The Social Survey, the Metropolitan Life Insurance Company, and the Beginnings of the US Public Health Service's Sickness Surveys

The earliest sickness survey of the US Public Health Service, which started in 1915, was the Service's first socioeconomic study of an industrial community. It was also the first to define illness as a person's inability to work. The survey incorporated the Metropolitan Life Insurance Company's definition of illness, which, instead of sickness rates, focused on duration of illness as a proxy of time lost from work. This kind of survey took place in the broader context of the reform movements of the Progressive Era and the social surveys conducted in the United States, which led to the creation of the Federal Commission on Industrial Relations, where the Service's sickness survey originated. The Service's focus on the socioeconomic classification of families and definition of illness as the inability to work enabled it to show the strong link between poverty and illness among industrial workers. The leader of the survey, Edgar Sydenstricker, and the Metropolitan Life Insurance Company came up with new ways to measure the health of the population, which also influenced the Service's studies of the effects of the Great Depression on public health and the National Health Survey of 1935-1936. (Am J Public Health. 2021; 111(11):1960-1968. https://doi.org/10.2105/AJPH.2021.306454).

Model migration and rough edges: British actuaries and the ontologies of modelling

The existing literature on modelling provides two main ways of viewing model migration: a modular view, which seeks to decompose models in their constitutive elements, and thus provides a view on what it is that migrates; and a practice-based view, which focuses on modelling as an activity, and understands a model as intricately entangled with its context of use. This article brings together these two sensitivities by focusing on ontologies of modelling. The paper presents a case study of the appropriation of modern finance theory's 'no-arbitrage' models by British actuaries - a process that gradually unfolded at around the turn of the century and led to significant friction within the UK's insurance industry. We can distinguish two main modelling ontologies: a 'risk-neutral ontology', which underpins no-arbitrage models and holds that the value of financial instruments is determined by 'arbitrage'; and, a 'real-world ontology', which assumes that the economic world consists of real probabilities that may be approximated through a combination of archival-statistical methods and expert judgment. The appropriation of the risk-neutral modelling ontology was made possible by the declining legitimacy of actuarial expertise as 'financial stewards' of life insurance companies. The risk-neutral modelling ontology provided an 'objective' alternative to the traditional actuarial models, which explicitly required actuaries to make 'prudent' judgments. Despite the fact that the no-arbitrage modelling was considered an 'objective' affair, the valuation models that insurers use today are strongly shaped by political compromises, a result of the 'rough edges' of models.

The mutual shaping of life insurance and medicine in Finland

This article examines the mutual shaping of medicine and private life insurance in Finland before the Second World War. Based on historical texts and archival material, it shows the important effects that the involvement of medicine in client selection for life insurance companies had on medical knowledge and practice. The analysis focuses on the tensions between the main actors in life insurance underwriting--candidates, insurance agents, examining physicians and the central office--as well as the medical examination as the key site of these tensions. The article shows how the introduction of a set of procedural and technical innovations reshaped the medical examination and helped to stabilize the fraught network of life insurance underwriting. These innovations re-scripted medical work. They stressed objective measurable knowledge over the personal skill and clinical acumen of the examining physician, propagated the physical examination and the use of diagnostic technologies and vital standards, multiplied medicine's administrative tasks, and contributed to the introduction of a risk factor approach to medicine. Moreover, the social organization of life insurance promoted the spread of these objects, practices and tasks to other fields of medicine. The case displays how medical innovations are developed through the situated interplay of multiple actors that cuts across the science-society boundary.

Queer(ed) risks: life insurance, HIV/AIDS, and the "gay question"

In 2004 the Association of British Insurers (ABI) issued its second Statement of Best Practice on HIV and Insurance. This prohibited use of the "gay question" (employed by some underwriters in application forms for life insurance to identify heightened risk of infection with HIV), in response to growing criticism that the practice was actuarially unreliable, unfair to gay men, and unnecessary, given the availability of alternative "behaviour-based" risk criteria. While the overhaul of this controversial practice is clearly a victory for gay (male) identity politics, this paper argues that the interests of gay men seem to have dominated at the expense of a more far-reaching critique of the industry's evaluation of infection risk. It contends that a more radical (or "queerer") challenge is needed which can better understand and address the injustices created by criteria for appraising risk of infection that still remain in place.

