satisfying as an opera or ballet.

What is Utopia?

The epithet, “slouching towards utopia,” summarizes DeLong’s argument that we have embraced trade and globalization, technological innovation, and “safety net” republican democracies because we believe they will move us that much closer to utopia itself. However, DeLong does not give us a precise definition of his version. And as the cliché goes, the word “utopia” means both “no place” and “the good place”—the location of perfection. There’s hardly a consensus on what this ideal place might be and whether it can actually be created.

The two “Golden Ages” of the West (Slouching 1.0 and 2.0)—if we can in fact call them that—were significant steps forward, but it seems a stretch to say that they laid a path for possible utopia or helped wipe away the vast suite of human indignities and tragedies. Yes, we can achieve economic growth and material prosperity; and, yes, we can reduce the vagaries of the market through government interventions, but can we truly make humanity happy and wholly satisfied with life?

If so, it’s hardly clear how governments can achieve this. If recent history is any guide (be it Trumpism; our slavish attachment to social media, iPhones, and AI; Brexit; Russia’s invasion of Ukraine, China’s threat to invade Taiwan, etc.), we still don’t even know what we are looking for in terms of the Promised Land.

Is it Finland?

From what one can infer, the “utopian model” for DeLong is present-day Finland—a democratic market-oriented nation-state with large government involvement in the economy. If surveys are to be believed, Finland is indeed the happiest place on Earth. But I’m sure it’s news to the Finns that they have achieved utopia.

And if it is a utopia, it might just be for them. How can we replicate such a thing across the planet, where each country has its own history, institutions, cultures, political objectives and requirements, and notions of the good life, and where nationalism all too easily slips into hatred and “otherism”? (Not for nothing, the Finns joined NATO for this reason.)

The Gales of Destruction

The paradox of utopia is that it can only happen in a world where the rug is not constantly being pulled out from beneath us. But the quest to achieve material Peace on Earth requires constant change. As Joseph Schumpeter has pointed out, economic growth, by its very nature, forces us to be ever hit by the economic gales (and occasional hurricanes) of creative destruction.

Our current world of slow growth exposes the utopian contradictions of capitalism: even with material prosperity at hand, low growth rates create “idle hands,” which are used to divide and cast blame on the “other.” Yet to get back to rapid growth to achieve full employment requires intense industrial competition and constant innovation. Growth has to be so rapid to not only absorb the newly minted adults but also to re-employ those who are victims of the incessant industrial restructuring. In the developed world, it seems this might be a near-impossible task.

It’s also easy to see how constant change can make us richer, but it’s hard to see how this will make us happier. As the economist Richard Easterlin has pointed out—in what has become known as the Easterlin Paradox—if we are in a perpetual rat race to improve our material position, the average person’s sense of well-being will remain constant since we are always comparing ourselves to those above us in the social and economic ladder. Happiness, it seems, is a zero-sum game.

If the lesson of the 20^th century is anything, it’s that no one can agree on exactly what utopia is. How can we be slouching toward it when we don’t even know what it is?

The Role of the Mind?

Utopia is a state of mind, and the quest for it requires us to think more deeply about the role of the mind in the evolution of economic history. DeLong rightly focuses on the important economic theorists of the long 20^th century. He is to be commended for his attempt to weave history, economics, and ideas into a grand narrative.

The devastating ideologies of the 20^th century—be it Socialism or Fascism—were smacked onto the world because aggressive and ambitious leaders believed that they were good ideas, at least for them. They sold ideologies that filled an emotional void first and then they ran their economies on the fly accordingly.

Let us not forget that Marx published The Communist Manifesto nearly two decades before he provided his economic theory in Das Kapital for the supposedly inevitable proletarian takeover. Never mind that Lenin decided it was better to take matters into his own hands and foment revolution rather than wait for the inevitable to emerge eventually. For that matter, Adam Smith provided intellectual cover for the British navy to create colonies, client states, and treaty ports.

Modern Gospels

One of the implicit themes of the book is that we can use the Gospels as a metaphor about how to think about the 20^th century. Jesus’s sayings were, in part, about creating a new religion—a new overarching utopia for humanity. But this religion was replaced in the 20^th century with state-sponsored ideology. The quest for utopia fell apart because ideology was not made for man, as it were. In its wake, we have modern capitalism, a paradoxical ideology of the negative, which says that we must wholeheartedly believe that every other ideology about the market is wrong.

