But this dichotomy — that we must choose economy or health — is a false one, as many economists have argued. In the 19th century, reformers broke the false dichotomy between health and the economy by arguing that “health is wealth.” While this has become a pithy slogan in modern times, it had a far more significant meaning in its earliest days. We need to resurrect this understanding and use it to convince government officials that regularly and consistently investing in public health bolsters human and economic well-being. Ignoring public health considerations, by contrast, is a recipe for driving the economy down.
Setting up a false binary between health and economy has a long history of influencing political decisions in the United States. When businessmen doubled as political leaders, as was the case in many 19th-century cities (and again today), they made decisions to advance their own interests. This often meant refusing health investigations that might harm their real estate values and rejecting sanitary provisions for which they would have to pay directly, such as landlords improving housing conditions.
Political leaders were reluctant to enact measures that might interfere with the local economy in the short term. Quarantines, the most common method of disease prevention, for example, stopped the flow of goods and people into port cities — thereby halting trade and slowing the marketplace. Even when an epidemic was imminent, city governments accordingly were slow to enforce quarantine measures and drew ire because quarantines disrupted local businesses and jobs.
The results were catastrophic: In the decades before the Civil War, epidemics of yellow fever and cholera regularly ravaged American cities; the death toll from routinely occurring endemic diseases, such as typhoid, was also high.
To stem this deadly tide, physicians urged governments at all levels to change their priorities. Rather than invest solely in improvements for business and trade, such as costly waterfront and railroad projects, physicians and reformers pushed governments to regularly invest in proactive public health measures that would improve sanitary conditions and prevent diseases, thereby sustaining economic growth in the long run.
The pithy argument that “health is wealth” was a key ingredient of this successful pressure campaign. When this phrase emerged in the 1840s and 1850s, it was not an empty platitude that individuals should be grateful for their health, as it became over time, but a political argument that health, by enabling labor, created the nation’s wealth and required protection.
This argument proved convincing because public health reformers appealed to politicians’ and businessmen’s shared bottom line: profits. Reformers had long criticized capitalism for creating overcrowded and unsanitary conditions that fostered disease, but they grasped that they could also use the logic of capitalism to advance public health.
Adam Smith had argued “labor is wealth,” and New York City physician John Hoskins Griscom built on that argument when he asserted “the health of the people affect[s] the capacity and interests of the state.” Public health reformers like Griscom based their arguments upon labor because health determined how productive individuals and the entire labor force could be. Health was the necessary prerequisite for wealth.
“Health is wealth” was the shorthand for this argument and ultimately the motto for public health organizations across the country. Businessmen found this logic compelling in extreme moments, such as when Chicago’s Board of Trade feared that nose guard-wearing dockworkers would stop working to avoid inhaling disease-causing miasmas or when the 1863 draft riots pushed sanitary conditions and economic inequality to the forefront of New York City politics. In both of these moments, businessmen agreed with reformers that health was necessary for labor and labor was necessary for business, pressuring city governments to enact health measures. Businessmen’s actions had long-term consequences: After the draft riots, New York’s businessmen chartered a sanitary survey that led to the 1866 creation of the Metropolitan Board of Health, the United States’ first permanent board of health staffed by physicians and scientists.
As an argument and a motto, “health is wealth” justified spending government money on such sanitary measures as cleaning streets, supplying clean water, installing sewer lines and spraying disinfectants in public places. Through boards of health, cities also began regulating “nuisances detrimental to health,” a category that included noxious byproducts released by industries; we call them pollutants today. Doing so ensured that people would be able to work and that the economy would continue to generate profits.
To those who questioned the cost of these measures, Massachusetts reformer Lemuel Shattuck reminded them that public health “is not an expense, but an investment … which is designed to add to the wealth and not to the poverty of the Commonwealth.”
American businessmen and politicians seized upon this promise, but in the process they diluted the motto’s original meaning. In New Orleans, businessmen who had lost control of the city during the Civil War and Reconstruction, rallied around “Public Health is Public Wealth” to reclaim the city government after the devastating yellow fever epidemic of 1878. To redeem their city’s reputation as an economic center, these businessmen approached public health as a business problem and argued that health directly increased wealth — but this was more sloganeering than a sign of a deep commitment to public health.
Similarly, patent medicine producers started advertising their dubious wares under the slogan “health is wealth,” convincing individuals that they could purchase health for themselves regardless of their living conditions. Advertisements adjusted the phrase into a self-help mantra, such as those for Dr. Radway & Company’s medicines that asserted “health of the body is wealth of mind” throughout the 1880s.
Today, however, we need to return this phrase to its original meaning. Public health is a prerequisite for a functional — or booming — economy. And failing to adequately invest in public health over time has made the pandemic worse and necessitated the lockdown that has proved so economically damaging.