Plague and Renaissance in Tuscany

by Paolo Malanima (Magna Græcia University of Catanzaro)

This blog forms part D in the EHS series: The Long View on Epidemics, Disease and Public Health:Research from Economic History).

The full paper from this blog post was published on the Economic History Review and is available here 


Picture 1
The Triumph of Death. Source: Francesco Petrarca, Trionfi: Ms., 1081. Biblioteca Nazionale, Rome.

In 1346, astrologers announced that the conjunction of three planets foretold great and serious events (“grandi e gravi novitadi”).[3] This was quickly confirmed: early in January 1348, two Genoese galleys landed at the port of Pisa, a few kilometres from the city centre. These two galleys began their voyage in Caffa (Teodosia) on the Black Sea.  They had stopped in Messina earlier, and were en-route to Genoa. After landing at Pisa, the mariners went to the marketplace, where, subsequently, many of the locals became ill and quickly died. Panic gripped the city inhabitants (“fu sparto lo grande furore per tucta la cictà di Pisa”).[4]

From Pisa, the Black Death commenced its march on Europe. In a matter of months it was chronicled that nearly 80 per cent of Pisa’s inhabitants had died. By March, 1348,  the first cases of plague occurred in Florence and the plague affected other, close Tuscan cities, progressing at a speed of one kilometre per day.

At the time of the Black Death, Tuscany was one of the most populated areas of Europe, with approximately one million inhabitants.[1] In the fourteenth century, the population density of Tuscany was approximately three times that of Europe (excluding Russia), and roughly twice that  of England and Wales.

The first wave of the plague was followed by several other attacks: according to a seventeenth-century writer, between 1348 and 1527, there were at least 19 further outbreaks.[2] The Tuscan population reached its minimum around 1440, with barely 400,000 inhabitants. It began to slowly recover from the middle of the fifteenth century, reaching 900,000 inhabitants by 1600. The birthplace of the European Renaissance was one of the most devastated regions. The last assault by the plague occurred in 1629-30, after which the plague disappeared from Tuscany.

Picture 1
Figure 2. Part A: Florence price index, 1310-1450; Part B: Daily real wage rates of masons, 1310-1450. Please note that  in A  the price index has a base of 1 for the period 1420-40; in B the nominal wage is divided by the price of the basket.
Source: P. Malanima, ‘Italy in the Renaissance: a Leading Economy in the European context, 1350-1550’, Economic History Review , 71 (2018), pp. 3-30.

What were the economic effects of these outbreaks of plague? The main effect was a sudden change in the ratio of factors of production. The plague destroyed humans, but not the capital stock (buildings, tools), natural capital (that is physical resources), or human capital (knowledge). Consequently, the capital stock per worker increased and, therefore, so did labour productivity. With few exceptions, the consequences of the Black Death were similar across Europe.[5]

In Tuscany, which suffered frequent and powerful outbreaks of the plague, the ratio between production factors changed the most, leading to a decline in output prices (Figure 2, A). The fall in prices was immediate following the Black Death. However, because of bad harvests and military events, an apparent reversal of the trend occurred at the end of the century. Similarly, the price of labour only increased above its base year from about 1450-70 (Figure 2, B). These changes were known to the Florentine government when it noted, in a decree of 1348, that, while “many citizens had suddenly become the poor, the poor had become rich”.[6]

The curve of Tuscan GDP per capita is shown in Figure 3. We note that the trend began to rise soon after the main outbreak of the plague, but started to decline soon after the population was recovering, after the middle of the century. It reached its maximum around 1410-60. At the time, per capita GDP in Tuscany was higher than elsewhere in Europe. In the first half of the fifteenth century, its annual level was about 2,500 present euros, compared to 2,000 euros in 1861 (the date of national unification).

Picture 1
Figure 3. Real per capita GDP (Florentine Lire 1420-40). Notes: The lower curve refers to the yearly percentage changes from the trend of GDP per capita.
Source: as Figure 2.