The point is that economic theory—both descriptive and mathematical—is essentially just a justification for what people want to see in society.^[1] There never was value-free economics. The ideological economists of the 20^th century wore it on their sleeves. Perhaps the key value of DeLong’s book is to show that throughout history, religion. and economic theory were often two sides of the same coin, and we need to think more deeply about how our beliefs, perceptions, imaginings, and ideas are just as important, if not more so, than the dry equations of profit and utility maximization, and market equilibria. Modern economic theory, after all, is just a story about how we ought to behave as atomistic individuals.

Our history was created from the “dialectic” between those who believed the market was good versus those who did not. Slouching helps us to see that more clearly.

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^[1] Yes, today’s economics is a social science that attempts to adhere to the scientific method, but it’s also important to recognize that the neoclassical theories of utility and profit maximization are implicitly ideas about how to achieve a version of economic utopia: if an economy maximized total utility and total profits, we’d be living in economic paradise.

June 16, 2020 by Jason Barr 1 Comment

Disease and Unease in New York City (Part I): Mortality Rates since 1800

Jason M. Barr June 16, 2020

Pandemic 2020

On March 11, 2020, the World Health Organization officially declared the COVID-19 outbreak a pandemic. The first case appeared in Wuhan, China, on December 31, 2019. It arrived in the United States toward the end of January. On March 1, the New York metropolitan region saw its initial infection, and soon after, it became one of the world’s epicenters.

The general response by governors across the country was to close businesses, schools, and other public institutions, and send everyone home to “shelter in place.” While the epidemic in New York is far from over, isolation policies have worked to the degree that the region can begin to reopen. Arguably, the reason that the coronavirus requires a swift and forceful policy of social distancing is that not only can the infection cause terrible illnesses, but is also frequently fatal, either from the virus itself or a secondary disease, such as pneumonia. A recent study estimated that as many as 13 people out 1,000 infected are killed by it (compared to 1 in 1,000 for influenza), though that estimate is likely on the high end.

But this raises the question of how bad has the COVID-19 epidemic been in terms of mortality rates for dense cities like New York? In many respects, the history of cities is the history of the ebb and flow of shocks to our health and well-being. Here, we review over two centuries of mortality rates in New York City to not only place COVID-19 in context but also to see how the nature of mortality has evolved. To do this, we separate mortality rates into two parts. First is to look at the baseline or trend rates, and second is to review the so-called excess death rates–those years in which deaths were unusually high relative to the norm. How does the increase in deaths from COVID-19 compare to other big epidemics of the past like the 1918 influenza outbreak or the frequent smallpox epidemics of the 19^th century?

Our Urban History

Taking this long-run view allows us to draw some conclusions. First, there is a complex relationship between density and mortality. Just because a place is dense does not mean it automatically has a higher death rate. Manhattan’s death rate peaked in 1849, yet its population continued to rise until 1910. New York City’s death rate has steadily fallen over the last 170 years (data sources are here).

Second, the city is far healthier today than it has ever been in its 400-year history. Before the coronavirus came along, one could argue that it was experiencing a kind of golden age of low mortality. And while COVID-19 is likely to increase the number of deaths in New York by over 40% as compared to last year, ironically, the death rate for the city will be as it was in 1995.

Third, despite dire predictions of the COVID-19 epidemic destroying the city, a long-run view suggests this conclusion is premature. New York, over the centuries, has weathered many, many epidemics. Though the suffering they cause is devastating, the city has not only survived but has also become stronger as a result. The seeds of tragedy plant the flowers for a better, healthier place. Horrible events are met by collective action that improves the human condition (though frequently more slowly than it should). While this may be small comfort to those harmed, it should help us, as a society, feel more confident about our cities.

