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Popular Science Monthly/Volume 82/April 1913/The Life Insurance Company as a Dynamic in the Movement for Physical Welfare

THE LIFE INSURANCE COMPANY AS A DYNAMIC IN THE MOVEMENT FOR PHYSICAL WELFARE
By EUGENE LYMAN FISK, M.D.

MEDICAL DIRECTOR, POSTAL LIFE INSURANCE COMPANY, NEW YORK

THE average careless liver, although he may be perfectly willing to swallow some "magic" elixir, exhibits uneasiness tinged with suspicion when approached on the subject of prolonging his life by means of adjusting him to his environment. He is more than likely to regard the span of life as fixed by some immutable, if not divine, law, and while comfortably optimistic about attaining the limit fixed by such law, cherishes but little hope of "beating the game." In other words, that convenient individual, the "man on the street," is sceptical about materially prolonging his life without surrendering some of the indulgences which he thinks make life worth living. It is this attitude of mind which leads him frequently to characterize the health-reformer as a "kill-joy," who is "against everything." Now it is unquestionably true that the health-conservation activities that have lately arisen in a few of the leading life-insurance companies have for their business object a mere mathematical increment to the years of life. Indeed, the only legal warrant for the expenditure of the policyholders' money in this work is the probability of attaining such a result, and thereby lowering the cost of insurance. But it is far from the minds of those directing this new force for human betterment, to advocate a mere niggardly or parsimonious hoarding of existence, without regard to its quality, color or meaning. The real warfare is against needless misery, preventable disease, mental and physical inefficiency, and the pitiable handicaps that not only shorten life, but take out of it the color and the satisfaction that make it worth living. Using the term in no sinister Nietzschean sense, the superman should not only live long, but live well, deriving his joy in life from the normal hormones circulating in his tissues, and not from the fleshpots or narcotic indulgences of our friend the careless liver. The prolongation of life is the end that justifies the financial expenditure, but the immediate work in hand is to make life more livable.

Let it be understood, then, that the health-conservationist who is not himself in need of mental hygiene is "against" many things, in favor of many things, and out to kill only the kind of "joy" that kills.

The belief that the death-rate, especially among selected insured lives, is a fixed quantity, is still held by many experienced insurance men, notwithstanding much recent evidence to the contrary. The constant use of actuarial tables, both in business practise and in the statutes governing the maintenance of reserves by life-insurance companies, tends to give a certain fixity-and authority to such tables which they derive from no natural law.

The recent medico-actuarial investigation of the experience of 43 American companies, for example, shows a marked improvement since the quinquennium 1885-1890, among the younger-age groups, and a distinct deterioration among those over age 60.

Any assumption that either the death-rate or the span of life is a fixed quantity necessarily involves the postulate that either the conditions affecting the mortality are unchanging, or that each change is neutralized and balanced by some other change, thus keeping the rate in equilibrium.

As a matter of fact, the general death-rate throughout the civilized world has been falling for several centuries, although there is no evidence that the span of life has increased within recent years, the lowered death-rate resulting largely from the saving of lives in the younger age-groups.

That these movements of mortality are not beyond the control of man is shown by this lowering of the death-rate in the age-groups most affected by the communicable diseases which have recently yielded to the attacks of science. That science can likewise influence the mortality from diseases resulting from faulty living-habits or the mere wear and tear of existence, can not be questioned, and the alleged mysterious fixity of the death-rate or of the span of life should not be held up as a bugaboo to restrain such efforts.

That the mortality in the average life-insurance company is far higher than it need be, and could be lowered, even among good, average insured lives, by improved living-habits, is shown by the experience of the United Kingdom Temperance and General Provident Institution.

This remarkable exhibit shows that in the institution mentioned, two large bodies of lives, almost equal in numbers, and homogeneous except for the use of alcohol, moved alongside of each other for forty-four years, and that one group, the abstainers, at all times exhibited a markedly superior vitality to the other group—the non-abstainers—the total difference in favor of the abstainers during the period covered being 27.4 per cent., although the mortality among the general, or non-abstaining class was only 91 per cent, of that expected according to the British Om Table, representing the experience in 63 British offices. This is not an isolated experience, as recent British and American experiences show an even greater difference in favor of the abstainer.

Now it is fair to assume that if, by educational methods, a company could influence 10 per cent, of its policyholders to lead a careful hygienic existence, the mortality in such a group would be lowered at least to the degree exhibited by the abstainers in the British company above referred to.

