Water, Race, and Disease (review)

History is littered with unintended consequences, often tragically so. However, from time to time great good has resulted from human behavior grounded in the most reprehensible of human emotions and motives. Early twentieth-century southern racism nourished Jim Crow patterns of racial discrimination—and yet, as University of Pittsburgh historian Werner Troesken demonstrates, it was southerners' very fear of the "other" that resulted in better health and longer lives in the African American community decades before the flowering of the civil rights movement.

While many historians see suffrage and protest as instruments for achieving social justice, Troesken has discovered that public health measures can also serve the underprivileged by improving their health and lengthening their lives. Troesken's data and statistical analysis demonstrate how improvements in water purification and waste removal dramatically lowered the morbidity and mortality rates of typhoid and other waterborne diseases for African Americans as well as for their white neighbors. Indeed, his analysis suggests that while the civil rights movement brought many advances, it did little to improve black life expectancy, which slowed after 1960 and remains seven years less than that of whites. The big jump occurred between 1900 and 1940: life expectancy for urban blacks from birth rose by nearly 50 percent, from thirty years in 1900 to forty-four in 1940. But why would early twentieth-century southern racists spend money on public health measures that would improve the lot of African Americans? Perhaps that was not the intended consequence.

Southern whites feared that waterborne diseases in black neighborhoods might eventually affect them. Stuart Galishoff's 1985 study of turn-of-the-century Atlanta found that whites did, at times, spend money to purify the water supply and remove wastes from black sections of Atlanta because "germs know no color line."¹ However, Troesken goes further, explaining that the very facilities that whites built to ensure their own health in the age of Jim Crow, when inequalities in education and suffrage abounded, often improved African American health as well. This was an unintended consequence of the "geography of race," the residential patterns of blacks and whites. Troesken observes that at the turn of the last century southern cities were often less segregated than they are now, and publicly financed water and waste-removal services that served a particular geographic area thus often served both blacks and Caucasians. African Americans benefited even more than Caucasians because the latter could often afford to pay privately for such services, while most African Americans in the South could not.

Troesken's data are prodigious. He conducted statistical tests on a data set exceeding 250,000 households, including specific information on access to public water and sewer lines. Of special interest to scholars is his use of data from the 1897 Negro Mortality Project conducted by African American leaders: the instrument, which resembled a census, includes data on more than a thousand African American urban dwellers and has been little used by previous scholars. What do Troesken's data reveal? Urban blacks who lived in cities where residential segregation was not as fully developed as it would be in the decades to come enjoyed a drop in morbidity and mortality from waterborne diseases such as typhoid and diarrhea. In cities such as Memphis, where residential segregation was not rigid, even racist politicians who staunchly defended segregation could not serve the public health needs of whites without serving African Americans as well. However, in cities such as Savannah, where residential patterns reflected a strict separation of the races, public health improvements provided by clear water and waste removal echoed the racial divide.

Water, Race, and Disease offers important historical insights into the history of American racial relations and public health, although Troesken spares his readers little of the statistical scaffolding that supports his argument. Stylistically more of a research report than an elegantly crafted monograph, this volume will not find a place on many undergraduate reading...