Lastly, just as land values can be an indicator of the health of a city’s real estate and economy, mortality rates can be an indicator of the health and well-being of its residents. Constant advances in technology, scientific knowledge, and medical treatments generate improvements in the quality of life. On the other hand, because of random shocks (outbreaks of disease or terrorism) or ongoing urban problems (such as crime, poverty, or failures in governance), these forces drag down health and increase mortality. As a result, the history of mortality is like a horse race between the “good” and the “bad.” When mortality rates are rising, or even flat, it means urban problems are occurring at a rate that, on average, offsets the improvements. When mortality is falling, it means that the advances are winning. In the very long run, the improvements have (and will) carry the day.

Mortality Rates for New York City, 1804-2020. Mortality rates are total deaths per 1,000 residents. Note for 2020, I assumed total deaths from 2019 plus deaths from COVID-19, as of June 16, 2020 (this means the actual death rate for 2020 will likely be higher). Sources: See here.

Mortality since 1800: A Helicopter View

Before we proceed, however, one caveat is in order. The focus here is on gross mortality rates: the number of deaths per 1,000 residents. It is admittedly an overly broad indicator. Different groups, of course, have different mortality rates, such poor versus rich, and infants and the elderly compared to young adults, and so on.[1] A more comprehensive history would need to detail how the less-advantaged groups have fared over time. The quality of a society can be measured by the health of those with the fewest resources. Nonetheless, gross mortality rates can help tell the story of a city’s health and history.

Looking at the broad sweep of mortality in New York City shows, roughly speaking, five major periods. Period I is from about 1800 to 1860. This was a time of rapid urban growth alongside frequent and devastating epidemics (as will be discussed in more detail below), with death rates peaking before the Civil War. Period II is from about 1860 to 1890. This time can be called post-peak mortality, where death rates fell over the period returning to a level that was not seen until the early 1800s. Period III, from about 1890 to 1925, is the Mortality Transition, as mortality rates steadily declined, and converged to those of the United States as a whole.

Period IV, from 1925 to 1990, is what might be called net-zero mortality—two sets of forces were working at odds—improved health and medical care were fighting against ongoing urban problems, such as air pollution, crime, and unemployment. While death rates for the city stayed in a limited band, they began to diverge from the United States, which saw declining mortality. Period V started around 1990, after the crack cocaine epidemic passed, and crime rates began to decrease.[2] The death rate in New York City dropped to a new low level. This is where we were when COVID-19 came along. In fact, starting in 1996, New York’s mortality rate has been lower than that of the United States. Pretty good for a city that was (proverbially speaking) told by President Gerald Ford in 1976 to “drop dead.”

Mortality Rates and Population for New York City (Manhattan) from 1804-1890. Notes: Mortality rates are deaths per 1,000 residents. The trend line shows that mortality rates over the period did not change, on average. Also note that population estimates before 1865 are in 5-year intervals. Sources: See here.

The Epidemic Century

From at least 1791 to 1900, New York City experienced frequent and devastating epidemics.[3] One can even say that epidemics were a regular part of life. The “normal” baseline death rate in New York City, in a good year, in the first half of the 19^th century was between 25 and 30 deaths per 1,000 residents. But constant epidemics continually moved the city above that rate. Epidemics often doubled the death rates above the baselines. Between 1804 and 1887, there were at least 25 epidemics, for an average of one every three years. In fact, in the years 1834, 1849, 1851, 1854, 1864-1865, and 1872, two epidemics were occurring at the same time.

The Diseases

By far, up until 1875, the most frequently recurring epidemic was from smallpox. This is ironic since a vaccine was known since the early 1700s. Yet it did not entirely disappear from the city until after 1902 (though a brief resurgence came in 1947). Two diseases tied for second, in terms of frequency: typhoid/typhus fever, and cholera. Typhoid/typhus fever was transmitted through contaminated food and water, and from direct contact with the infected. Cholera was also spread by contaminated food and water. Additionally, Yellow fever was a regularly appearing epidemic, which first arrived in New York in 1791 and disappeared after 1822. It was transmitted by mosquitoes, which likely spawned in the marshes and still waters of the island.

Arguably, the worst year for the city was 1849 (just at the height of immigration from the Irish Potato Famine) when over 5,000 people died of cholera, and the death rate spiked to 60 deaths per 1,000 residents. The additional deaths from cholera, if scaled up to today’s population count, would amount to the equivalent of about 95,000 additional deaths in 2019! And, in the three years from 1847 to 1849, there were some 8,000 reported deaths from typhoid, cholera, and smallpox combined.