Inasmuch as the net premium for an abstainer at age 35, under an average distribution of endowment and whole-life policies, would be $3.03 per thousand of insurance in force less than for a non-abstainer, we have here a figure representing the actual saving on such lives, the net premium being comparable to the cost of manufacture in trade. Applying this factor to the old-line insurance in force in the United States—about $18,000,000,000—a saving would result, over and above the cost of carrying on the work, of $5,000,000 annually. There would also be an annual saving of approximately 10,000 lives. These are the minimum

PSM V82 D387 Uk life insurance graph related to alcohol consumption.png

Fig. 1. Experience of the United Kingdom Temperance and General Provident Institution of London. Healthy males; whole-life policies; amounts; 1866-1910.

Expected mortality, British Om table 100.00%
Ratio actual to expected mortality, non-abstainers 91.27%
Ratio actual to expected mortality, abstainers 66.25%
Mortality among abstainers 27.4 per cent, less than among non-abstainers.

figures that can be derived from any scientific ground of experience. They can be increased according to one's confidence in the ability of hygienists to guide the public into conservation methods of living. No effort is here made to compute the enormous reflex benefits to the public at large from these activities among insured lives.

Is the work worth while? If so, how can it be carried on to the best advantage? The answer is found in a brief survey of the resources of the life-insurance companies. 25,000,000 old-line policyholders pay annually, to about 250 companies, more than $600,000,000 in premiums; these companies hold $4,000,000,000 in assets to protect $18,000,0000,000 of insurance in force; they employ 20,000 agents and 80,000 medical examiners, in addition to home-office employees, banks of deposit and collection, etc., and they pay out more than $400,000,000 annually in death-claims, endowments, etc., to policyholders, all of which is evidence of the vast and intricate ramifications of the business throughout the social structure. Every policyholder is in touch with at least two other individuals, thereby affording the life-insurance companies seventy-five million points of contact with the public, and constantly open channels of communication through which educational material may be transmitted.

We may summarize the reasons why life-insurance companies should engage in health conservation work as follows:

1. The machinery is at hand.

2. It can be utilized without loss, and with probable gain to both company and policyholder.

3. The very nature and extent of the life-insurance business imposes a public obligation to exercise this power for the welfare of the people.

The medical and scientific staff of a life-insurance company is trained in the consideration of disease-tendencies, rather than active diseased conditions. The influence of living-habits and the significance of physical disabilities and abnormalities, and especially of personal and family history, upon large masses of insured lives, form the body of the rapidly developing science of medical selection. By combining this intrinsic knowledge with the readily available extrinsic data relating to personal hygiene, the medical officers of a life-insurance company are, or should be, especially well equipped to guide their policyholders toward safe and sane living-habits. Furthermore, experience shows that the policyholder will listen to the advice of his life-insurance office on such matters, because he discerns the practical business motive that prompts it, however liberal an admixture there may be of normal, genuine interest in human betterment.

The lines along which such work may be carried on are too numerous to permit of minute description in this article. Briefly, they may be summarized as follows: health-hints and instructions distributed with premium-notices; periodical bulletins covering the fundamental principles of healthful living; cooperation with boards of health and other welfare-agencies, by furnishing statistical and other information accumulated by the company's bureau of research; the creation of public sentiment where needed, for the enforcement of health-laws and proper equipment and support of health-departments; persistent effort in favor of legislation for the proper registration of vital statistics; persistent publicity to the need for national, state and local warfare against preventable disease, not only of the communicable class, but of those conditions arising from wear and tear, maladjustment and faulty living-habits. These are a few of the many activities that could readily be carried on by well-equipped life-insurance companies.

The best way to learn this game is to play it. There is such a wealth of opportunity that after the work is once commenced, organization and development will soon follow.

Probably the most important and direct way to benefit the policyholder, and—by force of example—the public at large, is through a system of free, annual, medical examinations, for the purpose of detecting disease or disease-tendencies at the earliest possible moment. This principle of periodic inspection or examination, which seems so radical as applied to man, is accepted as commonplace when applied to the institutions or machines employed by him, such as banks, insurance companies, steam-boilers, elevators, life-preservers, etc., none of which can compare with the human organism in value, complexity or capacity for going wrong. Why not examine the human machine every year? Is there any important objection, except man's silly, subconscious feeling that he is a thing apart from the rest of nature. The bacillus typhosus has no such illusions regarding mams apartness, and, however difficult it may be to apply the law of the conservation of energy to man's mental processes, there is no doubt but that it applies to his body, and that the violation of physical and physiological laws is followed by damage and degeneration which are not always manifest until they are beyond the power of science to repair. Many a life has been saved by the warning of incipient disease gained through a life-insurance examination. Why should such benefits be casual instead of systematic?