Was there real growth in Tuscany after the Black Death? The blunt answer is: no. Following Simon Kuznet’s seminal work, we know that modern economic growth is characterised by simultaneous growth in population and product, with the latter growing relatively faster. Furthermore, modern growth implies the continuous growth of product per capita. However, as this case study demonstrates, product per capita rose because the population declined so dramatically, and Tuscan GDP per capita was highly volatile. Indeed, in some years the latter could fluctuate by 10 to 20 per cent, which would be highly unusual by present standards (although the current COVID outbreak might mean that there will be even greater fluctuations in standards of living and mortality). Another difference between modern growth and growth in the Ancien Régime concerns structural change. Modern growth implies a relative rise in the product of industries and services, and, consequently, a rise in urbanisation. In Renaissance Tuscany exactly the opposite occurred. In 1400, the urbanisation rate was half the level reached in about 1300. Approximately 450 years later, the pre-plague level was not yet attained. The rate achieved in 1300 was only surpassed at the start of the twentieth century.


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[1] M. Breschi, P. Malanima, Demografia ed economia in Toscana: il lungo periodo (secoli XIV-XIX), in M. Breschi, P. Malanima (eds.), Prezzi, redditi, popolazioni in Italia: 600 anni, Udine, Forum, 2002, pp. 109-42 (from this paper is taken the following demographic information).

[2] F. Rondinelli, Relazione del contagio stato in Firenze l’anno 1630 e 1633, Firenze, G.B. Landini, 1634.

[3] M. Villani, Cronica, in G. Villani, Cronica con le continuazioni di Matteo e Filippo, Torino, Einaudi, 1979, p. 295.

[4] R. Sardo, Cronaca di Pisa, O. Banti (ed.), Roma, Istituto Storico Italiano per il Medio Evo, 1963, p. 96.

[5] P. Malanima, The Economic Consequences of the Black Death, in E. Lo Cascio (ed.), L’impatto della “Peste Antonina”, Bari, Edipuglia, 2012, pp. 311-30.

[6] Quoted in S. Cohn, ‘After the Black Death: Labour Legislation and Attitudes towards Labour in late-medieval Western Europe’, Economic History Review, 60 (2007), p. 480.




Demand slumps and wages: History says prepare to bargain

by Judy Z. Stephenson (Bartlett Faculty of the Built Environment, UCL)

This blog is part of the  EHS series on The Long View on Epidemics, Disease and Public Health:Research from Economic History).

Big shifts and stops in supply, demand, and output hark back to pre-industrial days, and they carry lessons for today’s employment contracts and wage bargains.

Canteen at the National Projectile Factory
Munitions factory in Lancaster, 1917 ca.
Image courtesy of Lancaster City Museum. Available at <;

Covid-19 has brought the world to a slump of unprecedented proportions. Beyond immediate crises in healthcare and treatment, the biggest impact is on employment. Employers, shareholders and policymakers are struggling to come to terms with the implications of ‘closed-for-business’ for an unspecified length of time, and laying-off workers seems the most common response, even though unprecedented government support packages for firms and workers have heralded the ‘return of the state’, and the fiscal implications have provoked wartime comparisons.

There is one very clear difference between war and the current pandemic: that of mobilisation. Historians tend to look on times of war as times of full employment and high demand. (1). A concomitant slump in demand and a huge surplus of de-mobilised labour were associated with the depression in real wages and labour markets in the peacetime years after 1815. That slump accompanied increasing investment in large scale factory production, particularly in the textile industry. The decades afterwards are some of the best documented in labour history (2), and they are characterised by frequent stoppages, down-scaling and restarts in production. They should be of interest now because they are the story of how modern capitalist producers learned to set and bargain for wages to ensure they had the skills they needed, when they needed to produce efficiently. Much of what employers and workers learned over the nineteenth century are directly pertinent to problems that currently face employers, workers, and the state.

Before the early nineteenth century in England – or elsewhere for that matter – most people were simply not paid a regular weekly wage, or in fact paid for their time at all (3). Very few people had a ‘job’, and shipwrights, building workers, some common labourers, (in all maybe 15% of workers in early modern economies) were paid ‘by the day’, but the hours or output that a ‘day’ involved were varied and indeterminate. The vast majority of pre-industrial workers were not paid for their time, but for what they produced.

