Role of the environment in the decline of infant mortality: an analysis of the 1911 Census of England and Wales

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Abstract
Summary: This study tests the proposition that the contribution of environmental factors to the reduction of infant mortality early in the twentieth century was greater than that made by the alleviation of poverty. The estimates were obtained from retrospective reports of women enumerated at the 1911 Census, and covered the period from approximately 1895 to 1910. Infant mortality by father's occupation underwent an average decline of 35% from a peak infant mortality rate (IMR) of 132, with wide variation. The removal of poor (usually urban) residential conditions was probably associated with the decline, but, except at the extremes, income did not explain the differences. In the 97 great towns, the subject of this study, where the average decline in IMR was also 35% from a peak of 146, the rate of urbanization over 20 years accounted for a significant proportion of the differential decline, and measures of poverty added little to the explanation. This conclusion survived multivariate analysis using urban development and poverty level as explanatory variables, and controlling for fertility decline and selective migration.