Epidemiology and Health Care Reform: The National Health Survey of 1935-1936

Abstract

The National Health Survey undertaken in 1935 and 1936 was the largest morbidity survey until that time. It was also the first national survey to focus on chronic disease and disability. The decision to conduct a survey of this magnitude was part of the larger strategy to reform health care in the United States. The focus on morbidity allowed reformers to argue that the health status of Americans was poor, despite falling mortality rates that suggested the opposite. The focus on chronic disease morbidity proved to be an especially effective way of demonstrating the poor health of the population and the strong links between poverty and illness. The survey, undertaken by a small group of reform-minded epidemiologists led by Edgar Sydenstricker, was made possible by the close interaction during the Depression of agencies and actors in the public health and social welfare sectors, a collaboration which produced new ways of thinking about disease burdens.

Chronic illness: a revisionist account

“…And just as the 19 th century physician reported the patterning of signs and symptoms accompanying a pathological lesion, so the 20 th century physician reported the population distributions of chronic illness/chronic disease/disabling disease. Numerous health surveys of the population were carried out in the inter‐war years, from the small United Charities of Chicago survey of 184 families under treatment for an extended period of time (Bedford ) to the celebrated National Health Survey conducted in 1935–1936 by the US Public Health Service (Weisz ) which estimated that 20 million cases of disabling illness would occur in the population (National Health Conference report, ). Giving evidence to a Congressional hearing in 1939 Leland claimed to know of 4,000 such surveys (Leland ).…”

“…Omran's thesis has proved influential (with over 1700 citations) as a means of explaining the emergence of chronic disease/illness during the inter‐war period of the 20 th century (Weisz ) and its growing prevalence during the second half of the century (Weisz and Olszynko‐Gryn ). The sociology of health and illness, with its frequent investigations of the personal and social impact of chronic illness, has accepted Omran's argument, implicitly or explicitly, to explain the emergence of this new form of sickness during the 20 th century.…”

‘To regulate and confirm inequality’? A regional history of geriatric hospitals under the English National Health Service,c.1948–c.1975

“…Since the rise of hospital medicine in the early nineteenth century, status and resources increasingly accrued to curative care for acute illnesses, to the detriment of the ‘chronic’ patient (Peroni 1981; Starr 1982: 157–9, 171). The concept of ‘chronicity’ was polysemic, variously indicating factors like insidious onset, episodic course, long duration and incapacity from employment, but in Britain it was synonymous largely with age (Peroni 1981: 43–4; Weisz 2011: 442). An acute/chronic distinction was perpetuated by organisational arrangements, with the charity-funded voluntary hospitals refusing to admit ‘incurable’ or potential long-stay cases, which by necessity then fell on public provision – the Poor Law (Abel-Smith 1964: 36–45).…”

A review of the use of health examination data from the Health Survey for England in government policy development and implementation

“…The National Health Survey undertaken in the USA in 1935 and 1936 was the first large survey examining health status. Its aim was to study the extent and nature of disability in the general population, particularly chronic disease and physical impairment [ 1 ]. It became the main data source contributing to the government’s health proposals [ 1 ].…”

“…Its aim was to study the extent and nature of disability in the general population, particularly chronic disease and physical impairment [ 1 ]. It became the main data source contributing to the government’s health proposals [ 1 ]. Since then the National Health and Nutrition Examination Survey (NHANES) has run intermittently since the 1960s and on a rolling basis since 1999; anecdotal evidence links this survey to many health policy decisions [ 2 ].…”