The 'cultural inflation of morbidity' during the English mortality decline: a new look


Gorsky, Martin, Guntupalli, Aravinda Meera, Harris, Bernard and Hinde, Andrew (2011) The 'cultural inflation of morbidity' during the English mortality decline: a new look. Social Science & Medicine, 73, (12), 1775-1783. (doi:10.1016/j.socscimed.2011.09.028).

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Description/Abstract

This article contributes to the debate about using insurance records to reconstruct historical experiences of sickness during the Western mortality transition. Critics regard these sources as problematic as they measure morbidity indirectly through absences from work; these might be determined not by timeless biological criteria but by more contingent factors, notably shifting norms surrounding the sick role and responses to economic incentives (for which we adopt the generic term ‘cultural inflation of morbidity’). We review historical demographers’ contributions to this literature and discuss the concepts of moral hazard and the principal/agent problem as developed by health economists. This leads us to frame three empirical tests for ‘cultural inflation’ which allow us to assess the validity of insurance records for deriving morbidity trends: was there an increasing frequency of claims for complaints of diminishing severity; were unduly prolonged claims noticeable, particularly by older people for whom sickness benefit may have compensated for income insecurity; and did the insurer satisfactorily manage the agency problem to ensure reliable physician gatekeeping? We analyse records of the Hampshire Friendly Society, an exceptionally well-documented fund operational in Southern England, 1825–1989. Findings are based on a dataset of individual sickness histories of a sample of 5552 men and on qualitative documentary analysis of administrative records. On each count our results fail to demonstrate a cultural inflation of morbidity, except perhaps for those aged over 65. However, occasional discussion in the administrative records of economic incentives encouraging unnecessary prolongation of claims means we cannot rule it out entirely.

Item Type: Article
ISSNs: 0277-9536 (print)
Keywords: england, morbidity, insurance, friendly society, cultural inflation, sick role, uk, historical
Subjects: H Social Sciences > HA Statistics
R Medicine > RA Public aspects of medicine
H Social Sciences > HN Social history and conditions. Social problems. Social reform
Divisions: Faculty of Social and Human Sciences > Social Sciences
ePrint ID: 200919
Date Deposited: 26 Oct 2011 16:04
Last Modified: 14 Apr 2014 11:06
Projects:
The health and morbidity of friendly society members in the late-nineteenth and twentieth centuries
Funded by: ESRC (RES-062-23-0324)
Led by: Bernard Jonathan Harris
1 May 2007 to 30 April 2009
URI: http://eprints.soton.ac.uk/id/eprint/200919

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