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]. / Geschichte der Versicherungsmedizin in Deutschland.

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.