Health inequality: evidence from 19th century Netherlands

Abstract

Persistent health inequality offers a significant opportunity to improve welfare and productivity, and understanding its causal pathways is key to adequate policy design. In this thesis, I first review the literature on health inequality in contemporaneous settings to establish the contribution of studies using historical data such as the ones provided here. Studying health shocks in a historical setting can illuminate their potentially different consequences along the development path. Furthermore, the distribution of improvements to health conditions within the family may play a key role in the evolution of inequality. Using death, birth, and marriage certificates of two provinces of the Netherlands, I first analyse the effect on health inequality of a health shock (an undetermined epidemic) in the early 19th century. Lower socioeconomic status groups were not only more negatively affected by the shock but also experienced worse health in the aftermath, worsening overall health inequality among survivors. I also study the so-called birth-order effect (differences in outcomes between siblings of different orders of birth) on survivability in the 19th and early 20th centuries and found a small but significant negative effect of older siblings of the same gender on survivability and a positive effect of older siblings of different gender. However, this effect did not increase as life conditions improved, and it was not overly present among any particular socioeconomic group, suggesting relatively equal access to improvements in health.