So much for theory. In a modest way, the company with which I have the honor to be associated has for several years been trying out these theories in the laboratory of practical business experience. Our Health Bureau was established in 1909, and has covered the following activities: periodical bulletins have been issued, dealing with such subjects as the causation of degenerative affections of the heart, blood vessels and kidneys; affections of the nose, throat and lungs, with preventive measures; hygiene of the eye; dental and oral hygiene; obesity and its prevention; drug addiction; physiological effects of alcohol and tobacco; causation and prevention of typhoid, yellow fever, malaria, pneumonia, etc.; increase in the death-rate from cancer, and how to meet it by general and surgical methods; courage as a health-asset; diet-hints; summer and winter hygiene, etc. Statistical pamphlets, addresses, etc., have been issued, showing the increase and decrease in mortality from various diseases, and practical lessons have been drawn therefrom. Many thousands of such monographs have been distributed to boards of health, schools, colleges and other centers of social influence. The privilege of free annual medical examination has been extended to policyholders since 1909. Although less than 10 per cent, of the policyholders have annually availed themselves of this privilege, the results more than justify the company's action. Forty per cent, of the risks examined were found impaired, as some misinterpreted the system as an emergency relief plan for the sick, rather than a measure of disease prevention. Nevertheless, of those found impaired, 44 per cent, were absolutely unaware of their impairment, showing the positive need for such a system. The following analysis of the impaired lives may prove of interest:

Analysis of Risks Found Impaired Free Annual Health Bureau Examinations

Average age, 49 years, 9 months. Amount of insurance, $1,590,635.

Diseases Ages
29-30,
Per
Cent.
Ages
30-40,
Per
Cent.
Ages
40-50,
Per
Cent.
Ages
50-60,
Per
Cent.
Ages
60-70,
Per
Cent.
Ages 70
Over,
Per
Cent.
Per
Cent.
Total
Num-
ber Ex-
amined
Affections of heart, blood vessels and kidneys, diabetes 4.98 18.35 21.65 31.60 23.37 4.54 28
Per cent, at each age-period unaware of such impairment 65.21 57.81 63.00 60.27 56.48 57.14 . . . .
Pulmonary 4.76 35.71 33.33 14.29 11.90 . . . . 2.5
Nervous 6.82 22.72 38.63 22.72 9.09 . . . . 2.7
Digestive 1.66 33.33 25.00 31.66 8.33 . . . . 3.6
Miscellaneous 2.22 17.77 42.22 22.22 13.33 2.22 2.7
Distribution of all impairments by age-periods 4.59 17.91 25.11 29.09 19.60 3.37 39.5

The above should be interpreted as follows: Of the risks showing affections of heart, blood-vessels, kidneys and diabetes, 4.9 per cent, were between 20 and 30, 13.8 per cent, between 30 and 40, etc. 63 per cent, of those between 40 and 50 affected with diseases of heart, blood-vessels, kidneys and with diabetes were unaware of impairment. 4.5 per cent, of all impairments found occurred in the age-group between 20 and 30, 17.9 per cent, between 30 and 40, etc. 96 per cent. of those unaware of impairment exhibited affections of heart, blood-vessels, kidneys and diabetes. 39.5 per cent, of those examined were found impaired.

Attention is called to the large percentage of degenerative affections found at middle life, among those who supposed that they were in sound health.

The mortality experience, although derived from a comparatively small group, has extended over a sufficient period to prove instructive, and is set forth in the following charts:

PSM V82 D390 Insurance losses and gains calculated on mortality.png

Group I. No impairment found

PSM V82 D391 Insurance analysis of free annual medical exam costs.png

 

Group II. Impaired

Fig. 2. Analysis of Policyholders who Availed Themselves of the Privilege of Free Annual Medical Examination, 1909-1912.

Among those found unimpaired, the mortality was only 29 per cent, of the American Experience Table, showing a saving of about 21 points of the mortality expected by the average company among lives exposed for like periods. These risks, although unimpaired, were advised regarding living-habits, eating, drinking, smoking, etc., arid the saving indicated is properly credited to this system.

The group reported impaired comprised some individuals who were almost in articulo mortis, hence an expected mortality of 200 per cent, of the American Experience Table might have been regarded as well within the mark. However, the actual mortality in the group was only 99 per cent, of that table. That is, where we expected 200 to die, only 99 deaths actually occurred.

The net saving, over and above the cost of operation of our bureau, was at the rate of about $20,000 per year. Now, the annual saving, based upon the hypothesis derived from the British company's experience would, in our company, have been at the rate of about $12,000 per year, showing that the theoretical estimates were conservative, and more than justified by the actual test of experience. The full effect of the educational propaganda could not, of course, be traced in the mortality fluctuations even of a very large company, and I have only attempted to show the results among those who were actually known to be in touch with our health bureau.

Important health-conservation activities are as yet carried on by only three leading companies out of the 250 now operating in this country. The health bureau established in the Association of Life Insurance Presidents, in 1910, is keeping alive the conservation-idea, but it is a mere adumbration of what could and should be accomplished through the enormous resources available. The pressure of public opinion is needed to set in motion this vast machinery for lifting the burdens of humanity.