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Bo Burström, MD, PhD, Gloria Macassa, MD, Lisa Öberg, PhD, Eva Bernhardt, PhD and Lars Smedman, MD, PhD

Bo Burström and Gloria Macassa are with the the Centre of Health Equity Studies, Stockholm University/Karolinska Institutet, and the Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Stockholm, Sweden. Lisa Öberg is with the Centre of Health Equity Studies, Stockholm University/Karolinska Institutet and the Department of History, Södertörn University College, Huddinge, Sweden. Eva Bernhardt is with the Centre of Health Equity Studies, Stockholm University/Karolinska Institutet and the Department of Sociology, Stockholm University. Lars Smedman is with the Centre of Health Equity Studies, Stockholm University/Karolinska Institutet and the Department of Woman and Child Health, Karolinska Institutet.

Correspondence: Requests for reprints should be sent to Bo Burström, MD, PhD, Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, SE-171 76 Stockholm, Sweden (e-mail: bo.burstrom{at}phs.ki.se).

Today, many of the 10 million childhood deaths each year are caused by diseases of poverty—diarrhea and pneumonia, for example, which were previously major causes of childhood death in many European countries. Specific analyses of the historical decline of child mortality may shed light on the potential equity impact of interventions to reduce child mortality.

In our study of the impact of improved water and sanitation in Stockholm from 1878 to 1925, we examined the decline in overall and diarrhea mortality among children, both in general and by socioeconomic group. We report a decline in overall mortality and of diarrhea mortality and a leveling out of socioeconomic differences in child mortality due to diarrheal diseases, but not of overall mortality. The contribution of general and targeted policies is discussed.

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