The University of Southampton
University of Southampton Institutional Repository

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), pp. 1775-1783. (doi:10.1016/j.socscimed.2011.09.028).

Record type: Article


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.

Full text not available from this repository.

More information

e-pub ahead of print date: October 2011
Published date: December 2011
Keywords: england, morbidity, insurance, friendly society, cultural inflation, sick role, uk, historical
Organisations: Social Sciences


Local EPrints ID: 200919
ISSN: 0277-9536
PURE UUID: 00f9082f-4942-4059-9217-be7af5a04afc

Catalogue record

Date deposited: 26 Oct 2011 16:04
Last modified: 18 Jul 2017 11:13

Export record



Author: Martin Gorsky
Author: Aravinda Meera Guntupalli
Author: Bernard Harris
Author: Andrew Hinde

University divisions

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton:

ePrints Soton supports OAI 2.0 with a base URL of

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.