These workers  earned piece rates, like today’s delivery riders earn ‘per drop’, and uber drivers earn ‘per ride’, or garment workers per unit made. When supply of materials failed, or demand for output stalled, workers were not paid, irrespective of whether they could work or not. Blockades, severe weather, famine, plague, financial crises, and unreliable supplies, all stopped work, and so payment of wages ended.  Stoppages were natural and expected. Historical records indicate that in many years commercial activity and work slowed to a trickle in January and February. Households subsisted on savings or credit before they could start earning again, or parishes and the poor law provided bare subsistence in the interim. Notable characteristics of pre-industrial wages – by piecework and otherwise – were wage posting and nominal rate rigidity, or lack of wage bargaining. Rates for some work didn’t change for almost a century, and the risk of no work seems to have been accounted for on both sides. (4).

Piecework, or payment for output is a system of wage formation is of considerable longevity   and its purpose was always to protect employers from labour costs in uncertain conditions. It seems attractive because it transfers  the risks associated with output volatility from the employer to the worker.  Such a practices are the basis of today’s  ‘gig’ economy.  Some workers – those in their prime who are skilled and strong – tend to do well out of the system, and enjoy being able to increase their earnings with effort. This is the flexibility of the gig economy that some relish today.  But its less effective for those who need to be trained or managed, older workers, or anyone who has to limit their hours.

However, piecework or gig wage systems have risks for the employer. In the long run, we know piece bargains break down, or become unworkably complex as both workers and employers behave opportunistically (5). Where firms need skilled workers to produce quickly, or they want to invest in firm or industry specific human capital to increase competitiveness through technology, they can suddenly find themselves outpriced by competitors, or with a labour force with a strong leisure preference or, indeed,  a labour shortage. Such conditions characterised early industrialisation. In the British textile industry this opportunism created and exacerbated stoppages throughout the nineteenth century. After each stoppage both employers and workers sought to change rates. But new bargains were difficult to agree. Employers tried to cut costs. Labour struck. Bargaining for wages impeded efficient production.

Eventually, piecework bargains formed implicit, more stable contracts and ‘invisible handshakes’ paved the way to the relative stability of hourly wages and hierarchy of skills in factories (though the mechanism by which this happened is contested) (6). The form of the wage slowly changed to payment by the hour or unit of time.  Employers worked out that ‘fair’ regular wages (or efficiency wages),  and a regular workforce served them better in the long run than trying to save labour costs through stoppages. Unionisation bettered working conditions and the security of contracts. The Trade Board Act of 1909 regulated the wages of industries still operating minimal piece rates, and ushered in the era of collective wage bargaining as the norm, which only ended with the labour market policies of Thatcherism and subsequent governments.

So far in the twenty-first century, although there has been a huge shift to self-employment, gig wage formation and non-traditional jobs (7) we have not experienced the bitter bargaining that characterised the shift from piecework to time work two hundred years ago, or the unrest of the 1970s and early 1980s. Some of this is probably down to the decline of output volatility that accompanied increased globalisation since the ‘Great Moderation’ and the extraordinarily low levels of unemployment in most economies in the last decade (8). Covid-19 brings output volatility back, in a big, unpredictable way, and the history of wage bargaining indicates that when factors of production are subject to shocks, bargaining is costly. Employers who want to rehire workers who have been unpaid for months, may find established wage bargains no longer hold. Now, shelf stackers who have risked their lives on zero hours contracts may think that their pay rate per hour should reflect this risk. Well-paid professionals incentivised by performance related pay are discovering the precarity of ‘eat what you kill’, and may find that their basic pay doesn’t reflect the preparatory work they need to do in conditions that will not let them perform. Employers facing the same volatility might try to change rates, and many employers have already moved to cut wages.

Today’s state guarantee of many worker’s income, unthinkable in the nineteenth century laissez-faire state, are welcome and necessary. That today’s gig economy workers have made huge strides towards attaining full employment rights would also appear miraculous to most pre-industrial workers. Yet, contracts and wage formation matter. With increasing numbers of workers without job security, and essential services suffering demand and supply shocks, many workers and employers are likely to confront significant shifts in employment.  History suggests bargaining for them is not as easy a process as the last thirty years have led us to believe.