A brief historical sketch of the Association of Life Insurance Medical Directors of America (ALIMDA), the predecessor of the American Academy of Insurance Medicine (AAIM)

This is a brief historical sketch of ALIMDA, the name of our professional organization when it was founded at a meeting of a few medical directors in New York City in 1898. The principal source for its contents is based on recollections of my own experience with ALIMDA/AAIM since I first became a member after appointment as an Assistant Medical Director of the company then known as New England Mutual Life Insurance Company, in Boston, in 1952. I was never an officer of ALIMDA or AAIM, but I attended most of its meetings, and I was involved in our mortality research activites.

The National Insurance Acts 1911-1947, the approved societies and the Prudential Assurance Company

The role of the British major life assurance companies in administering the National Insurance Acts in the guise of approved societies has long been controversial. The companies have been accused of profiteering rather than civic duty or social altruism. This article, using the Prudential Assurance Company as a case study, questions this argument. Life assurance companies such as the Prudential were fundamental to the operational running of national health insurance in the first half of the twentieth century due to their scale, scope and expertise. In addition, they were keen to extend the scope of national health insurance and campaigned to make the acts more comprehensive. Finally, while the companies certainly did see benefits in administering the acts, these were related more to corporate identity, branding and public relations than to direct pecuniary gain. An analysis of the inclusion of the life insurance companies in the administration of the National Health Insurance Acts is thus as important for an understanding of twentieth-century Britain as it is for the development of modern social welfare.

[The history of insurance medicine in Germany]

Necessity for insurance was recognized even in ancient and medieval times. In modern times, mathematical and statistical research into mortality ratios, led to the start up of insurance companies. Medical advice was needed. Family doctors, medical advisers and chief physicians of the insurance companies became essential for insurance medicine. The "numerical method" and improved tarif systems were used to investigate the survival rates of people in poor health. In Germany, extensive statistical analysis of medical records was performed in a central data management office (Mitteilungsstelle für Sonderwagnisse). The Dr. Karl-Wilder-Foundation of the German insurance companies subsidized research into causality of diseases, course and prognosis affecting life expectancy. In health insurance publications on historical insurance medical work are rare. In accident insurance medicine, concrete conception of terms started especially after the second world war. Insurance medical knowledge was promoted in the department for insurance medicine of the German Association for Insurance Science (Deutscher Verein für Versicherungswissenschaft). Scientific publication started in 1886. Collaboration with related disciplines such as traumatology, forensic medicine and biostatistic was beneficial and should be extended in the future.

Insurance against germ theory: commerce and conservatism in late-Victorian medicine

This article highlights the role played by commercial life insurance companies in determining the response to tuberculosis in Britain between 1865 and 1920. Late-Victorian life offices hired two sorts of physicians to help them screen out high-risk proposals: provincial medical examiners, who collected fees for examining candidates; and salaried medical advisors, who developed guidelines for the medical examination and interpreted the examiners' findings for the head office. The latter set of physicians, many of whom worked at specialist consumption hospitals in London, established an orthodoxy among life offices that privileged hereditarian explanations for the cause of tuberculosis. The provincial examiners resisted that orthodoxy, arguing that advances in public health and treatment rendered irrelevant any apparent correlation between family history and tuberculosis. In adjudicating this internal dispute, life offices stood by their salaried advisors, but in the process pushed them away from viewing disease in terms of specific causes and toward viewing disease in terms of statistical correlation. This victory of statistics over etiology preserved, at least for the rest of the twentieth century, the institutional prominence of insurance as a technique for coping with medical uncertainty.

The origin of the "ideal" body weight equations

OBJECTIVE

To provide a historical perspective on the origin and similarity of the "ideal" body weight (IBW) equations, and clarify the terms ideal and lean body weight (LBW).

DATA SOURCES

Primary and review literature were identified using MEDLINE (1966-November 1999) and International Pharmaceutical Abstracts (1970-November 1999) pertaining to ideal and lean weight, height-weight tables, and obesity. In addition, textbooks and relevant reference lists were reviewed.

DATA EXTRACTION

All articles identified through the data sources were evaluated. Information deemed to be relevant to the objectives of the review were included.

DATA SYNTHESIS

Height-weight tables were generated to provide a means of comparing a population with respect to their relative weight. The weight data were found to correlate with mortality and resulted in the use of the terms desirable or ideal to describe these weights. Over the years, IBW was interpreted to represent a "fat-free" weight and thus was used as a surrogate for LBW. In addition, the pharmacokinetics of certain drugs were found to correlate with IBW and resulted in the use of IBW equations published by Devine. These equations were consistent with an old rule that was developed from height-weight tables to estimate IBW. Efforts to improve the IBW equations through regression analyses of height-weight data resulted in equations similar to those published by Devine.

CONCLUSIONS

The similarity between the IBW equations was a result of the general agreement among the various height-weight tables from which they were derived. Therefore, any one of these equations may be used to estimate IBW.

