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2022 | OriginalPaper | Chapter

4. Sickness Experience in England, 1870–1949

Authors : Andrew Hinde, Martin Gorsky, Aravinda Guntupalli, Bernard Harris

Published in: Standard of Living

Publisher: Springer International Publishing

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Abstract

Using data from the Hampshire Friendly Society, a sickness insurance institution in southern England, we examine morbidity trends in England between 1870 and 1949. Morbidity prevalence increased between 1870 and around 1890, mainly because of a rise in the average duration of sickness episodes, but after 1890 average durations fell markedly even though the incidence of sickness rose. During the first two decades of the twentieth century, sickness prevalence increased gradually, but this rise was entirely due to the greatly increased duration of claims made by men aged 65 years and over. After the early 1920s, both the incidence and the average duration of sickness claims declined. These trends seem to be measuring ‘objective morbidity’: they vary closely with year-on-year changes in the mortality of men of working age, but do not show any clear relationship with real wages or unemployment. Our conclusions are different from those of earlier research using English sickness insurance data. We believe that one reason for this was a methodological problem with the analysis performed by nineteenth-century actuaries.

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Alternatively, they indicate that a person’s health rendered him or her unable to carry out the duties of their normal employment (Harris et al. 2011, p. 644).

The rules of the Hampshire Friendly Society as set out in 1868 used the phrase ‘rendered incapable of gaining his livelihood’ to describe qualifying sickness (Hampshire Friendly Society 1846–77, p. 19).

We did compare the trends in sickness incidence using different assumptions and found that they moved in parallel: the choice of assumption did not seem to affect our estimate of the trend.

An advantage of the ‘minimum incidence’ assumption is that the difference between the estimates of incidence immediately before and after 1895 is also small.

An 11-point moving average seemed to us to offer the best compromise between smoothness and fidelity to the original data. We use the moving averages solely to aid visual interpretation of the graphs.

To achieve consistency, we deliberately ignore data for the years from 1895 onwards which indicate that a man had two or more spells of sickness in the same year, and count these as if they were a single spell. In effect, we are transforming the data for the period 1895 onwards so that they are reported in the same way as the data for the period 1870–1894.

The effect of the coarser level of detail in the data before 1895 is that the incidence of sickness is underestimated by about 10% compared with the period from 1895 onwards.

The real wage series was originally produced by Phelps-Brown and Hopkins (1956). We have preferred this series to more recent variants as it relates specifically to working class men in southern England, into which group most of the HFS members fell. The unemployment data were originally published by Feinstein (1972, pp. T126–T127) and refer to the whole of the United Kingdom (UK). Given the impact of both occupational and regional factors on UK unemployment rates during this period, these statistics may not be an accurate guide to fluctuations in the level of unemployment among members of the Hampshire Friendly Society.

Although national insurance was introduced in 1911, the labour market was then severely disrupted by World War I. Our dummy variables assume national insurance started to take effect in 1919 (it was officially introduced earlier but World War I intervened before it could have a widespread impact), and the introduction of state contributory pensions (for workers over the age of 65) took effect in 1926 (Macnicol 1998, p. 214).

These measures of mortality fall short of the ideal for our purposes, but in different respects. The Hampshire-specific mortality rate from influenza and bronchitis is geographically a better measure of changes in the disease environment faced by the men in our sample, but includes death rates for infants and children. The national death rates for adult males are a better age match to the men in the sample, but are less geographically focussed. For the mortality data for Hampshire, we only analyse the period 1870–1935 as population data for the late 1930s and early 1940s are likely to be unreliable because of World War II (which led to population movements which were not captured by official statistics as there was no population census in 1941).

It is possible that the weak effects of some social and economic covariates (notably unemployment) arise because unemployment rates in Hampshire did not reflect national rates. We have not been able to locate time series of local unemployment rates.

Gorsky et al. (2011, pp. 1,781–2) noted that concern that HFS members were using sickness to disguise unemployment was only rarely mentioned in the annual reports of the Society. It might be argued that unemployment itself could lead to ill-health and thus we might expect sickness rates to rise at times of high unemployment. This may be true, but the effect is likely to be too weak to detect in our data, as even in the worst years of the early 1930s, the national unemployment rate did not rise above 16%. Ismay (2015) reminds us that friendly societies were able to exclude from membership individuals known to or suspected to be likely to try to take unfair advantage of being members. She also argues that they fostered a loyalty and a feeling among their members that did much to nullify the moral hazard associated with commercial insurance contracts (although others have suggested that such traditional loyalty became severely strained during the early twentieth century, and Downing (2015) argues that it varied both between societies and between different branches of the same society).

Omran’s model has not gone unchallenged. Weisz and Olszynko-Gryn (2010), for example, argued that it is overdetermined by contemporary development theory. Here, however, we are not concerned with what drives the epidemiologic transition, simply with the fact that it involves a shift in the distribution of causes of death.

The HFS data do provide information on the causes of episodes of sickness, but unfortunately for our purposes only from 1895 onwards. Although there is some uncertainty about the underlying causes of the decline in tuberculosis mortality, epidemiological thinking both in the early twentieth century and nowadays favours improved isolation of infected cases and hence reduced transmission rates (Newsholme 1908; Wilson 2005) which would lead to a reduced incidence of this disease. Since tuberculosis was a long-lasting condition, this is likely to have reduced the mean duration of sickness episodes as a whole.

Of course, the arrival of the Russian influenza may have resulted in greater awareness of the disease and an increased tendency to report it as a cause of death. Our main point, though, is that the Russian influenza heralded a step change in the incidence of mortality from the disease in England and Wales which lasted for at least two decades.

They are, for example, included in the standard book of formulae and tables which all actuarial students of the Institute and Faculty of Actuaries use in the professional examinations (Institute and Faculty of Actuaries 2002).

We all knew John in different ways, as both friend and colleague, and are delighted to have this opportunity to express our appreciation of him.

This volume has demonstrated the enormous range of John’s sympathies and research interests. Our own work overlapped with his in relation both the history of health and the history of social insurance. So far as health is concerned, we had common interests in relation both to anthropometric history and the history of morbidity. John was instrumental in providing us with an early platform for our work on the sickness records of the Hampshire Friendly Society when he edited a special issue of Social Science History, and our contribution to this volume arises directly from that. We hope it is a contribution which he would have welcomed and approved.

Over the years, we had the pleasure, individually and collectively, of meeting John at several academic gatherings, including meetings of the Economic History Society, the Society for the Social History of Medicine, and conferences on Economics and Human Biology. It was always a pleasure to hear his own work and he was a sympathetic and perceptive analyst of the work of others. He was also great company.

John was a great supporter of early-career researchers. He offered his support as research mentor and referee and was a source of great inspiration, both intellectually and personally. He had a brilliant mind and a very kind soul, and it was a privilege to have known him.

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Title: Sickness Experience in England, 1870–1949
Authors: Andrew Hinde
Martin Gorsky
Aravinda Guntupalli
Bernard Harris
Publisher: Springer International Publishing
Book: Standard of Living
Print ISBN: 978-3-031-06476-0

Electronic ISBN: 978-3-031-06477-7

Copyright Year: 2022
DOI: https://doi.org/10.1007/978-3-031-06477-7_4