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(1). Allen, R. (2009). Engels’ pause: Technical change, capital accumulation, and inequality in the British industrial revolution. Explorations in Economic History, 46(4), 418-435; Broadberry et al, (2015). British Economic Growth, 1270-1870. CUP.

(2). Huberman. M., (1996) Escape from the Market, CUP, chapter 2.

(3). Hatcher, J., and Stephenson, J.Z. (Eds.), (2019) Seven Centuries of Unreal Wages, Palgrave Macmillan

(4). J. Stephenson and P. Wallis, ‘Imperfect competition’, LSE Working Paper (forthcoming).

(5). Brown, W. (1973) Piecework Bargaining, Heinemann.

(7). See debates between Huberman, Rose, Taylor and Winstanley in Social History 1987-89.

(6). Katz, L., & Krueger, A. (2016). The Rise and Nature of Alternative Work Arrangements in the United States, 1995-2015. NBER Working Paper Series.

(8). Fang, W., & Miller, S. (2014). Output Growth and its Volatility: The Gold Standard through the Great Moderation. Southern Economic Journal, 80(3), 728-751.


The Long View on Epidemics, Disease and Public Health: Research from Economic History, Part C

by Vincent Geloso (King’s University College at Western University Canada), discussing Werner Troesken’s ‘The Pox of Liberty’


Geloso Image 3
At the Gates, 1885. Available at NIH.

Shutdowns, quarantines, lockdowns and curfews impose economic costs. Yet, from a public health perspective, shutdowns, quarantines, lockdowns and curfews have benefits in that they limit contagion risks and deaths. There is thus a trade-off to be made. Economists, epidemiologists and others have tried to measure the costs and benefits of the measures presently adopted by governments. The idea is to identify which measures are too extreme in that they increase economic distress [i], might induce behavioral responses that mitigate the effectiveness of public health measures [ii] or that are simply too costly compared to other alternatives.

However, these trade-offs understate the complex web of issues associated with public health measures. At least, that it is the conclusion that emerges after reading Werner Troesken’s The Pox of Liberty:  How the Constitution Left Americans Rich, Free, and Prone to Infection (University of Chicago Press, 2015).

Few economists (none, probably) would dispute that the state has a role in the domain of public health. After all, while self-quarantining exists, it would clearly be “underprovided” if marginally disinclined individuals were not somewhat coerced into quarantining themselves. Thus, there is a role for government. Normally, this is the end of the story – at least from the perspective of welfare economics. “Not so” replies Troesken! Institutions that exert the coercion necessary to produce public health measures are also able to use coercion for other, less beneficial purposes, which also generate a series of trade-offs.


Geloso Image
The Cow-Pock—or—the Wonderful Effects of the New Inoculation! By satirist James Gillray, 1802. Available here.


The first trade-off

Troesken concentrates on inoculation and vaccines in the  late 19th and early 20th centuries, to argue that the United States was an incredibly rich country by the standard of the time and also exhibited exceptionally high (and probably underestimated) smallpox death rates compared to other countries. To explain the puzzle, Troesken argues that by expanding and securing economic freedoms, the Constitution also constrained the ability of governments to prevent contagion of infectious diseases in the short-run. Under the Equal Protection and Due Process Clauses of the Constitution, numerous public health measures were overturned – including measures to make vaccination compulsory. Consequently, Americans were likelier to die from highly contagious diseases.

Geloso Image 2
The Next To Go: Fight Tuberculosis, 1919. Available at NIH.

Yet, the same constraints also protected property rights and economic freedoms, which allowed Americans to grow exceptionally rich during the late 19th and early 20th centuries.


The second trade-off

Certain diseases are easily combatted  thanks to economic prosperity (either directly through improved nutrition or indirectly through the ability to make certain investments). Other diseases are less sensitive to the income of the people they maim or kill. [iii] Thus, it might be conjectured that the Constitution made Americans richer and sicker from smallpox  while simultaneously  reducing the likelihood of their dying from other diseases. This is the basis of  Troesken’s chapter,  “The palliative effects of property rights”. The wealth of America made it easier to invest in capital-intensive projects to deal with waterborne diseases and typhoid fever. Troesken demonstrates how the protections afforded by the Constitution encouraged investments in water treatment infrastructures because it protected private firms from politically opportunistic behavior and   bondholders from default.  These protections made Americans less likely to die from typhoid fever.

