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.They had not then learned to view life insurance from the actu-arial standpoint, nor had they then appreciated the profound meaning of thestudy of the class, of groups, of individuals, of selected lives, and noted whatthe combination and grouping and classification of these varied human unitsinto such groups would show when the mortality was thoroughly workedout.If we as Medical Directors have progressed at all in the past twentyyears, it is, I think, in the realization of the fact that we no longer deal asMedical Directors with the individual, but with the class, that we must thinkin the language of the actuary and not in that of the physician.64Actuaries also changed their views as quantitative medical data be-came more available, according to an insurance official in 1911:Until a few years ago it was almost a universal custom to confine the actuarystrictly to the mathematics of the business, and the Medical Director to theselection of risks.That was unavoidable when statistics regarding mortalityamong the different classes of risks were very scanty, and when selection wastherefore largely based on the judgment and experience of the medical man.With the advance in knowledge of the mortality under different conditionsand with the increase in competition, it became necessary for the MedicalDirector to have a knowledge of statistics, and for the Actuary to learn theviews of the Medical Director in order to properly compile statistics bearingon the selection of risks.65Throughout the first half of the century, life insurance companiescontinued to innovate in medical diagnosis.They conducted research on 74 The Invention of the Risk Factorimproving the accuracy and reliability of urinalyses and adding blood sugarmeasurements.Insurance companies were among the first large-scale usersof chest X rays for tuberculosis in the 1920s and electrocardiographs forheart disease in the 1920s and 1930s.66 By requiring their medical examin-ers to use the tests, insurance companies educated tens of thousands ofphysicians about new developments in diagnosis.Thus the life insurance industry used medical statistics to make im-portant discoveries in disease etiology and prognosis and educated theirmedical examiners about them.As a result of the educational process, mostphysicians gradually accepted the concept that asymptomatic personal char-acteristics could increase the long-term risk of developing disease. PART IIHealth Education for Healthy Lifestyles 6CULTURAL ANDENVIRONMENTAL INFLUENCESON URBAN MORTALITY RATES[In my study of ten blocks of tenements in New York City, the] com-parison.has proven most surprising, for while in certain blocks[populated by one nationality group] there is a very high [infant] deathrate, in certain other blocks [populated by a different nationality group],half a mile away.the [infant] death rate is only one-half as great asthe average death rate of the city,.yet in the latter district there is agreater population, the tenement houses are taller, and the generalsanitary conditions are worse.(New York City physician, 1908)1The invention of the actuarial risk factor was one of two major innovationsrequired for the formulation of programs to promote healthier lifestyles.The other was the concept of educating the public that personal behaviorscan affect health.The discovery that some lifestyles were healthier thanothers emerged from findings that nationality groups with similar in-comes and living conditions varied widely in their total and infant mortal-ity rates.One of the major uses of vital statistics in the early twentieth centurywas to compare the health status of different population groups.National-ity groups were the most important groups in the northeastern andmidwestern cities teeming with immigrants and their children.Federal,state, and local governments regularly gathered information on place of77 78 Health Education for Healthy Lifestylesbirth and the place of birth of both parents.Individuals were categorized as native born, foreign born, and foreign stock (native born with at leastone foreign born parent).Nationality groups were useful categories because they constitutedgenuine communities.They shared languages, neighborhoods, occupations,cultures, churches, and fraternal and mutual aid societies.Their membershad high rates of marriage within the group.Group solidarity was strength-ened by language barriers, discrimination, and mutual hostilities with othernationality groups.The foreign born and their children were also considered the sourceof most social and health problems.In his 1870 book, The Dangerous Classesof New York, Charles Loring Brace, a pioneer in the social welfare move-ment, stated that an immense proportion of our ignorant and criminalclass are foreign born; and of the dangerous classes here, a very large part,though native-born, are of foreign parentage. He cited statistical tabulationsof prison populations as evidence.About 1900, the journalist Hutchins Hapgoodobserved in the first analytical description of an immigrant community:The Jewish quarter of New York is generally supposed to be a place of pov-erty, dirt, ignorance, and immorality the seat of the sweatshop, the tene-ment house, where red-lights sparkle at night, where the people are queerand repulsive.Well-to-do persons visit the Ghetto merely from motives ofcuriosity or philanthropy; writers treat of it sociologically, as a place incrying need of improvement.2Immigrant Nationality GroupsAn understanding of the health and social problems of the foreign bornand their children requires some description of their patterns of migrationand experiences in America.Although early twentieth-century America hasbeen considered a refuge for impoverished and subjugated groups in Eu-rope, most immigrants were continuing a long European tradition of mi-gratory work.Throughout the seventeenth and eighteenth centuries, manyof the rural poor in Europe sought periodic employment away from theirfarms to supplement their incomes.The women found jobs such as domes-tic servants and seamstresses in the pre-industrial European cities and themen worked as farm laborers and migratory workers.Few came to theUnited States because of the cost and dangers of ocean travel in the smallsailing ships and most of those who did were permanent settlers.3 Cultural and Environmental Influences on Urban Mortality Rates 79Changes in European life during the nineteenth century forced manyrural Europeans to become migratory workers.The population of Europegrew from 187 million in 1815 to 468 million in 1913, excluding 52 mil-lion persons who emigrated from Europe [ Pobierz całość w formacie PDF ]