A short history of mortality

A short history of mortality: being itself a cautionary tale!

Historical changes in the objectives of the periodic health examination

Important historical changes have occurred both in the content of the periodic health examination and in the legitimacy with which this examination has been viewed. These changes reflect fundamental shifts in the objectives of the examination and in the concerns of its advocates, the most prominent of whom have been physicians; leaders in the life insurance, private corporate, and prepaid health care industries; and medical expert panels. The shifting dominance of concerns has driven the development of the periodic health examination, and continual reassessment of the value and limitations of the examination is warranted.

Other than healing: medical practitioners and the business of life assurance during the nineteenth and early twentieth centuries

The purpose of this paper is to explore briefly the nature, development and implications of the relationship between medical practitioners and life assurance companies. The aim is to elucidate the development both of the medical profession and the life insurance business--two important aspects of economic and social change in the nineteenth and early twentieth centuries which are usually treated separately. The focus is primarily, though not exclusively, on Scottish companies as they carried out a disproportionately large amount of the UK life assurance business by the mid-nineteenth century. The insurance industry's increasing, and increasingly systematic, tapping of medical expertise enabled it to raise profits by reducing losses on standard policies and by venturing out into types of business previously thought too risky. While nineteenth-century medical therapeutics may have left much to be desired, medical involvement in insurance suggests that medical practitioners were by no means ineffective. At the same time, a substantial proportion of the medical profession gained valuable part-time appointments which helped to alter the diagnostic techniques of the profession more generally. Thus insurance turns out to be an especially important element in the 'non-healing' aspects of medicine, with spin-offs for the healing side as well.

[Order of mortality, duration of life and annuities in Johann Peter Süssmilch's Göttliche Ordnung]

The government of Providence builds the order which pastor Süssmilch sees in the demographic events and especially the order of mortality. God governs the length of human life and assigns to each person a just balance between fear of death and expectation of life. This authorizes Süssmilch to clarify the notions of probable life and life expectancy with the design to treat of their main application in the field of political arithmetic, that is the computations of Government loans under the form of annuities on lives. So he treats of an important question which concerns the history of actuarial calculation as well as the history of probability, of statistics and demography. We cannot forget also the political and philosophical points of view which the pastor underlines vividly: what sort of contract joins the creature and his God? This study of the contingent but optimal regularities which Providence makes in the world builds an important contribution to the physico-theological current.

Friendly societies

Readers will probably be aware of the two friendly societies associated with the dental profession, the Dentists' Provident Society Ltd. and the Dentists' and General Mutual Benefit Society, which offer permanent sickness cover to their members. They may not be aware, however, that these societies are part of a wider movement which at one time offered almost the only available protection for the worker against the expenses of sickness and death.

A calculating profession: Victorian actuaries among the statisticians

Historians of science naturally tend to express interest in other forms of intellectual activity only when these intersect with science. This tendncy has produced a number of enlightening studies of what happens when science and (for instance) law or theology come into contact, but little by way of how science enters into the calculations and social status of such forms of knowledge after the conjuction has passed. Recent work in the sociology of professions, in contrast, has focused attention precisely on those moments when the expert knowledge produced by different group doesnotoverlap. This has been the contribution of Andrew Abbortt's theory of “jurisdictional boundaries” between competing professions. The case of Victorian actuaries who worked hard to maintain unique intellectual claims in the competitive life insurance industry while maintainiing strong social connections and overlaps in knowledge with organized science, challenges the way both historians of science and sociologists of professions view contending knowledge claims. By observing what motivated actuaries to forge an alliance with men of science in the 1820s, then tracing their gradual recognition of a need to distance themselves from certain of the “scientific” values that had earlier informed their collective identity, it is possible to make sense of connections as well as disconnections between science and other forms of knowledge. A history of quantification from the actuaries' perspective, in other words, allows us to view science bothasandincontext.

Actuarial contributions to life table analysis

The correct principles for the construction of life tables and more particularly select life tables were developed by actuaries in England in the first half of the 19th century. Actuaries explored the phenomenon of selection not only between the insured and annuitants but also in the general population, distinguishing among initial temporary selection, antiselection, and class selection. The conclusion was reached early that no such thing as an unselected population exists. Group life insurance experience among the actively employed has been shown to provide a more appropriate standard of expected mortality than general population death rates in studies of medical impairments and occupational hazards at ages under 65 years. Mortality rates derived from the Cancer Prevention Study can serve as a useful standard of expected mortality when the objective is determination of excess mortality compared with ostensibly healthy persons at ages 65 years and older.