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.
What Cholera Taught Us About Economics
When we think of economic development, most of us picture factories, new technologies, and data centers, but some of the most important economic transformations actually involve the boring, unglamorous work of building infrastructures such as sewers and aqueducts.
The cholera outbreaks of the mid-19th century reshaped how we think about public health. As an example, the “Great Stink” of London to build one of the world’s first large-scale sewer systems. This infrastructure project saved both the lives and the economy of Londoners. From this cholera outbreak to the more recent COVID-19 pandemic, societies have been repeatedly reminded of the costs of not considering public health as an economic infrastructure.
According to UNICEF, every dollar invested in sanitation and clean water yields more than four dollars in economic benefits through lower healthcare costs and increased productivity. The World Health Organization estimates that if healthcare spending was increased by an average of 1% of national Gross Domestic Product (GDP), we would save over 60 million lives per year, and increase the global average lifespan by 3.7 years by 2030. In addition to the health benefits, achieving these health goals also means that low and middle income countries may achieve an additional growth of 2-4%.
When we think of economic development, most of us picture factories, new technologies, and data centers, but some of the most important economic transformations actually involve the boring, unglamorous work of building infrastructures such as sewers and aqueducts.
The cholera outbreaks of the mid-19th century reshaped how we think about public health. As an example, the “Great Stink” of London to build one of the world’s first large-scale sewer systems. This infrastructure project saved both the lives and the economy of Londoners. From this cholera outbreak to the more recent COVID-19 pandemic, societies have been repeatedly reminded of the costs of not considering public health as an economic infrastructure.
According to UNICEF, every dollar invested in sanitation and clean water yields more than four dollars in economic benefits through lower healthcare costs and increased productivity. The World Health Organization estimates that if healthcare spending was increased by an average of 1% of national Gross Domestic Product (GDP), we would save over 60 million lives per year, and increase the global average lifespan by 3.7 years by 2030. In addition to the health benefits, achieving these health goals also means that low and middle income countries may achieve an additional growth of 2-4%.
Economic Impact of Increased Healthcare Spending
World Health Organization
World Health Organization
Despite all these benefits, investment in prevention is an uphill political battle and a difficult sell. Preventive infrastructure does not get the same front-page attention that emergency responses often do. Even though everyone agrees that investing in prevention is less costly than investing in response, governments are more likely to fund health after the damage is done, which is often too late.
That’s why we should be thinking of health as an investment, not as an expense. Governments, institutions such as the World Bank and IFC, non-profit organizations, and the private sector are all working together to change the way we finance and invest in health systems and properly govern investments in preparedness and prevention.
That’s why we should be thinking of health as an investment, not as an expense. Governments, institutions such as the World Bank and IFC, non-profit organizations, and the private sector are all working together to change the way we finance and invest in health systems and properly govern investments in preparedness and prevention.
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.