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.They had not then learned to view life insurance from the actu-arial standpoint, nor had they then appreciated the profound meaning of thestudy of the class, of groups, of individuals, of selected lives, and noted whatthe combination and grouping and classification of these varied human unitsinto such groups would show when the mortality was thoroughly workedout.If we as Medical Directors have progressed at all in the past twentyyears, it is, I think, in the realization of the fact that we no longer deal asMedical Directors with the individual, but with the class, that we must thinkin the language of the actuary and not in that of the physician.64Actuaries also changed their views as quantitative medical data be-came more available, according to an insurance official in 1911:Until a few years ago it was almost a universal custom to confine the actuarystrictly to the mathematics of the business, and the Medical Director to theselection of risks.That was unavoidable when statistics regarding mortalityamong the different classes of risks were very scanty, and when selection wastherefore largely based on the judgment and experience of the medical man.With the advance in knowledge of the mortality under different conditionsand with the increase in competition, it became necessary for the MedicalDirector to have a knowledge of statistics, and for the Actuary to learn theviews of the Medical Director in order to properly compile statistics bearingon the selection of risks.65Throughout the first half of the century, life insurance companiescontinued to innovate in medical diagnosis.They conducted research on 74 The Invention of the Risk Factorimproving the accuracy and reliability of urinalyses and adding blood sugarmeasurements.Insurance companies were among the first large-scale usersof chest X rays for tuberculosis in the 1920s and electrocardiographs forheart disease in the 1920s and 1930s.66 By requiring their medical examin-ers to use the tests, insurance companies educated tens of thousands ofphysicians about new developments in diagnosis.Thus the life insurance industry used medical statistics to make im-portant discoveries in disease etiology and prognosis and educated theirmedical examiners about them.As a result of the educational process, mostphysicians gradually accepted the concept that asymptomatic personal char-acteristics could increase the long-term risk of developing disease. PART IIHealth Education for Healthy Lifestyles 6CULTURAL ANDENVIRONMENTAL INFLUENCESON URBAN MORTALITY RATES[In my study of ten blocks of tenements in New York City, the] com-parison.has proven most surprising, for while in certain blocks[populated by one nationality group] there is a very high [infant] deathrate, in certain other blocks [populated by a different nationality group],half a mile away.the [infant] death rate is only one-half as great asthe average death rate of the city,.yet in the latter district there is agreater population, the tenement houses are taller, and the generalsanitary conditions are worse.(New York City physician, 1908)1The invention of the actuarial risk factor was one of two major innovationsrequired for the formulation of programs to promote healthier lifestyles.The other was the concept of educating the public that personal behaviorscan affect health.The discovery that some lifestyles were healthier thanothers emerged from findings that nationality groups with similar in-comes and living conditions varied widely in their total and infant mortal-ity rates.One of the major uses of vital statistics in the early twentieth centurywas to compare the health status of different population groups.National-ity groups were the most important groups in the northeastern andmidwestern cities teeming with immigrants and their children.Federal,state, and local governments regularly gathered information on place of77 78 Health Education for Healthy Lifestylesbirth and the place of birth of both parents.Individuals were categorized as native born, foreign born, and foreign stock (native born with at leastone foreign born parent).Nationality groups were useful categories because they constitutedgenuine communities.They shared languages, neighborhoods, occupations,cultures, churches, and fraternal and mutual aid societies.Their membershad high rates of marriage within the group.Group solidarity was strength-ened by language barriers, discrimination, and mutual hostilities with othernationality groups.The foreign born and their children were also considered the sourceof most social and health problems.In his 1870 book, The Dangerous Classesof New York, Charles Loring Brace, a pioneer in the social welfare move-ment, stated that an immense proportion of our ignorant and criminalclass are foreign born; and of the dangerous classes here, a very large part,though native-born, are of foreign parentage. He cited statistical tabulationsof prison populations as evidence.About 1900, the journalist Hutchins Hapgoodobserved in the first analytical description of an immigrant community:The Jewish quarter of New York is generally supposed to be a place of pov-erty, dirt, ignorance, and immorality the seat of the sweatshop, the tene-ment house, where red-lights sparkle at night, where the people are queerand repulsive.Well-to-do persons visit the Ghetto merely from motives ofcuriosity or philanthropy; writers treat of it sociologically, as a place incrying need of improvement.2Immigrant Nationality GroupsAn understanding of the health and social problems of the foreign bornand their children requires some description of their patterns of migrationand experiences in America.Although early twentieth-century America hasbeen considered a refuge for impoverished and subjugated groups in Eu-rope, most immigrants were continuing a long European tradition of mi-gratory work.Throughout the seventeenth and eighteenth centuries, manyof the rural poor in Europe sought periodic employment away from theirfarms to supplement their incomes.The women found jobs such as domes-tic servants and seamstresses in the pre-industrial European cities and themen worked as farm laborers and migratory workers.Few came to theUnited States because of the cost and dangers of ocean travel in the smallsailing ships and most of those who did were permanent settlers.3 Cultural and Environmental Influences on Urban Mortality Rates 79Changes in European life during the nineteenth century forced manyrural Europeans to become migratory workers.The population of Europegrew from 187 million in 1815 to 468 million in 1913, excluding 52 mil-lion persons who emigrated from Europe [ Pobierz całość w formacie PDF ]