Panic in the City

The random emergence of the epidemics caused the same kind of panics then as we see with coronavirus today. As one scholar writes about the 1832 cholera outbreak,

On Sunday, July 2, despite a calculated official silence, the existence of the first cases of cholera in the city was an open secret. Mass exodus from the city had already begun. To those able, flight was the immediate and traditional reaction. A hyperbolic and sarcastic observer remarked later that on Sunday “fifty thousand stout-hearted … New Yorkers scampered away in steamboats, stages, carts, and wheel barrows.” Farm houses and country homes within a thirty mile radius of the city were filled.

The feeling of dread was a common element of city life, as historical demographer, Gretchen Condran, writes,

Cholera and yellow fever defined the practical and emotional meaning of epidemics during the late eighteen and early nineteenth centuries. Virtually no deaths from these two diseases were recorded in the nonepidemic years. They arrived suddenly, ran their course in a matter of months, and then returned some years later with little or no warning….That a person could be well in the morning and dead before nightfall, a stark contrast to the lingering illness associated with many epidemic diseases like tuberculosis, added to the fear and panic that accompanied these epidemic diseases.

Was Density to Blame?

While I will have more to say about the role of urban density and epidemics in a future post, suffice it to say, the relationship between population density and the severity of epidemics is not so simple. Dense tenement districts were often hot spots for the epidemics, and the poor disproportionately suffered more than the rich, many of whom fled the city during the crises.

But over time, diseases like yellow fever and cholera would largely be eliminated, even as the tenement districts became more crowded. While poor hygiene and lack of sanitation were part of the problem, so was the city-wide environment. New York City, then as today, was a great hub of economic activity, and it was mainly through the port that diseases would enter and spread.

At the time, when germ theory was still not largely understood, health officials assigned blame for these diseases on many factors that seem strange to us today. There were also moral dimensions to their assessment—the poor immigrants huddled together in their dank, dirty tenements were responsible for these diseases because of their poor characters. Or as stated in an 1865 report by the Association for Improving the Condition of the Poor in New York (likely referring to the Irish),

[L]arge masses of the population are debased by the wretched condition in which they are compelled to live. These conditions should be improved; still, it would be true of many thousands, that if left to the uncontrolled indulgence of their reckless, filthy habits, they would convert a palace into a pigsty, and create “fever-nests” and hotbeds of vice and corruption, under circumstances most favorable to health, comfort, and social elevation.

The Mortality Transition

Starting around 1890 or so, the regularly occurring epidemics became less devastating. This is not to say the city was free of epidemics, but those that did occur killed proportionally fewer people. And overall, by the late 1880s, the death rate in New York City began to fall quickly. In 1890, there were 25 deaths per 1,000 residents. By 1925, it was more than half of that at 11.4.

The reasons for the mortality transitions were many. First, scientific knowledge of germ theory helped people better understand and prevent the spread of diseases. In the second half of the 19^th century, New York City expanded its water and sewerage system, which, over time, became universal. Housing reforms cracked down on excessive crowding and unhealthy living conditions. Mass transportation investments and rising incomes allowed people to live further away from the city center and have more housing.

Mortality Rates for New York City and the United States, 1920-1990. Note that mortality rates are deaths per 1,000 residents. From 1920 to about 1940, mortality rates in NY were lower than the U.S. Then they began to diverge, with rates in New York city rising from 1955 to 1970, a difficult period for New York. Sources: See here.

Flatlining

But starting in the 1920s and up until around 1990, mortality rates in New York remained steady, between 10 and 12 deaths per 1,000 residents. What is particularly noteworthy is that mortality rates declined faster in the U.S. than in New York City. However, New York was suffering from a series of problems that were counteracting improvements overall. The effect was a kind of net-zero for gross mortality rates—improvements and problems were offsetting each other. From 1955 to 1970, mortality rates in the city were, in fact, increasing, even while they were falling throughout the rest of the country.

New York, during its industrial heyday, was a very polluted and congested place. Starting in the late 1960s, the city’s industrial base began to disappear, putting many low- and middle-class people out of work. Racial problems intensified as cities throughout the U.S. saw the rise of so-called black ghettos, marked by hyper-segregation and concentrations of poverty, crime, and drugs. In 1975, the government was on the verge of bankruptcy and was forced to reduce services that protected the public. City problems were killing people faster than medical improvements could keep them alive.