One could reply to Troesken that the United States is, in many ways, an oddity. Yet, this strange trade-off can be seen through a global lense as well. If Troesken is correct, institutional regimes that score high with regards to economic freedom are ill-equipped to combat infectious diseases as the latter are better dealt with by strong and capable states. Thus, economic freedom would show a zero, or maybe even a positive, relation with death rates. However, these same regimes would be better able to combat “poverty diseases” as economic freedom promotes growth thereby improving the ability to combat certain diseases. Economic freedom would exhibit a negative relation with death rates from poverty diseases. Leandro Prados de la Escosura who compiled time-series of estimates of “economic liberty”, [iv] showed that this relationship was testable.  His measures are very similar to those used in the modern literature on economic freedom but with some differences. Regressing death rates from smallpox and typhoid fever on economic liberty data allows to test the validity of Troesken’s argument.

The result of such a test can be seen in Table 1 below. The relationship  is bivariate and plagued by the problem of a relatively small number of countries providing cause-specific death rates. Thus, it ought to be taken lightly; it is presented  only to suggest new directions of enquiry. Nonetheless, it is supportive of Troesken’s core idea: Economic liberty has no statistically significant effect on the log of smallpox death rates. However, it does have a strong significant effect on death rates from typhoid fever.

This complex trade-off can be summarized: one set of institutions makes us healthier and poorer now while making us less healthy than we could be in the future; the other set of institutions make us sicker and richer now while making us healthier than we could be in the future. Simplified in this manner, we can see the value of the points made by economists such as James Buchanan and Ronald Coase – institutions are not “all you can eat buffets”.

Geloso table

­­In the current crisis, this insight about the roles, advantages, limitations and consequences of public health measures is too often set aside. But this does not make it irrelevant. Unfortunately,  terms of explaining this powerful and crucial insight,  I am a poor substitute for Werner Troesken, [v] who died in 2018.  Nevertheless, his writing ought to be on all our minds when we consider the proper response to the current crisis.


[i] W. Kerr et al. 2017. “Economic recession, alcohol, and suicide rates: comparative effects of poverty, foreclosure, and job loss.” American Journal of Preventive Medicine, Vol. 54, n. 4, pp. 469-475.

[ii] A, Mesnard and P. Seabright. 2009. “Escaping epidemics through migration? Quarantine measures under incomplete information about infection risks.” Journal of Public Economics, Vol. 93, no. 7-8, pp. 931-938.

[iii] See notably the works of B. Harris, (2004). “Public Health, Nutrition, and the Decline of Mortality: The McKeown Thesis Revisited.” Social History of Medicine, Vol. 17, no. 3, pp. 379-407 and D. Bloom and D. Canning, (2007). “Commentary: The Preston Curve 30 years on: Still sparking fires.” International Journal of Epidemiology, Vol. 36, no. 3, pp. 489-499 for a summary of the complex relation between prosperity and health.

[iv] L. Prados de la Escosura, (2016). “Economic freedom in the long run: evidence from OECD countries, 1850-2007”. Economic History Review, Vol. 69, no.2, pp. 435-468

[v] I have applied his insights to the case of the Cuban health care system: see V. Geloso, G. Berdine and B. Powell,  “Making Sense of Dictatorships and Health Outcomes”, British Medical Journal: Global Health,  (forthcoming); G. Berdine, V. Geloso and B. Powell,  (2018). “Cuban Infant Mortality and Longevity: Health Care or Repression?” Health Policy & Planning, Vol. 33, no. 6, pp. 755-57.
A longer review of “The Pox of Liberty” by Vincent Geloso is available here:

See also, Clay, K.; Schmick, E. and Troesken, W. (2019) “The Rise and Fall of Pellagra in the American South”, Journal of Economic History 79(1):32-62, DOI:

and reviews by Kenneth F. Kiple in  The American Historical Review, , and a review by Alan M. Kraut in Bulletin of the History of Medicine:

