Posted: NOVEMBER 1, 2025
From Sewers to Sanitation: How Public Health Built Modern Economies
Public health drives prosperity. Explore how investing in prevention and health systems fuels economic growth and resilience.
What Cholera Taught Us About Economics
When we think about economic development, we tend to picture factories rising on city skylines, the hum of data centers, or the expansion of transport networks connecting regions together. Yet, history reveals that some of the most profound economic transformations began elsewhere — in the quiet, unglamorous work of building sewers, aqueducts, hospitals, and laboratories.
It was the cholera outbreaks of the mid-19th century that first reshaped how we think about public health. For example, the “Great Stink” of 1858 forced London to build one of the world’s first large-scale sewer systems. This infrastructure project not only saved lives but also saved the city’s economy. From cholera outbreaks to the COVID-19 pandemic, societies have been repeatedly reminded of the same costly lesson: public health is economic infrastructure.
According to UNICEF, every dollar invested in sanitation and clean water can yield more than four dollars in economic benefits through lower healthcare costs and increased productivity. The World Health Organization estimates that if healthcare spending were increased by an average of 1% of national Gross Domestic Product (GDP), we would save over 60 million lives per year, increasing the global average lifespan by 3.7 years by 2030. Attaining those health goals also means that low- and middle-income countries may achieve 2-4% additional economic growth on top of the health gains.
When we think about economic development, we tend to picture factories rising on city skylines, the hum of data centers, or the expansion of transport networks connecting regions together. Yet, history reveals that some of the most profound economic transformations began elsewhere — in the quiet, unglamorous work of building sewers, aqueducts, hospitals, and laboratories.
It was the cholera outbreaks of the mid-19th century that first reshaped how we think about public health. For example, the “Great Stink” of 1858 forced London to build one of the world’s first large-scale sewer systems. This infrastructure project not only saved lives but also saved the city’s economy. From cholera outbreaks to the COVID-19 pandemic, societies have been repeatedly reminded of the same costly lesson: public health is economic infrastructure.
According to UNICEF, every dollar invested in sanitation and clean water can yield more than four dollars in economic benefits through lower healthcare costs and increased productivity. The World Health Organization estimates that if healthcare spending were increased by an average of 1% of national Gross Domestic Product (GDP), we would save over 60 million lives per year, increasing the global average lifespan by 3.7 years by 2030. Attaining those health goals also means that low- and middle-income countries may achieve 2-4% additional economic growth on top of the health gains.
Economic Impact of Increased Healthcare Spending
World Health Organization
World Health Organization
That said, prevention remains an uphill political sell and very difficult to execute. Preventive infrastructure does not get the front-page attention that emergency responses usually do. Everyone agrees that prevention costs less than response, but governments and markets tend to fund it only after the damage is done, which is usually too late.
That’s why rethinking health as an investment, and not as an expense, is at the heart of the global conversation today. Governments, institutions like the World Bank and IFC, not-for-profit organizations, and the private sector are working together to change how health systems are financed and investments in preparedness and prevention can be governed properly.
That’s why rethinking health as an investment, and not as an expense, is at the heart of the global conversation today. Governments, institutions like the World Bank and IFC, not-for-profit organizations, and the private sector are working together to change how health systems are financed and investments in preparedness and prevention can be governed properly.
Health Is Wealth: Lessons from Pandemics
In my latest video on Economic Origins, I explore the economic history behind pandemics like cholera and discuss why prevention remains such a challenging political and budgetary sell.
I also speak with Dr. Magnus Lindelow, the World Bank’s Global Program Lead for Pandemic Preparedness, and Zeynep Kantur, Global Head of Health at IFC, about what it will take to reverse this dynamic and how the private sector can help meet the global financing gap.
In my latest video on Economic Origins, I explore the economic history behind pandemics like cholera and discuss why prevention remains such a challenging political and budgetary sell.
I also speak with Dr. Magnus Lindelow, the World Bank’s Global Program Lead for Pandemic Preparedness, and Zeynep Kantur, Global Head of Health at IFC, about what it will take to reverse this dynamic and how the private sector can help meet the global financing gap.
Is Health the Most Overlooked Economic Driver?
Please let me know what you think in the comments section of the video.