Homicides in New York City, 1804-2019. The orange line is homicides per million residents. The blue line is percent of deaths from homicide. Sources: See here.

The Role of Homicides

New York City has always had to deal with violent crime and homicide. Here we take a brief detour to look at the long-run role of homicide in influencing mortality rates. The conclusion from this analysis is that homicides have always represented a small fraction of the total number of deaths, even in the most violent years. In the 1970s and 1980s, homicides accounted for between 2-3% of total deaths (which, of course, is still too many). In 2019, murder rates were as low as they have been since the 19^th-century. Before the modern period, the Civil War era was particularly violent, especially during the Draft Riots of 1863. Though the official figure was that 119 people killed, estimates of the actual number is as high as 1,200.

Mortality Rates in New York City, 1980-2020. The orange line up to 2019 are actual mortality rates. For 2020, mortality is estimated based on last year’s death rate and number of current recorded deaths from COVID-19. The red circle for 2001 is deaths from the 9/11 terrorist attacks. The black line is the mortality rates excluding HIV/AIDs, 9/11, and COVID-19. Sources: See here.

A New Hope: Since 1990

And then, perhaps unexpectedly, death rates in New York City began to decline. In 1990, mortality rates were about 10.1 people per 1,000 residents. By 2019, they were down to around 6.3, a reduction of over 37%. Many of the urban problems that plagued the city started to dissipate. Crime rates began to plunge, and the internet and telecommunication revolution created new employment sectors. New York City experienced a renaissance, and its residents were healthier as a result. Aside from the HIV/AIDS crisis (and some severe influenza outbreaks in 1957 and 1968), there has not been an epidemic in the city since 1918. However, between 1983 and 2017, some 83,000 New Yorkers died from HIV. In the worst years of 1994 and 1995, HIV-related deaths increased the mortality rate by 11% above baseline.

As of this writing, New York City has seen 17,351 confirmed COVD-19 deaths and another 4,692 probable deaths. The city will likely end the year with a mortality rate of around 9.0, which was last seen 25 years ago. As a comparison, the Spanish Flu Epidemic of 1918 increased the number deaths in the city by 25% as compared to the year before. To date, the coronavirus has increased the number of deaths by 42% versus 2019. So the COVID-19 epidemic will likely be worse than the 1918 flu epidemic, but not as bad as those that occurred before the Civil War.

The Future

Nonetheless, if there is one conclusion that emerges from the long run analysis is that all epidemics that hit the city were eventually banished. Sometimes, however, they took a while to be eliminated, but they were eliminated. Today, it is hard to feel and understand what diseases like yellow fever, cholera, and typhoid fever did to the people of the city, since their impacts happened so long ago. However, likely each one generated fear and panic and instilled a sense of impending doom. But the idea of New York City, as a home for strivers, as a vibrant center of culture and life will persist. It is this idea that moves us to solve our problems and will oneday return New York City back to us.

Thanks to Troy Tassier for helpful comments.

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[1] There is also another important issue to consider, namely that of measurement. The mortality rate is defined as the number of deaths per 1,000 residents. This is possibly problematic on two fronts. First, we don’t know the actual number of deaths in a given year, since reported deaths almost surely undercount the true numbers. Second, population counts also need to be approximately accurate. There’s not much that can be done on this front, but likely, today, measurements for both figures are more accurate and so, if anything, the under counts of deaths was much higher in the 19^th century, which would suggest even larger improvements in health and well-being than indicated by the official data. However, the problem with measuring COVID-19 deaths brings to light the problem of measuring death counts during epidemics.

[2] The HIV/AIDs crises began in 1983. Deaths peaked in 1995 and steeply dropped until 2000. Since then, deaths from HIV have steadily declined.

[3] Until 1874, New York City was Manhattan. After that, the city annexed the western parts of the Bronx. In 1898, the city then annexed the rest of the Bronx, Queens, Brooklyn, and Staten Island. Here death rates until 1900 are given for Manhattan; from 1901 to the present, death rates are for the entire city.