Vincent Geloso


The Long View on Epidemics, Disease and Public Health: Research from Economic History Part B*

This piece is the result of a collaboration between the Economic History Review, the Journal of Economic History, Explorations in Economic History and the European Review of Economic History. More details and special thanks below. Part A is available at this link 

Bubonic plague cases are on the rise in the US. Yes, really. - Vox
Man and women with the bubonic plague with its characteristic buboes on their bodies — a medieval painting from 1411.
 Everett Historical/Shutterstock

As the world grapples with a pandemic, informed views based on facts and evidence have become all the more important. Economic history is a uniquely well-suited discipline to provide insights into the costs and consequences of rare events, such as pandemics, as it combines the tools of an economist with the long perspective and attention to context of historians. The editors of the main journals in economic history have thus gathered a selection of the recently-published articles on epidemics, disease and public health, generously made available by publishers to the public, free of access, so that we may continue to learn from the decisions of humans and policy makers confronting earlier episodes of widespread disease and pandemics.

Generations of economic historians have studied disease and its impact on societies across history. However, as the discipline has continued to evolve with improvements in both data and methods, researchers have uncovered new evidence about episodes from the distant past, such as the Black Death, as well as more recent global pandemics, such as the Spanish Influenza of 1918. In this second instalment of The Long View on Epidemics, Disease and Public Health: Research from Economic History, the editors present a review of two major themes that have featured in the analysis of disease. The first  includes articles that discuss the economic impacts of historical epidemics and the official responses they prompted.  The second  turns to the more optimistic story of the impact of public health regulation and interventions, and the benefits thereby generated.


Pieter Bruegel the Elder, The Triumph of Death (1562 ca.)

Epidemics and the Economy

 The ways in which societies  and economies are affected by repeated epidemics is a question that historians have struggled to understand. Paolo Malanima provides a detailed analysis of how Renaissance Italy was shaped by the impact of plague: ‘Italy in the Renaissance: A Leading Economy in the European Context, 1350–1550’. Economic History Review 71, no. 1 (2018): 3-30. The consequences of plague for Italy are explored in even more detail by Guido Alfani who demonstrates that the peninsula struggled to recover after experiencing pervasive mortality during the seventeenth century: ‘Plague in Seventeenth-century Europe and the Decline of Italy: An Epidemiological Hypothesis’. European Review of Economic History 17, no. 4 (2013): 408-30.  Epidemics cause multiple changes to the economic environment which necessitates a multifaceted response by government.  Samuel Cohn examines the  oppressive nature of these  reactions in his luminous study of the way European governments sought to prevent workers benefiting from the increased demand for their labour following the Black Death: ‘After the Black Death: Labour Legislation and Attitudes Towards Labour in Late-Medieval Western Europe’. The Economic History Review, 60, no. 3 (2007): 457-85.  


The Black Death Actually Improved Public Health | Smart News ...
Josse Lieferinxe, Saint Sebastian Interceding for the Plague Stricken (1497 ca)


Public Health

Richard Easterlin’s  panoramic overview of mortality  shows that government policy was critical  in reducing levels of mortality from the early nineteenth century. Economic growth by itself did not lift life expectancy. This major  paper illuminates the essential contribution of public intervention to health in modern societies:  “How Beneficent Is the Market? A Look at the Modern History of Mortality.” European Review of Economic History 3, no. 3 (1999): 257-94. .  Does strict health regulation save lives?  Alan Olmstead and Paul Rhode respond to this question in the affirmative by explaining how the US federal government succeeded in lowering the spread of tuberculosis by establishing controls on cattle in the early part of the twentieth century. Their analysis has considerable contemporary relevance:  only robust and universal controls saved lives: ‘The ‘Tuberculous Cattle Trust’: Disease Contagion in an Era of Regulatory Uncertainty’.  The Journal of Economic History 64, no. 4 (2004): 929–63.

Human society has achieved enormous gains in life expectancy over the last two centuries. Part of the explanation for this improvement  was improvements in key infrastructure.  However, as Daniel Gallardo‐Albarrán demonstrates, this was not simply a  question of ‘dig and save lives’, because  it was the combination  of types of structure  — water and sewers – that mattered: ‘Sanitary infrastructures and the decline of mortality in Germany, 1877–1913’, The Economic History Review (2020). One of the big goals of economic historians has been to measure the multiple benefits of public health interventions. Brian Beach,  Joseph Ferrie, Martin Saavedra, and Werner Troesken,  provide a  brilliant example of how novel statistical techniques  allow us to determine the gains from one such intervention – water purification. They demonstrate that the long-term impacts of reducing levels of disease by improving water quality were large when measured in education and income, and not just lives saved: ‘Typhoid Fever, Water Quality, and Human Capital Formation’.  The Journal of Economic History 76, no. 1 (2016): 41–75. What was it that allowed European societies to largely defeat tuberculosis (TB) in the second half of the twentieth century? In an ambitious  paper, Sue Bowden, João Tovar Jalles, Álvaro Santos Pereira, and Alex Sadler, show that a mix of factors explains the decline in TB: nutrition, living conditions, and the supply of healthcare: ‘Respiratory Tuberculosis and Standards of Living in Postwar Europe’.  European Review of Economic History 18, no. 1 (2014): 57-81.

What We Can Learn (and Should Unlearn) From Albert Camus's The ...
Thomas Rowlandson, The English Dance of Death (1815 ca)

This article was compiled by: 


If you wish to read further, other papers on this topic are available on the journal websites:


*  Special thanks to Leigh Shaw-Taylor, Cambridge University Press, Elsevier, Oxford University Press, and Wiley for their advice and support.

The Long View on Epidemics, Disease and Public Health: Research from Economic History, Part A

This piece is the result of a collaboration between the Economic History Review, the Journal of Economic History, Explorations in Economic History and the European Review of Economic History. More details and special thanks below. Part B can be found here


Exhibit depicting a miniature from a 14th century Belgium manuscript at the Diaspora Museum, Tel Aviv. Available at Wikimedia Commons.

As the world grapples with a pandemic, informed views based on facts and evidence have become all the more important. Economic history is a uniquely well-suited discipline to provide insights into the costs and consequences of rare events, such as pandemics, as it combines the tools of an economist with the long perspective and attention to context of historians. The editors of the main journals in economic history have thus gathered a selection of the recently-published articles on epidemics, disease and public health, generously made available by publishers to the public, free of access, so that we may continue to learn from the decisions of humans and policy makers confronting earlier episodes of widespread disease and pandemics.

Emergency hospital during influenza epidemic, Camp Funston, Kansas. Available at Wikimedia Commons.

Generations of economic historians have studied disease and its impact on societies across history. However, as the discipline has continued to evolve with improvements in both data and methods, researchers have uncovered new evidence about episodes from the distant past, such as the Black Death, as well as more recent global pandemics, such as the Spanish Influenza of 1918. We begin with a recent overview of scholarship on the history of premodern epidemics, and group the remaining articles thematically, into two short reading lists. The first consists of research exploring the impact of diseases in the most direct sense: the patterns of mortality they produce. The second group of articles explores the longer-term consequences of diseases for people’s health later in life.

L0025221 Plague doctor
Plague doctor. Available at Wellcome Collection.


L0001879 Two men discovering a dead woman in the street during the gr
Two men discovering a dead woman in the street during the Great Plague of London, 1665. Available at Wellcome Collection.


Patterns of Mortality

Emblems of mortality: death seizing all ranks and degrees of people, 1789. Available at Wikimedia Commons.

The rich and complex body of historical work on epidemics is carefully surveyed by Guido Alfani and Tommy Murphy who provide an excellent  guide to the economic, social, and  demographic impact of plagues in human history: ‘Plague and Lethal Epidemics in the Pre-Industrial World’.  The Journal of Economic History 77, no. 1 (2017): 314–43.  The impact of epidemics varies over time and few studies have shown this so clearly as the penetrating article by Neil Cummins, Morgan Kelly and Cormac  Ó Gráda, who provide a finely-detailed map of how the plague evolved  in 16th and 17th century London to reveal who was most heavily burdened by this contagion.  ‘Living Standards and Plague in London, 1560–1665’. Economic History Review 69, no. 1 (2016): 3-34. .  Plagues shaped the history of nations  and, indeed, global history, but we must not assume that the impact of  plagues was as devastating as we might assume: in a classic piece of historical detective work, Ann  Carlos and Frank Lewis show that mortality among native Americans in the Hudson Bay area  was much lower than historians had suggested: ‘Smallpox and Native American Mortality: The 1780s Epidemic in the Hudson Bay Region’.  Explorations in Economic History 49, no. 3 (2012): 277-90.

The effects of disease reflect a complex interaction of individual and social factors.  A paper by Karen Clay, Joshua Lewis and Edson Severnini  explains  how the combination of air pollution and influenza was particularly deadly in the 1918 epidemic, and that  cities in the US which were heavy users of coal had all-age mortality  rates that were approximately  10 per cent higher than  those with lower rates of coal use:  ‘Pollution, Infectious Disease, and Mortality: Evidence from the 1918 Spanish Influenza Pandemic’.  The Journal of Economic History 78, no. 4 (2018): 1179–1209.  A remarkable analysis of how one of the great killers, smallpox, evolved during the 18th century, is provided by Romola Davenport, Leonard Schwarz and Jeremy Boulton, who concluded that it was a change in the transmissibility of the disease itself that mattered most for its impact: “The Decline of Adult Smallpox in Eighteenth‐century London.” Economic History Review 64, no. 4 (2011): 1289-314.   The question of which sections of society experienced the heaviest burden of sickness during outbreaks of disease outbreaks has long troubled historians and epidemiologists. Outsiders and immigrants have often been blamed for disease outbreaks. Jonathan Pritchett and Insan Tunali show that poverty and immunisation, not immigration, explain who was infected during the Yellow Fever epidemic in 1853 New Orleans: ‘Strangers’ Disease: Determinants of Yellow Fever Mortality during the New Orleans Epidemic of 1853’. Explorations in Economic History 32, no. 4 (1995): 517.


The Long Run Consequences of Disease

‘Dance of Death’. Illustrations from the Nuremberg Chronicle, by Hartmann Schedel (1440-1514). Available at Wikipedia.

The way epidemics affects families is complex. John Parman wrestles wit h one of the most difficult issues – how parents respond to the harms caused by exposure to an epidemic. Parman  shows that parents chose to concentrate resources on the children who were not affected by exposure to influenza in 1918, which reinforced the differences between their children: ‘Childhood Health and Sibling Outcomes: Nurture Reinforcing Nature during the 1918 Influenza Pandemic’, Explorations in Economic History 58 (2015): 22-43.  Martin Saavedra addresses a related question: how did exposure to disease in early childhood affect life in the long run? Using late 19th century census data from the US, Saavedra  shows that children of immigrants who were exposed to yellow fever in the womb or early infancy, did less well in later life than their peers,  because they were only able to secure lower-paid  employment: ‘Early-life Disease Exposure and Occupational Status: The Impact of Yellow Fever during the 19th Century’.  Explorations in Economic History 64, no. C (2017): 62-81.  One of the great advantages of historical research is its  ability to reveal how the experiences of disease over a lifetime generates cumulative harms. Javier Birchenall’s extraordinary paper shows how soldiers’ exposure to disease during the American Civil War increased the probability  they would  contract tuberculosis later in life: ‘Airborne Diseases: Tuberculosis in the Union Army’. Explorations in Economic History 48, no. 2 (2011): 325-42.


V0010604 A street during the plague in London with a death cart and m
“Bring Out Your Dead” A street during the Great Plague in London, 1665. Available at Wellcome Collection.


Patrick Wallis, Giovanni Federico & John Turner, for the Economic History Review;

Dan Bogart, Karen Clay, William Collins, for the Journal of Economic History;

Kris James Mitchener, Carola Frydman, and Marianne Wanamaker, for Explorations in Economic History;

Joan Roses, Kerstin Enflo, Christopher Meissner, for the European Review of Economic History.


If you wish to read further, other papers on this topic are available on the journal websites:


* Thanks to Leigh Shaw-Taylor, Cambridge University Press, Elsevier, Oxford University Press, and Wiley, for their advice and support.